Claudio Flores

Prognostic factors for patients with newly diagnosed brain metastasis from breast cancer.

AIM This retrospective study determined features associated with brain metastasis (BM) in women with breast cancer. PATIENTS & METHODS A total of 215 initially early breast cancer cases were included. We reviewed files and CT scan images of BM. RESULTS Median age was 47 years and most of our cases were stage III (58.6%), grade III (62.8%), ER negative (62.3%) and nonluminal (59.1%). Median survival after BM was 4 months. Nonluminal, extracranial disease, time to CNS shorter than 15 months, >three brain lesions and poor breast-graded prognostic assessment and recursive partitioning analysis scores were associated with shorter survival. Adding extracranial disease to breast-graded prognostic assessment score also predicted survival after BM. Radiation response was assessed in 57 patients and response tended to be associated with nonluminal phenotype but not with survival. CONCLUSION Factors associated with both initial tumor and clinical features at BM time are associated with shorter survival in our Latinas population.

Association between mammographic features and response to neoadjuvant chemotherapy in locally advanced breast carcinoma

PURPOSE Mammography is the cornerstone of breast cancer (BC) evaluation. This report investigates whether breast density (BD) and mammographic features of the tumor can provide information on both BC susceptibility to chemotherapy and other clinicopathologic features of locally advanced BC (LA BC). MATERIALS AND METHODS We evaluated mammography films and clinicopathological information of patients with LA BC who received neoadjuvant chemotherapy (NAC) followed by tumor resection at the Instituto Nacional de Enfermedades Neoplásicas (INEN) from 2000 to 2011. RESULTS We selected 494 LA BC cases. Most cases were at clinical tumor stage 4 (48.5%), node stage 1 (58.8%) and had high histologic grade (53.3%). BI-RADS 1, 2, 3, and 4 BD were found in 16.9%, 22%, 35.7% and 25.1% of patients, respectively. High BD has been associated with younger age (p<0.001), obesity (p=0.017) and no skin infiltration (T3 vs T4) (p=0.018). An association between dusty microcalcifications and HER2 group, as well as between casting microcalcifications and TN BC group (p=0.05) was found. NAC included anthracyclines and taxanes in 422 (85.5%) cases. Miller-Payne pathologic responses 4 and 5 (pCR) in the primary lesion and absence of axillary lymph nodes involvement were found in 15.3% of cases and were associated with younger age (p<0.001) and HG-3 lesions (p<0.001), but not with mammographic images. CONCLUSION Mammographic features are associated with specific clinicopathological features of pre-NAC BC lesions but do not predict pCR. The implications and biological reasons for these findings require further study.

P45 Prognosis of Elderly Patients with Metastatic Lung Cancer in Oncosalud-AUNA

Background: A solitary pulmonary nodule (SPN) is a common and increasing clinical problem. Differential diagnosis is broad and often challenging, mainly in patients with previous cancer. Aim: Analyze patientswith SPNandprevious cancer and comparemetastatic andprimary lung cancer (PLC) lesions. Method: Patients with SPN on computerized tomography scan and history of cancer (except basal cell carcinoma)who underwent surgical resections between January 2015 and December 2017 at Hospital da LuzeLisboa were included. All cases were evaluated at a multidisciplinary lung cancer tumor board team meeting. We analyzed histology, demographic and radiological features. p-values 0.05 were considered significant. Results: There were included 29 patients with history of cancer: 12 colorectal, 8 breast, 4 genitourinary, 4 lung and 1 sarcoma. PLC was diagnosed in 15 (51.7%), metastasis in 11(37.9%)8 colorectal, 1 genitorectal, 1 atypical lung carcinoid and 1 sarcoma and benign lesions in 3. Surgery was the diagnosis procedure in 24(82.8%)e17 with frozen section. There were no significant differences between primary and metastatic neoplastic lesions in gender, age and smoking history (p>0.05). All subsolid nodules (n1⁄45) were PLC. In solid neoplastic SPN, 10 PLC and 11 metastasis, there was no difference in diameters. Irregular edge was associated with PLC lesions (p1⁄40.008) and smooth margin with metastasis (p1⁄40.001). Lobulated margins did not seem differentiate neoplastic lesions (p1⁄41.0). Conclusion: PLC is an important diagnosis in the differential diagnosis of NPS, including in patients with a history of cancer. Radiological features can help to discern primary to metastatic SPN in this group.

Impact of modified Glasgow prognostic score and neutrophil/platelet-lymphocyte ratio on survival metastatic colorectal cancer (mCRC).

e15557Background: Modified Glasgow Prognostic Score (mGPS), was reported as a good prognostic factor for OS, in other neoplasms, however its role in mCRC it’s still being studied. High circulating ...

Prognostic value of neutrophil- (NLR) and platelet-lymphocyte ratio (PLR) in patients with metastatic colorectal cancer (mCRC) with KRAS, BRAF: A Peruvian point of view.

e15550Background: High circulating neutrophil-lymphocyte ratio (NLR) and platelet-lymphocyte ratio (PLR) appears to be prognostic in metastatic colorectal cancer (mCRC), they have been suggested as...

MGMT promoter methylation in Peruvian patients with glioblastoma

Purpose O6-methylguanine–DNA methyltransferase (MGMT) promoter methylation predicts the outcome and response to alkylating chemotherapy in glioblastoma. The aim of this study is to evaluate the prevalence of MGMT methylation in Peruvian glioblastoma cases. Patients and methods We evaluated retrospectively 50 cases of resected glioblastoma during the period 2008–2013 at Instituto Nacional de Enfermedades Neoplasicas in Peru. Samples consisted of paraffin embedded and frozen tumour tissue. MGMT-promoter methylation status and the expression level of MGMT gene were evaluated by methylation-specific PCR and real-time PCR, respectively. Results Unmethylated, methylated and partially methylated statuses were found in 54%, 20% and 26% of paraffin-embedded samples, respectively. Methylation status was confirmed in the Virgen de la Salud Hospital and frozen samples. There was an association between the status of MGMT-promoter methylation and the level of gene expression (p = 0.001). Methylation was associated with increased progression-free survival (p = 0.002) and overall survival (OS) (p < 0.001). Conclusion MGMT-promoter methylation frequency in Peruvian glioblastoma is similar to that reported in other populations and the detection test has been standardised.

Gender and outcomes in non-small cell lung cancer: an old prognostic variable comes back for targeted therapy and immunotherapy?

Background There are well-known differences in gender outcome in non-small cell lung cancer (NSCLC) and other cancers. In this work, we evaluated several randomised clinical trials to explore the gender influence in the outcome of patients with NSCLC treated with targeted therapy and immunotherapy. Methods We performed a series of meta-analysis to compare the gender outcome in the routine setting for overall survival and progression-free survival (PFS) in phase III randomised clinical trials comparing EGFR inhibitors versus chemotherapy (OPTIMAL, LUX-lung 3, LUX-lung 6, EURTAC, ENSURE and WTJOG); ALK inhibitors versus chemotherapy (ASCEND 4, ASCEND 5, PROFILE 1014 and NCT009323893) and anti-PD1 checkpoint inhibitors versus chemotherapy (CheckMate 017, CheckMate 026, CheckMate 057, KEYNOTE 010 and KEYNOTE 024). Results Female patients with NSCLC have a reduced risk of death compared with men (HR=0.73; 95% CI 0.67 to 0.79; p<0.00001). Women had a better benefit from EGFR inhibitors than men (HR=0.34; 95% CI 0.28 to 0.40; p<0.00001 vs HR=0.44; 95% CI 0.34 to 0.56; p<0.00001, respectively). The benefit from ALK inhibitors was similar for both genders (HR=0.51; 95% CI 0.42 to 0.61; p<0.00001 vs HR=0.48; 95% CI 0.39 to 0.59; p<0.00001, for women and men, respectively). Anti-PD1 inhibitors significantly improved the PFS in male patients when compared with chemotherapy (HR=0.76; 95% CI 0.68 to 0.86; p<0.00001); in contrast, women showed no benefit in 5/5 randomised trials (HR=1.03; 95% CI 0.89 to 1.20; p=0.69). Conclusions In this exploratory study, some targeted treatments were influenced by gender. Despite differences in outcomes that could be attributed to different histology, EGFR and smoking status, gender should be evaluated more deeply as prognostic variable in patients with NSCLC.

Abstract P1-06-12: Optimizing the use of oncotype Dx in early breast cancer

Background: Oncotype Dx (ODX) prognosticates the risk of recurrence and predicts the benefit of adjuvant chemotherapy in estrogen-receptor-positive breast cancer (BC). However, its cost makes it prohibitive for many health care systems. Our objective was to develop a model that uses routine clinical and pathological parameters to identify ODX high risk patients which require adjuvant chemotherapy. Methods: We retrospectively reviewed ODX and pathology reports from 190 early BC patients treated between 2014 and 2016 in a specialized cancer center. Our population was divided into a training (n:133) and validation set (n:57). In the training set, among available clinico-pathological variables (age, T, ER, PR, Ki67, Elston-Ellis grade) a multiple linear regression model was carried out to select those significantly associated with ODX. Coefficients of statistically significant variables were used to build an equation. The equation was applied in the training set. These results were confronted to ODX categories. The best threshold for selecting high risk patients was identified in the training set and tested in the validation set. Results: Among the tested variables, tumor size (pT), progesterone receptor (PR), Ki67 and Ellston-Ellis grade were significantly associated with ODX RS (Table 1). The linear predictor is: (0.2544 x pT) – (0.0739 x PR) + (0.0861 x Ki67) + (5.4232 x Elston grade). The threshold score for this equation was set on 14 to discriminate high from low-intermediate risk patients. The test was able to correctly classify high risk patients with a sensitivity of 78%, a specificity of 72% and a negative predictive value of 98%. Conclusion: With further refinement ODX could be omitted in patients classified as high risk by our predictor therefore restricting and optimizing the use of ODX to a smaller population of patients. The observed ODX distribution in our patients is similar to previously reported series suggesting that this equation could be informative in similar clinical settings. Additional external testing using new datasets is ongoing. Citation Format: Ruiz R, Namuche F, Flores C, Aguilar A, Gomez HL. Optimizing the use of oncotype Dx in early breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-12.

Which is better? Carboplatin versus cisplatin for locally advanced cervical cancer: Peruvian experience.

e17004Background: Cervical cancer occurs mostly in developing countries, being locally advanced cancer the majority. The standard treatment is chemo-radiation with platinum salts. Carboplatin is co...

Response to neoadjuvant chemoradiation in rectal cancer: Experience from the national cancer institute of Peru.

e15157Background: Preoperative Chemoradiation (CRT) in rectal cancer has benefit in local control. 50 - 60% of cases are down-staged and 20% achieve a pathologic complete response (pCR). Despite th...