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

80s Breast Cancer—Triple-Negative/Cytotoxics/Local Therapy
1126 General Poster Session (Board #34C), Sat, 8:00 AM-12:00 PM
Axillary lymph node status in breast cancer staging: What patient and tumor
factors affect the accuracy of ultrasound-guided fine needle aspiration?
Presenting Author: Celin Chacko, Montefiore Medical Center, Bronx, NY
Background: The purpose of the study is to evaluate the accuracy of
ultrasound-guided fine needle aspiration (FNA) of axillary lymph nodes(ALNs)
in patients with breast cancer and to determine factors that
influence accuracy of ultrasound-guided FNA. Methods: Retrospective
review of patients with breast cancer who had FNA of ALNs as well as
sentinel lymph node excision or complete axillary dissection. Patients
treated with neoadjuvant chemotherapy were excluded. 55 axillary FNAs in
54 patients were included in the final analysis. Pathology reports were
reviewed for size of the primary tumor, FNA results, number of positive
ALNs, and greatest tumor size in ALNs. FNA was performed if a suspicious
lymph node was identified. Surgical sentinel lymph node biopsy or full
axillary dissection were the reference standard. Micrometastases (� 0.2
mm) and isolated tumor cells in the lymph node were included in the
negative group. Atypical and nondiagnostic FNA results were considered
negative cytologic results. Significance was analyzed using the Mann-
Whitney test. Results: Size of the primary cancer ranged from 0.3 mm to
8.5 cm. The sensitivity of FNA was 73%, with positive predictive value of
97% and negative predictive value of 52%. The NPV of FNA for primary
tumors �1 cm, 1.1-2, 2.1-5 and �5 cm is 100%, 36%, 50% and 66%
respectively. Correlation of primary tumor size with sensitivity of FNA was
not statistically significant. The sensitivity of FNA for lymph nodes with
metastatic deposit � 5mm, 6-10mm, 11-15mm, 16-20mm, and 21mm�
is 0%, 57%, 59%, 89%, and 100%, which is statistically significant (p �
0.007). The number of positive ALNs at axillary dissection is not correlated
to the sensitivity of FNA. The sensitivity of FNA for 1-3, 4-9 and 10�
positive ALNs is 78%, 64% and 80%. Conclusions: Our findings indicate
that FNA of suspicious axillary lymph nodes is valuable even in small
tumors, which differs from the literature. The overall negative predictive
value of FNA is 52%, so sentinel lymph node biopsy is essential after
negative FNA. Sensitivity of FNA increases with the size of the metastatic
deposit in the lymph node, but is not correlated to the number of positive
ALNs found at dissection.
1128 General Poster Session (Board #34E), Sat, 8:00 AM-12:00 PM
Phase I/II trial of partial breast irradiation (PBI) with various concurrent
chemotherapy regimens. Presenting Author: Lana Maria De Souza Lawrence,
The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University,
Baltimore, MD
Background: Potential benefits of concurrent chemo-radiation include: shorter
duration of treatment, smaller interval between surgery and adjuvant therapies,
and synergistic effects. We have previously shown that PBI with concurrent dose
dense doxorubicin and cyclophosphamide (ddAC) is well tolerated (Zellars JCO
2009). We performed a follow-up feasibility trial of PBI delivered concurrently
with other various chemotherapy regimens. Methods: Women with T1-2, N0-1
breast cancer s/p lumpectomy with �2 mm margins were eligible. Chemotherapy
regimen was at the discretion of the medical oncologist (Table). PBI (40.5 Gy in
15 daily 2.7 Gy fractions) was delivered within the first 2 cycles of chemotherapy.
Primary endpoints were hematologic and non-hematologic toxicities
graded according to Common Terminology Criteria for Adverse Events manual (v.
3.0). Results: Thirty-four patients enrolled with median f/u of 19.2 mos. (4.0 -
38.6). Mean tumor size was 1.8 cm (�/- 0.7 cm), 71% pN0, 68% HR �, 18%
Her2 �. All patients completed concurrent chemo-radiation. Three patients had
a 3-8 day delay in chemotherapy (1 grade 2 thrombocytopenia; 1 Grade 2 liver
enzymes; 1 T desensitization). There was 1 local (DCIS) and no regional/distant
recurrences or deaths. Toxicity: 2 grade 4 neutropenia (ddAC, TCarboH); 1 grade
3 neutropenia (post-AC paclitaxel); 1 Grade 3 hyponatremia and DVT (TC); 1
syncope (TAC). None had � grade 2 radiation dermatitis. Conclusions: PBI and
concurrent chemotherapy is associated with minimal toxicity and appears to be
well tolerated. These results deserve further investigation. Funded by The Breast
Cancer Research Foundation.
Regimen Patients N�34 Dose/schedule Schedule No. of cycles
Standard AC
then P
Dose dense
AC then P
2 A 60 mg/m 2
C 600 mg/m 2
P80mg/m 2
12 A 60 mg/m 2
C 600 mg/m 2
G-CSF
P80mg/m 2
TAC 1 T 75 mg/m 2
A50mg/m 2
C 500 mg/m 2
TC* 16 T 75 mg/m 2
C 600 mg/m 2
TCarboH 3 T 75 mg/m 2
Carbo AUC6
C#1 H 8mg/kg, then 6mg/kg
Q 3 wks
Qwk
Q 2 wks
Qwk
4
12
4
12
Q 3 wks 6
Q 3 wks 4-6
Q 3 wks 6
Abbreviations: C, cyclophosphamide; P, paclitaxel; T, docetaxel (Taxotere); A, doxorubicin
(Adriamycin); Carbo, carboplatin; H, trastuzumab (Herceptin); G-CSF, granulocyte colony
stimulating factor.
*One patient had 6 cycles of TC, all others had 4 cycles.
1127 General Poster Session (Board #34D), Sat, 8:00 AM-12:00 PM
Breast cancer surgery during pregnancy. Presenting Author: Rakesh Surapaneni,
Cooper University Hospital, Camden, NJ
Background: There is limited literature on breast surgery during pregnancy.
We present prospective registry data on 88 breast cancer patients who
underwent breast cancer surgery during pregnancy. Methods: The Cancer
and Pregnancy Registry is a voluntary international registry that prospectively
collects the clinical course, treatment, and disease outcome of
women diagnosed with cancer during pregnancy and the perinatal and
neonatal outcomes of their children. Results: We identified 88 patients who
were diagnosed with breast cancer and had surgery while pregnant. 59
patients (67%) underwent Mastectomy while29 patients (32%) underwent
breast conserving surgery (BCS). Out of 43 patients who underwent BCS as
their first surgery 13 patients (30.23%) required subsequent mastectomy
during pregnancy. 15 patients (34.88%) from the BCS group and 4
patients (8.69%) from the Mastectomy group had positive margins. There
was no significant difference between patients who underwent mastectomy
vs BCS based on Age (34.67 vs 34.72 P: 0.97), gestational age at surgery
(14.05 vs 16.06 P: 0.23) or ER positivity (47.5% vs 46.4% P: 0.93). 2
patients had neo-adjuvant chemotherapy. 17 patients (19.31%) had
sentinel lymph node biopsy. 37 patients (42%) had a pregnancy complication.
There was no difference in the rate of complication based on
mastectomy vs BCS(45.8% vs 34.5% P: 0.31). There was only 1 patient
(from mastectomy group) that delivered within 2 weeks of surgery. Of the
17 patients (19.3%) with spontaneous preterm delivery, there was no
difference between Mastectomy and BCS group (22% vs 13.2% P: 0.41).
Of the 25 patients (28.4%) with birth complications, there was no
significant difference between mastectomy vs BCS (30.5% vs 24.1% P:
0.53). There was also no difference in mean birth weight between the
groups (2598 grams vs 2672.3 grams P: 0.57). Conclusions: The data
supports the safety of breast cancer surgery during pregnancy. In addition,
there were no identified adverse effects in patients who underwent BCS as
opposed to mastectomy. Of note, only 19% of patients underwent sentinel
node biopsy which is considered the standard of care in early breast cancer
patients regardless of pregnancy status.
1129 General Poster Session (Board #34F), Sat, 8:00 AM-12:00 PM
18F-fluorodeoxyglucose (FDG) positron emission tomography (PET) as
early imaging biomarker of axillary sentinel lymph node (SLN) status in
locally advanced node-positive breast cancer (NPBC) patients (pts) receiving
neoadjuvant chemotherapy (NACT). Presenting Author: Yanina Dockx,
Antwerp University Hospital, Edegem, Belgium
Background: Use of FDG-PET in the early evaluation of NACT for NPBC is
currently under investigation. The aim of this study is to assess FDG-PET in
NPBC pts receiving NACT in order to identify a subset of pts that can be
spared axillary lymph node dissection (ALND) in case of response. Methods:
All pts (period 2009-2011) had [cT2 (�3cm)-T4, pN1-3], and no prior BC
treatment. All pts received 8 cycles (cy) of NACT �/- trastuzumab.
FDG-PET was performed at baseline and after 2 cy. After NACT, mastectomy
with SLN and ALND was peformed. As primary endpoint, the change
in maximum standardized uptake value (SUVmax) in the primary tumor (PT)
and ALNs was compared with pathological response (Jonckheere-Terpstra
test). Logistic regression was used to determine the predictive value of a
50% reduction in SUVmax on pathological response and SLN status.
Results: Forty-one pts were evaluable for the primary endpoint and 31 pts
had successful SN procedures. The median age was 49.8 years (range
27-75). Overall, 9.8% (4/41; 95% CI 2.7 – 23.1) of pts had progressive
disease (PD), 7.3% (3/41 ; 95% CI 1.5 – 19.9 ) stable disease (SD),
53.7% (22/41; 95% CI 37.4 – 69.3) partial response (PR), and 21.9%
(9/41; 95% CI 10.6 – 37.6) a complete pathological response (pCR). A
linear trend existed between pCR and higher decreases in SUVmax of the PT
site (p�0.008), but not with lymph node SUVmax (p�0.294). The odds of
achieving a pCR, increased significantly when SUVmax of the PT decreased
with �50% (OR 10.7; 95% CI 1.2 - 98.0; p�0.03), but not lymph node
SUVmax (OR 4.75; 95% CI 0.82 - 27.5; p�0.08). Achieving a true negative
SLN status was more likely with �50% reductions in PT SUVmax (OR 41.2;
95% CI 4.0 - 421.9; p� 0.002). A reduction of �50% in nodal SUVmax was not predictive of negative SLN status (OR 3.33; 95% CI 0.66 - 16.8;
p�0.1). Conclusions: Early changes in PT metabolism imaged with FDG-
PET after only 2 cy of NACT is a promising biomarker in the management of
the axilla in NPBC. Molecular imaging of PT biology and to a lesser extent of
axillary lymph nodes using FDG-PET warrants further study.
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