Yiwu Huang

Clinical outcomes in extracranial tumor sites and unusual toxicities with concurrent whole brain radiation (WBRT) and Erlotinib treatment in patients with non-small cell lung cancer (NSCLC) with brain metastasis

BACKGROUND Thirty percent of newly diagnosed NSCLC patients present with synchronous brain metastases, most of whom are treated with whole brain radiation. Systemic chemotherapy is usually avoided during WBRT due to concerns regarding toxicity. However, concurrent administration of targeted agents, such as Erlotinib, during WBRT may address systemic disease without causing toxicity. We report our institutional data on outcomes and toxicities with this treatment approach. MATERIALS AND METHODS Medical records of patients with newly diagnosed NSCLC and brain metastases receiving concurrent WBRT and Erlotinib treatment were reviewed. Radiographic response to therapy and toxicities were analyzed. RESULT Eight patients were identified and 7 were evaluable for response. All patients had intracranial disease control. In the extracranial sites, 3 (37.5%, intent-to-treat) showed partial response (PR), 2 (25%) had stable disease (SD), 1 (12.5%) had progression (PD) and 1 (12.5%) had new air space disease obscuring tumor response assessment. Among the three responders, two were female never smokers, while one was a female current smoker. Unanticipated grade 3 hepatotoxitity, hyponatremia, mental status changes, grade 3 and 4 thrombocytopenia, and grade 4 neutropenia with sepsis were observed. Three deaths occurred without clear signs of disease progression: one from neutropenic sepsis, one from wide spread air space disease, and one from neurologic deterioration. CONCLUSION Our data demonstrates a high percentage of extracranial tumor response rates with first line Erlotinib in selected NSCLC patients. We observed unexpected serious complications and postulate possible mechanisms. We recommend caution to be exercised when considering Erlotinib treatment during WBRT, particularly in regard to drug-drug interactions and infection control. Data from prospective trials are needed to determine the benefits and toxicities of Erlotinib during WBRT.

Immunogenicity of an Inactivated Monovalent 2009 Influenza A (H1N1) Vaccine in Patients Who Have Cancer

BACKGROUND The immune response of patients who have cancer, who may be receiving immunosuppressive therapy, is generally considered to be decreased. This study aimed to evaluate the immune response of cancer patients to the 2009 influenza A (H1N1) vaccine. PATIENTS AND METHODS We conducted a prospective single site study comparing the immune response after H1N1 vaccination of healthy controls (group A), patients who had solid tumors and were taking myelosuppressive chemotherapy (group B), patients who had solid tumors and were taking nonmyelosuppressive or no treatment (group C), and patients who had hematologic malignancies (group D). RESULTS At 2-6 weeks after vaccination, seroconversion was observed in 80.0% of group A (95% confidence interval [CI], 65.0%-89.7%), 72.2% of group B (95% CI, 55.9%-84.3%), 87.0% of group C (95% CI, 72.2%-94.7%), and 75.0% of group D (95% CI, 52.8%-89.2%) (p = NS). The geometric mean titer ratio, that is, geometric mean factor increase in antibody titer after vaccination, was 12.6 (95% CI, 7.9-19.9), 12.7 (95% CI, 7.3-22.1), 23.0 (95% CI, 13.9-38.2), and 12.1 (95% CI, 5.3-27.9) (p = NS), and the seroprotection rates were 95.5% (95% CI, 84.0%-99.6%), 79.0% (95% CI, 63.4%-89.2%), 90.5% (95% CI, 77.4%-96.8%), and 90.0% (95% CI, 71%-98.7%) in the corresponding groups (p = NS). Immune responses were robust regardless of malignancy, or time intervals between the use of myelosuppressive or immunosuppressive medications and vaccination. No participants developed clinical H1N1 infection. CONCLUSION Cancer patients, whether taking myelosuppressive chemotherapy or not, are able to generate an immune response to the H1N1 vaccine similar to that of healthy controls.

Isolated Sternal Involvement in Breast Cancer: Is it Truly Stage IV Disease?

PURPOSE There is no consensus regarding treatment for patients with breast cancer and isolated sternal involvement. Though classified as AJCC stage IV, this group of patients may have prolonged distant disease free survival. PATIENTS AND METHODS Retrospective case series of 8 patients with isolated sternal recurrence. Information regarding age, menopausal status, hormonal receptor status, HER2 status, initial treatment, time to sternal recurrence, treatment of sternal involvement, and outcome was obtained. RESULTS Median follow-up, 6 years. Seven of 8 diagnosed with metachronous sternal recurrence at a median of 3 years from initial breast cancer diagnosis, 1 with sternal involvement at initial diagnosis. Seven of 8 are alive, with one death from metastatic breast cancer 10 years after sternal recurrence. Six of 8 are without evidence of distant spread, 2 in continuous complete remission (CR) at 7 and 14 years from sternal recurrence. CONCLUSION While a small cohort, the excellent survival of the group identifies this as a distinct subset of metastatic disease, requiring special treatment considerations. Isolated sternal involvement could represent direct local-regional extension rather than systemic spread.

The influence of tumor location, histology, and patient ethnicity on the accuracy of EUS in staging gastric and gastroesophageal junction (GEJ) cancers.

39 Background: Endoscopic ultrasound (EUS) is a routine staging test performed in patients with gastric and GEJ cancers and is highly valuable in treatment planning. The reported accuracy varies from 40% to 90%. We aim to investigate the staging performance of EUS at our institution and hypothesize that EUS accuracy can be influenced by tumor location, histology, and patient ethnicity. Methods: We performed a retrospective analysis of patients diagnosed with gastric and GEJ cancer between January 2006 and June 2015 who had EUS proceeded directly by surgery. T and N staging by EUS were analyzed for their sensitivity, specificity, and positive (PPV) and negative predictive values using surgery as the gold standard. The following variables were evaluated: tumor histology (intestinal or diffuse type), location (GEJ, cardia, body, or antrum), and patient ethnicity (Asian versus non-Asian). Results: Over 46 patients who met the inclusion criteria, EUS had T and N accuracy of 47.8% and 58.7%, respectively (p <.0...

A Unique Case of Classic Kaposi's sarcoma restricted to the toes

BACKGROUND Kaposis sarcoma associated-herpesvirus causes all forms of Kaposis sarcoma, and six major subtypes have been described based on the amino acid sequences of the open reading frame K1. MAIN OBSERVATION A 71-year-old man from China, HIV negative, presented with nodules on the dorsal aspect of his toes. Biopsy confirmed the diagnosis of Kaposis sarcoma and virology studies of his blood and saliva confirmed the presence of Kaposis sarcoma associated-herpesvirus infection. Viral genotyping was consistent with subtype C3. Intervention has been deferred as our patient has remained clinically asymptomatic and without evident growth of his lesions over a 2-year follow up. CONCLUSIONS We herein report the first known case of Kaposis sarcoma restricted to the toes caused by the viral subtype C3 in an HIV-negative patient from Harbin, China.

Autoimmune Derangement in a Patient with Simultaneous Diagnoses of Primary Anti phospholipid Syndrome, Thrombotic Thrombocytopenic Purpura and Heparin Induced Thrombocytopenia

Primary antiphospholipid syndrome (APS), thrombotic thrombocytopenic purpura (TTP) and heparin induced thrombocytopenia (HIT) are all hypercoagulable conditions characterized by thrombocytopenia and high risks of thrombosis. A severe form of APS, namely catastrophic antiphospholipid syndrome (CAPS), further shares features with TTP by the presence of microangiopathic hemolytic anemia characterized by schistocytes on the blood smear. CAPS and TTP may be co-existing and an underlying autoimmune association was postulated. Here we report a patient who presented with initial symptoms of APS, who then simultaneously developed TTP and HIT after being exposed to Clopidogrel and Heparin. Our case suggests that the autoimmune deregulation in APS predisposes the patient to other immune related conditions.

Locally advanced pancreatic cancer in a socio-economically challenged population

Anne S. Renteria, MD, Bart K. Holland, MPH, PhD, Yiwu Huang, MD, PhD, Jay S. Cooper, MD, and Bernadine Donahue, MD Bone Marrow Transplant Program, The Tisch Cancer Institute, Mount Sinai Medical Center, New York; Preventive Medicine, Biostatistics, UMDNJ New Jersey Medical School, Newark; Hematology Oncology Department and Radiation Oncology Department, Maimonides Cancer Center, Brooklyn, New York

Outcome of Isolated Sternal Recurrence in Breast Cancer.

Introduction: Metastatic breast cancer to sternum is rare and its natural history and prognosis are not fully understood. Metastasis to sternum is considered as stage IV, but may represent local extension from internal mammary nodes. Here we present a case series of 7 patients with metastatic breast cancer to sternum with and without internal mammary node involvement.Method: Seven patients were identified by 5 medical oncologists from New York area with busy breast cancer practices, from 1991 to 2008. Patients chart were reviewed and information regarding age, menopausal status, hormone receptor status, Her2/neu status, initial treatment, time to sternal recurrence and treatment of metastatic disease were obtained.Results: Out of 7 patients with stages I to III at diagnosis, 4 were premenopausal. Two patients had triple negative tumors, 3 were ER/PR positive and 2 were Her2 positive. All patients received loco-regional treatment of the primary site with surgery and/or radiation. Five patients received adjuvant or neoadjuvant chemotherapy. Median time to sternal recurrence was 3 years. Two patients had biopsy confirmed metastasis to internal mammary nodes at relapse. All patients with recurrence received either chemotherapy, radiation or hormonal therapy. One patient received autologous bone marrow transplant after sternal recurrence. All 7 patients are alive, 5 of them in remission and 2 patients with stable disease. Median DFS in 5 patients with CR was 7.8 years.Conclusion: Isolated sternal recurrence with/without internal mammary node involvement is relatively uncommon and is classified as stage IV. On our review of 7 cases, 5 remain in continuous remission at a median of 8 years from recurrence. The other two patients have stable disease. These sternal lesions could possibly represent loco-regional recurrence rather than systemic relapse. Hence, isolated sternal recurrence from breast cancer may need to be stratified separately in studies of stage IV disease. Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 3054.