Sherry Pomerantz

The Effect of Diabetes on Oxaliplatin-Induced Peripheral Neuropathy

INTRODUCTION Chemotherapy-induced neurotoxicity is a significant source of morbidity for cancer patients. This study aimed to assess the relationship between preexisting diabetes and clinically significant (National Cancer Institute Common Toxicity Criteria grades 2 and 3) OXIPN; between diabetes, and the cumulative dose at onset of OXIPN; and between other preexisting medical conditions and the development of OXIPN. MATERIALS AND METHODS We reviewed medical records of all patients with stage II-IV colon cancer treated in the Albert Einstein Cancer Center, Philadelphia, with oxaliplatin from 2005 to 2009. Exclusion criteria included preexisting neuropathy, previous neurotoxic chemotherapy exposure, and incomplete medical records. The NCI Common Toxicity Criteria was used to grade sensory neuropathy. Univariate analysis was used to estimate odds ratios and confidence limits for prevalence of OXIPN in patients with and without diabetes. The mean level and cumulative doses were compared using the t test. RESULTS Sixty-two patients met the study criteria; 23 oxaliplatin-treated patients were excluded. The crude incidence of any OXIPN was 65%. There was no relationship found between development of OXIPN and the presence of diabetes, smoking, hypertension, or statin use. However, the mean cumulative dose of oxaliplatin was significantly lower for patients with diabetes who developed neuropathy, compared with those without diabetes (388 vs. 610 mg/m(2); P = .021). CONCLUSION Although the presence of diabetes did not appear to affect the severity of OXIPN, patients with diabetes developed OXIPN at a lower cumulative dose of oxaliplatin (P < .05). The results may have implications for treatment of patients with diabetes and colon cancer.

Reduced Risk of Bone Metastasis for Patients With Breast Cancer Who Use COX-2 Inhibitors

PURPOSE We hypothesize that the use of cyclooxygenase (COX)-2 inhibitors in early disease phases could protect against the development of bony metastases. PATIENTS AND METHODS The medical charts of patients with stage II-III breast cancer diagnosed between 1999 and 2005 were reviewed. Patients were subdivided according to the use of COX-2 inhibitors after the diagnosis and for > or = 6 months. Bivariate analyses were undertaken, and statistically significant variables were included in a multivariate logistic regression model. RESULTS Eleven percent of patients (74 of 644) who did not use COX-2 inhibitors developed bone metastases compared with 2% (1 of 48) of those who did use COX-2 inhibitors (Fisher exact test, P = .05). Significant predictors for bone metastases in a multivariate logistic regression model included: > or = 3 positive nodes (odds ratio [OR], 3.26 [95% CI, 1.79-5.93]; P < .001), stage IIB-IIIC disease (OR, 3.89 [95% CI: 1.74-8.69]; P = .001) and use of COX-2 inhibitors (OR, 0.12 [95% CI, 0.02-0.88]; P = .037). Adjusting for TNM stage, of the 327 patients with stages IIB-IIIC disease, 22% (63 of 293) had bone metastases in the non-COX-2 group versus 3% (1 of 34) in the COX-2 inhibitors consumers (Fisher exact test, P = .006). In this high-risk group of patients, the calculated OR associated with COX-2 inhibitors was 0.10 (95% CI, 0.01-0.78). CONCLUSION The use of COX-2 inhibitors could reduce the risk of bone metastases in stage II-III breast cancer.

A retrospective analysis of the demographic profile and clinical outcomes of stage III colon cancer patients treated with adjuvant chemotherapy in a real-world perspective.

648 Background: It is standard to use results of randomized controlled trials (RCT’s) for therapeutic decisions in community oncology. However participant selection in trial environments may not reflect real-world scenario. We aim to perform a retrospective analysis of patient profile and treatment outcomes in a community cancer center. Methods: Patients with stage III colon cancer offered adjuvant chemotherapy after curative resection from 2003-2010 (N=177) were reviewed. Eighty-seven patients with complete medical records were analyzed. Patient eligibility was assessed on criteria from the MOSAIC and NSABP C-07 trials. Eligible and ineligible patients were compared using Fisher’s exact test, Student’s t-test and Kaplan-Meier survival analysis. Results: The study group (females: 53%) with mean age of 65 years, was predominantly African American (60%). ECOG performance status was ≥ 2 in 13% patients. Only 29% satisfied all standard eligibility criteria. Ineligibility characteristics included age > 75 year...

Proteinuria monitoring in patients receiving bevacizumab at a community cancer center.

13 Background: The use of bevacizumab has been associated with the development of proteinuria. The manufacturer suggests monitoring for proteinuria with serial urine dipsticks. We set to evaluate the relevance and cost of this practice in a Community Cancer Center in Philadelphia. METHODS We performed a retrospective chart review at Albert Einstein Cancer Center. Consecutive patients treated with bevacizumab from January 2011 to March 2014 were included in the study. Primary endpoints were the incidence and grade of proteinuria under bevacizumab therapy and the implication of proteinuria in treatment (holding or cessation of bevacizumab). Secondary objectives included the association between the number of bevacizumab infusions or patients comorbidities (diabetes, hypertension, chronic kidney disease) and the development or worsening of proteinuria. We also calculated the cost of monitoring for proteinuria in our cohort. RESULTS 71 patients were screened. A total of 66 patients (corresponding to 738 infusions) were included in the analysis. Typical monitoring interval was every 2 cycles. None developed nephrotic range proteinuria. One patient (1.5%) developed grade 2 proteinuria. Bevaciuzumab was discontinued due to proteinuria in 2 patients (3%): neither of them developed permanent kidney damage or required an intervention as a consequence of the proteinuria. The most common reason of bevacizumab discontinuation was progression of disease (75%). Neither the number of infusions nor concomitant comorbidities were significantly associated with the development or worsening of proteinuria (p=0.8, p>0.05 respectively). The cost of monitoring for proteinuria in our cohort was estimated at

Repeat colonoscopy's value in gastrointestinal bleeding

3980. CONCLUSIONS These results show that the development of grade 2 proteinuria, let alone grade 3, with bevacizumab is uncommon and rarely affects treatment decisions in our Community Cancer Center. We therefore question the necessity of routine monitoring for proteinuria during bevacizumab treatment.

Abstract A132: A descriptive study on the factors affecting mortality and disease‐free survival among triple‐negative breast cancer patients

AIM To assess the diagnostic yield and clinical value of early repeat colonoscopies for indications other than colorectal cancer (CRC) screening/surveillance. METHODS A retrospective review of patients who had more than one colonoscopy performed for the same indication within a three year time frame at our tertiary care referral hospital between January 1, 2000 and January 1, 2010 was conducted. Exclusion criteria included repeat colonoscopies performed for CRC screening/surveillance, poor bowel preparation, suspected complications from the index procedure, and incomplete initial procedure. Primary outcome was new endoscopic finding that led to an endoscopic therapeutic intervention or any change in clinical management. Clinical parameters including age, sex, race, interval between procedures, indication of the procedure, presenting symptoms, severity of symptoms, hemodynamic instability, duration between onset of symptoms and when the procedure was performed, change in endoscopist, withdrawal time, location of colonic lesions and improvement of quality of bowel preparation were analyzed using bivariate analysis and logistic regression analysis to examine correlation with this primary outcome. RESULTS Among 19  772 colonoscopies performed during the above mentioned period, 947 colonoscopies (4.79%) were repeat colonoscopies performed within 3 years from the index procedure. Out of these repeat colonoscopies, 139 patient pairs met the inclusion criteria. The majority of repeat colonoscopies were for lower gastrointestinal bleeding (88.4%), change in bowel habits (6.4%) and abdominal pain (5%). Among 139 eligible patient pairs of colonoscopies, only repeat colonoscopies that were done for lower gastrointestinal bleeding and abdominal pain produced endoscopic findings that led to a change in management [25 out of 123 (20.33%) and 2 out of 7 (28.57%), respectively]. When looking at only recurrent lower gastrointestinal bleeding cases, new endoscopic findings included 8 previously undetected hemorrhoid lesions (6.5%), 7 actively bleeding lesions requiring endoscopic intervention, which included 3 bleeding arterio-venous malformations (2.43%), 2 bleeding radiation colitis (1.6%), and 2 bleeding internal hemorrhoids (1.6%), 5 previously undetected tubular adenomas [4 were smaller than 1 cm (4.9%) and 1 was larger than 1 cm (0.8%)], 3 radiation colitis (2.43%), 1 rectal ulcer (0.8%), and 1 previously undetected right sided colon cancer (0.8%). Of the 25 new endoscopic findings, 18 (72%) were found when repeat colonoscopy was done within the first year after the index procedure. These findings were 1 rectal ulcer, 3 radiation colitis, 4 new hemorrhoid lesions, 3 previously undetected tubular adenomas, and 7 actively bleeding lesions requiring endoscopic intervention. Of all parameters analyzed, only the interval between procedures less than one year was associated with higher likelihood of finding a clinically significant change in repeat colonoscopy (odds ratios of interval between procedures of 1-2 year and 2-3 year compared to 0-1 year were 0.09; 95%CI 0.01-0.74, P = 0.025 and 0.26; 95%CI 0.09-0.72, P = 0.010 respectively). No complications were observed among all 139 colonoscopy pairs. CONCLUSION There is clinical value of repeating a colonoscopy for recurrent lower gastrointestinal bleeding, especially within the first year after the index procedure.

Prevalence of Cocaine Use and Its Impact on Asthma Exacerbation in an Urban Population

Introduction: Triple‐negative breast cancer patients have a worse prognosis as compared to other subtypes of breast cancer. Patients are usually diagnosed at a younger age. Tumor size is usually larger with poorly differentiated histology and possible visceral metastasis. Several studies have been published on the risk factors for developing triple negative breast cancer. On the other hand, factors predicting mortality after diagnosis among triple negative breast cancer patients is still lacking. Objectives: The study aimed to describe the population of triple negative breast cancer patients diagnosed at Albert Einstein Medical Center from 2003–2007. Demographic data, risk factors and treatment interventions in this population were gathered. The measured outcomes were mortality and disease free survival. Methods: This study was a retrospective review of women diagnosed with triple negative breast cancer at the Albert Einstein Healthcare Network Cancer Center in 2003–2007. Patients diagnosed with cancer metastasized to the breast and causes of death other than from complications of cancer were excluded from the study. Statistical Analysis: Descriptive statistics and frequency distribution were used to categorize the characteristics of the subjects. Chi‐square test was used for bivariate analysis. Logistic regression was used for multivariate analysis. Results: A total of 214 patients were diagnosed with triple negative breast cancer from 2003–2007. 114 (53%) were African Americans, 84 (39%) were Caucasians and 16 (7%) belonged to other racial groups. The mean age of diagnosis was 56.6 (SD 15.9) years old. At the end of the four year period, 48 (22.4%) of the 214 patients died. Using chi square test and logistic regression, patients who underwent chemotherapy were less likely to die (95% CI 0.14 – 0.83, p 0.02, OR 0.35). The patients with tumor size more than 2 cm or had history of ischemic heart disease had increased mortality (95% CI 1.36 – 8.04, p 0.01, OR 3.3 and 95% CI 1.29 – 49, p 0.03, respectively). Chemotherapy was significantly associated with disease free survival (95% CI 1.49 – 18.65, p 0.01, OR 5.27). There was no significant association between mortality or disease free survival to age and race. Conclusion: Early diagnosis and screening significantly affects treatment and survival outcome. Prompt chemotherapy may contribute to a patient9s survival and disease free status. Tumor size more than 2 cms and the presence of ischemic heart disease were significant predictors of mortality outcome whereas age and race were not found to be associated with mortality or disease free survival. Citation Information: Cancer Prev Res 2010;3(1 Suppl):A132.