Browsing Over 852 Presentations
435P - Title: Primary Prophylaxis For Febrile Neutropenia - Is It Really Required For AC Chemoregimen In Breast Cancer Patients?
- Nageswara R. Palukuri
- Nageswara R. Palukuri
Abstract
Background
Breast cancer is the most frequently diagnosed cancer among the women. Chemotherapy is an integral part of the treatment and is associated with the improved survival. Most commonly used regimen is Doxorubicin and Cyclophosphamide followed by Taxane (AC-T). AC chemoregimen carries significant risk of febrile neutropenia and hence primary prophylaxis with growth factors is recommended which increases the cost of the treatment. The aim of the study is to identify the incidence of febrile neutropenia following AC chemoregimen without primary prophylaxis.
Methods
We retrospectively analyzed the case records of the localized breast cancer patients who were treated with AC chemoregimen without primary prophylaxis for febrile neutropenia.
Results
Between 2013 and 2017, a total of 231 cases received AC chemoregimen. A total of 14 (6%) patients were found to have febrile neutropenia. All patients were recovered by day 16 and no deaths were observed. Except for ECOG performance status no significant association was found with age, co-morbidities, menopausal status, body surface area and stage of the cancer. Source of infection could not be identified in any of the patients. There were no delays in treatment because of febrile neutropenia.
Conclusions
The incidence of febrile neutropenia is less in Indian patients. Breast cancer patients receiving AC chemoregimen can be managed without primary prophylaxis in resource limited setting.
Legal entity responsible for the study
Stalin Bala.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.
Emerging strategies in neoadjuvant treatment of patients with HER2 early breast cancer
- Fatima Cardoso
- Fatima Cardoso
21P - Correlation Between Expression of Topoisomerase II Alpha with Ki-67 and Tumor Size in Luminal B-Like Indonesian Breast Cancer Patients
- Helenia Putri
- Helenia Putri
- Maria A. Kristina
- Devita Widjaja
- Bernard A. Baskoro
- Erna Kristiani
Abstract
Background
In Indonesia, breast cancer has the second highest prevalence among all cancer diseases and most of them had Luminal B-Like molecular subtype. There are many factors that promote tumor cells growth such as Topoisomerase II Alpha (TOP2A) and Ki-67. TOP2A is a gene that cuts both strand of the DNA helix to unwind them. This facilitate protein synthesis and DNA replication. The more TOP2A, more replication of the cells which leads to high cells proliferation value. Cell proliferation value can be count with immunohistochemistry, Ki-67 stain. Ki-67 is a protein that is present during all active phases of the cell cycle and absent when the cells are resting. This make Ki-67 is one of the proliferation cells markers. From the literatures, the more TOP2A and Ki-67, the larger the tumor size is. Previous studies said that TOP2A have correlation with Ki-67, but not with tumor size in all subtypes of breast cancer patients. Aim of this study is specifically find the correlation of TOP2A with Ki-67 and tumor size just in one molecular subtype, Luminal B-Like in Indonesian breast cancer patients.
Methods
A cross-sectional design study was done and the data was collected from the patients’ medical records in Siloam Hospital Lippo Village within 2014-2018 period. Baseline characteristics were presented using descriptive statistics. Correlation between both variables was analyzed with Spearman correlation.
Results
A total of 141 breast cancer participants from all stages, with age range varied from 20 to 78 years old and 50.19 years old as the mean age (SD = 11.056) were enrolled to this study. Median values of TOP2A, Ki-67 and tumor size respectively are 30% (1%-80%), 70% (4%-95%), and 2 (0.3-30) cm. The expression of TOP2A with Ki-67 have a moderate positive correlation (r = 0.669, p = 0.000). Otherwise, there is no correlation between the expression of TOP2A and Ki-67 with tumor size.
Conclusions
There are correlation between TOP2A with Ki-67 but, there is no correlation with the tumor size. Further study with greater samples is needed to confirm the result.
Legal entity responsible for the study
Pelita Harapan University.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
111P - TAS-102 Followed by Regorafenib or the Reverse Sequence in Advanced Colorectal Cancer
- YUKI NAKATANI
- YUKI NAKATANI
- Shinya Ueda
- Yuko Tsuboguchi
- Yumi Yoshii
- Kohei Akiyoshi
- ASUKA Tsuya
- Shunsuke Okazaki
- Shinya Tokunaga
- Haruko Daga
Abstract
Background
TAS-102 and regorafenib were shown to have clinical activity in a large population of Japanese and Western patients with heavily pretreated advanced colorectal cancer. Median OS and PFS of TAS-102 were reported 7.1 and 2.0 months, and median OS and PFS of regorafenib were 6.4 and 1.9 months for refractory colorectal cancer. We usually treated TAS-102 and regorafenib for refractory colorectal cancer at late-line. However whether TAS-102 or regorafenib should be first is not clear. So we assessed efficacy and safety of TAS-102 and regorafenib for refractory metastatic colorectal cancer at retrospective.
Methods
We selected patients with advanced colorectal cancer treated both TAS-102 and regorafenib between June 2014 and October 2017 in our institution. TAS-102 (with each dose consisting of 35 mg per square meter) was administered twice daily, 5 days a week, with 2 days of rest, for 2 weeks, followed by a 14-day rest period, thus completing one treatment cycle. Regorafenib was administered 160 mg once daily for the first 3 weeks of each 4-week cycle.
Results
21 patients were treated of TAS-102 followed by regorafenib (TR) and 11 patients were treated of regorafenib followed by TAS-102 (RT). The median age of TR and RT were 63 and 60 years. Performance status of 1 and 2 for TR were 17 and 4, RT were 7 and 4 patients. All patients had received prior chemotherapy containing a fluoropyrimidine, oxaliplatin, and irinotecan. Response rate of TR and RT were 4% and 0%, disease control rate of TR and RT were14% and 18%. Median PFS of TR and RT were 54 days (95%CI 18-136) and 50 days (95%CI 25-167). Median OS of TR and RT were 237 days (95%CI 70-645) and 242 days (95%CI 79-405). Treatment discontinuation due to adverse events was more frequent in regorafenib phase.
Conclusions
There were no significant differences of effectiveness for TAS-102 followed by regorafenib or the reverse sequence in advanced colorectal cancer.
Legal entity responsible for the study
Haruko Daga Department of Medical Oncology, Osaka City General Hospital, Osaka, Japan.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
529P - The management and outcome of crizotinib resistant patients: comparison of patients who received ceritinib to those treated with chemotherapy or other oral TKI.
- Swaratika Majumdar
- Swaratika Majumdar
- Amit Agarwal
- Vanita Noronha
- Amit Joshi
- Vijay Patil
- Rajiv Kumar
- Kumar Prabhash
Abstract
Background
Sequential use of ceritinib in crizotinib pretreated advanced ALK rearranged NSCLC is efficacious. Availability of ceritinib in resource constrained settings is limited.Sequential use of ceritinib in crizotinib pretreated advanced ALK rearranged NSCLC is efficacious. Availability of ceritinib in resource constrained settings is limited.
Methods
Retrospective analysis of a prospective audit of all patients with advanced NSCLC (approved by Institutional Ethics Committee of Tata Memorial Hospital, registered with Clinical Trials Registry India, CTRI CTRI/2013/01/003335; all patients signed a written informed consent). All patients with ALK rearranged advanced NSCLC, who progressed on crizotinib were included. Data cutoff date was 17th July 2018. OS was calculated from the date of presentation to the hospital to date of death from any cause.
Results
Between March 2013 and April 2018, there were 100 patients. 62% were male with a median age of 50 years (IQR 21-68). 87% were never smokers and 80% had no comorbidities. 37% had received crizotinib as first line therapy. 65% had a single site progression, most commonly brain (25.5%). Overall, 38 patients received ceritinib at some point during therapy. Ceritinib was used in second line in 58% patients, third line in 29% and in fourth line and beyond in 13%. Other therapy consisted of chemotherapy (5%), crizotinib with chemotherapy (39%), crizotinib continuation (18%), Alectinib (1%) and no therapy (9%). Median follow-up of surviving patients was 50 months (range: 1 to 62). Median PFS of the patients who received ceritinib was 5 months (95%CI, 3.4 to 6.6). Median OS of the entire cohort was 30 months (95%CI, 23.6 to 36.4). The median OS of the patients who received ceritinib was 32 months (95%CI, 26.3 to 37.7) versus 29 months (95%CI, 21-37) for other therapies, p = 0.41 by log rank test.
Conclusions
In our cohort of patients with crizotinib resistant advanced NSCLC, there was no significant difference in OS and PFS between those who received ceritnib and those treated with chemotherapy/other TKI. In resource limited setting, chemotherapy or other TKI may be a practical alternative.
Legal entity responsible for the study
Tata Memorial Hospital, Parel, Mumbai.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
405P - The Impact of Awareness Program on the Knowledge, Attitude and Practice of Breast self examination among Female Healthcare workers in a Tertiary Hospital: An Interventional Study
- Soo Rah Angelle R. Kwak
- Soo Rah Angelle R. Kwak
Abstract
Background
In the Philippines, breast cancer is the leading cause of cancer death among women, hence, the public health sector advocated the secondary preventive measures, such as breast self-examination (BSE). This study aimed to assess healthcare workers' knowledge, attitude and practices of BSE and the impact of an awareness progam to these domains.
Methods
All female healthcare workers at least 18 years old who were not pregnant were eligible to the study. The respondents were randomly assigned either group A (control: brochure) or group B (interventional: awareness program and brochure). A validated questionnaire was used to assess the knowledge and attitude towards breast self-examination (BSE), while practice was based on the scoring of the principal investigator as the respondents perform BSE. After six weeks, all the domains were reassessed, and the scores were compared.
Results
The baseline characteristics between study groups were similar in almost all aspects. At baseline both study groups showed good knowledge, moderately good attitude and poor practice of BSE. After intervention, there was no significant difference in the knowledge, but there was a significant improvement in the attitude of the respondents who had encountered the awareness program. Both interventions significantly improved the practice scores, however, there was no significant difference between the study groups.
Conclusions
The respondents in this study were well-educated, hence the baseline knowledge scores were good. Similar to other studies, respondents with good knowledge also had good attitude towards BSE. However, practice was poor, thus it does not translate that respondents with good knowledge and attitude, will have good practice of BSE. The awareness program greatly made an impact on the attitude, compared to giving out brochures alone. Although, both interventions significantly improved the practice on BSE, the respondents with the awareness program had more improved respondents. Hence, the study showed that a well-planned awareness program will greatly improve the knowledge, attitude and practices of BSE of healthcare workers, but the superiority of the intervention is inconclusive.
Editorial acknowledgement
The investigator would like to express her gratitude to her mentors: Dr. Felycette Gay Lapus, Dr. Alisa Bernan and Dr. Jessie Orcasitas.
Legal entity responsible for the study
Department of Health XI Cluster Ethics Review Committee.
Funding
Has not received any funding.
Disclosure
The author has declared no conflicts of interest.
Gynaecological cancers
- Andres Maria Poveda Velasco
- Jae-Weon Kim
- Eric Pujade-Lauraine
- Hextan Yuen-Sheung Ngan
- Claire Scott
- Andres Maria Poveda Velasco
- Jae-Weon Kim
- Eric Pujade-Lauraine
- Hextan Yuen-Sheung Ngan
- Claire Scott
526P - Correlation between the response to critzotinib and concomitant genetic alterations in advanced lung cancer patients with ALK rearrangement
- Xiaoyan Liu
- Xiaoyan Liu
- Minjiang Chen
- Yan Xu
- Jing Zhao
- Wei Zhong
- Mengzhao Wang
Abstract
Background
The fusion gene echinoderm microtubule-associated protein-like 4 (EML4) - anaplastic lymphoma kinase (ALK) was found to be a driver mutation in lung cancer in 2007. Crizotinib can significantly prolong a patient’s survival and improve the quality of life in patients harboring ALK fusion gene.
Methods
The specimens enrolled in the study underwent next generation sequencing. The types of ALK fusion gene and contaminant mutations were identified and their correlation with crizotinib efficacy was explored.
Results
197 patients with advanced ALK-positive lung cancer received crizotinib treatment at Peking Union Medical College Hospital and Peking University Cancer Hospital from January 2013 to December 2017. After excluding cases with incomplete medical records and inadequate tissue samples, 16 cases were enrolled in the study and the specimen underwent next-generation sequencing. The main ALK fusion type was V1 fusion (37.5%); followed by V3 fusion (31.25%). No difference was found in clinical characteristics and crizotinib efficacy between patients with different types of ALK fusion genes. Patients with shorter progression free survival (PFS) have a larger number of genetic mutations (p = 0.048). According to the mutation types, three mutational signatures were identified, namely, signature A, B and C. Patients with mutation signature A have a prolonged PFS (p = 0.026).
Conclusions
No association between crizotinib efficacy and types of ALK fusion variant was found. However, crizotinib efficacy was associated with mutation signature and mutation number.
Legal entity responsible for the study
Peking Union Medical College Hospital.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
431P - A randomized study comparing two different training programs
- Anne Bellens
- Anne Bellens
- Bernard Sabbe
- Peter Van Dam
Abstract
Background
Even mild cognitive dysfunction can have profound impact on professional, social and psychological functioning in cancer survivors. Up to date no therapeutic intervention, besides cognitive behavior therapy and mindfulness, has proven to improve this problem. Cognitive testing is rarely performed in mild cognitive impairment. The effect of playing an online video game was investigated on various cognitive domains (attention, psychomotor speed, episodic memory, working memory and executive function), as well as on perception of quality of life, anxiety and depression, cognitive failure, sleep and cognitive insight.
Methods
46 patients of the breast cancer-unit of the Antwerp University Hospital complaining of chemo-brain voluntarily enrolled between august 2016 and october 2017. Aged 18-70 years, without brain metastasis, signs of dementia, or severe hearing- or vision impairment. They were randomized in two groups: group A (N = 23) played a videogame “Aquasnap” (MyCognition, London, UK) for 6 months and 90 minutes per week. Group B (N = 23) started the same video game after a waiting period of 3 months and played for 3 months. All patients performed online cognitive testing at home with “MyCQ Med” provided by the same company, on a monthly basis. Psychometric testing was offered at onset, 3 and 6 months using RAND 36, Hospital Anxiety and Depression Scale, Cognitive Failure Questionnaire, Pittsburgh Sleep Quality Index and Beck Cognitive Insight Scale.
Results
Both groups showed a significant (p < 0.05) improvement in cognitive testresults (episodic memory, processing speed, working memory, executive function and attention), anxiety, sleep latency time, mental and cognitive health perception, vitality, quality of life, from onset to endpoint. Both groups showed deterioration of self-reflection. There was no difference between the two groups in objective cognitive testing, cognitive insight, perception of anxiety, depression, sleep quality, cognitive failure nor overall well-being.
Conclusions
Both interventions had and an apparent effect on cognitive functioning. Overall a significant improvement of anxiety, vitality, sleep and cognitive perception was documented.
Clinical trial identification
B300201627683.
Legal entity responsible for the study
\"Comite voor Methisch Ethiek\", Antwerp University Hospital, Belgium.
Funding
University Hospital Antwerp, Multidisciplinary Oncology Centre Antwerp, Belgium (MOCA), MyCognition, Ltd, London, United Kingdom.
Disclosure
All authors have declared no conflicts of interest.
Approaches towards inoperable HCC: Role of external beam radiotherapy evidence and comparison with other local treatment
- Jinsil Seong
- Jinsil Seong
Discussion led by moderators
- Rick L. Haas
- Rick L. Haas
YO46 - Occult Papillary Thyroid Carcinoma Presenting With Cervical Neck Lymph Node Metastasis
- SUNGHOON HONG
- SUNGHOON HONG
- JONGEUN Lee
- SUNWOOK Han
- SUNGYONG Kim
Abstract
Case Summary
Purpose: Papillary thyroid carcinoma (PTC) consist 75–85% of all thyroid cancers Among them, occult papillary thyroid carcinoma presented as isolated cervical lymphadenopathy, it may imitate the course of a benign disease, thus delaying diagnosis and proper treatment. We report a case of a 74-year old who presented occult papillary thyroid carcinoma.
Case: A 74-year-old man visited a endocrinology department due to diabetes mellitus, and performing neck dopler ultasonography due to cervical vascular evaluation. Incidentally, 13x11 mm sized mass was noticed on right thyroid robe which look like benign feature and 22x16mm sized mass was noticed on right neck level III which suspicious features for malignancy. Hematologic test was no abnormal value, thyroid scans were performed using Tc-99m and no abnormality was found in other sites. Fine needle aspiration was done, the result of right thyroid was non-diagnostic feature, and Rt. neck level III lymph node was metastatic papillary carcinoma. Total thyroidectomy with right functional neck dissection was performed. Right thyroid mass was nodular hyperplasia, otherwise seven out of twenty – one lymph node was metastatic papillary carcinoma.
Discussion: Enlarged cervical LN can be evaluated with ultrasound, radionuclide scans, CT and/or MRI, but 25% of patients with PTC may have normal thyroid imaging. Ultrasonographic features which supported metastatic papillary carcinoma in cervical LNs are cystic masses with thickened-irregular inner lining. If a suspicious LN was detected, FNA can be performed as a first step. FNA is a useful method for determining of typical diagnostic cytopathologic features of PTC. Proposed treatment for patients diagnosed as PTC with metastasis to cervical LN is total thyroidectomy and appropriate ipsilateral and/ or contralateral modified radical neck dissection.
Conclusions: When a metastatic LN is present but clinical/radiological exams reveal a normal appearing thyroid, the best choice as the first diagnostic step is FNA of LN. Thyroidectomy should be performed for definitive diagnosis and treatment of metastatic PTC. When it is followed up by postoperative radionuclide scan and lifelong suppressive thyroxin, outcome is usually good.