Browsing 408 Presentations
Introduction
- Carsten Denkert (Marburg, Germany)
- Carsten Denkert (Marburg, Germany)
115P - Factors associated with mastectomy in women with small residual tumour after neoadjuvant chemotherapy for breast cancer
- Emma Bernell (Stockholm, Sweden)
- Emma Bernell (Stockholm, Sweden)
- Aafke Duinmeijer (Stockholm, Sweden)
- Renske Altena (Stockholm, Sweden)
- Theodoros Foukakis (Stockholm, Sweden)
- Hanna Fredholm (Stockholm, Sweden)
Abstract
Background
Mastectomy is the most common type of surgery after neoadjuvant chemotherapy (NACT). We aimed to characterize the factors associated with mastectomy even after good response to NACT.
Methods
Women treated with NACT in Stockholm between 2007-2017 (N=1463) were identified in the Swedish National Quality Register for Breast Cancer. Logistic regression analyses were used to identify factors associated with mastectomy in women with small residual tumor, defined as ypT≤20 mm in the mastectomy specimen. The ratio between tumor volume (including all foci and cancer in situ) and excised breast volume was calculated in order to describe the tumor-affected proportion on a randomly selected subset of women having a mastectomy (n=136).
Results
A total of 1041 women (71.2%) underwent mastectomy and 422 (28.8%) breast conserving surgery (BCS). In the mastectomy group, 551 (52.9%) had a residual invasive tumor extent of ≤20 mm. Factors independently associated with having a mastectomy and ypT≤20 mm after NACT were diagnosis in the earlier study periods [2007-2010 (OR 11.09, 95% CI 6.42-19.16, p<.001) and 2011-2014 (OR 2.92, 95% CI 2.10-4.07, p<.001)], younger age [age <40 (OR 2.08, 95% CI 1.39-3.13, p<.001) and age 40-49 (OR 1.61, 95% CI 1.12-2.32, p=.011)], large tumor size at diagnosis [cT3 (OR 4.25, 95% CI 2.47-7.31, p<.001) and cT4 (OR 7.42, 95% CI 2.25-24.52, p=.001)], pre-treatment biopsy being PR negative (OR 1.55, 95% CI 1.04-2.31, p=.032) or HER2 positive (OR 1.51, 95% CI 1.10-2.06, p=.011). After a median follow-up time of 3.5 years, local relapse rate was 3.3% (14/422), 3.8% (21/551) and 5.7% (28/490) in the BCS, mastectomy with ypT≤20 mm and mastectomy with ypT>20 mm groups respectively (p=.158). Only 10.3% (14/136) of women who had undergone mastectomy had >10% of breast volume consisting of tumor.
Conclusions
In this population-based study, mastectomy after NACT was commonly used even in women with good tumor response, especially in younger women and tumours with certain high-risk features. However, a strong trend of more BCS is seen in the more recent years of the study period without compromising local disease control.
Legal entity responsible for the study
Karolinska Institutet.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Beyond HER2: Dissecting tumour heterogeneity
- Aleix Prat (Barcelona, Spain)
- Aleix Prat (Barcelona, Spain)
Novel Anti-HER2 Monoclonal Antibody
- Thomas Bachelot (Lyon, France)
72P - Non-mass like enhancement patterns on MR mammography and their pathological correlation
- Aman Parashar (Delhi, India)
- Aman Parashar (Delhi, India)
- ANkush Jajodia (New Delhi, India)
- Arvind Chaturvedi (New Delhi, India)
- AVINASH Rao (new delhi, India)
- ANURAG Mehta (new delhi, India)
- Dinesh Chandra Doval (New Delhi, Rohini, India)
- AMRITH Bp (new delhi, India)
- Pavani Medisetty (Rohini, India)
- Venkata Pradeep Babu Koyyala (New Delhi, India)
- Sunil Pasricha (New Delhi, India)
- Maria La Mantia (Palermo, Italy)
- Muralidharan K. Chllamma (Toronto, Canada)
- Doris Leithner (New York, United States of America)
- Maurius E. Mayerhoefer (vienna, Austria)
- Antonio Russo (Palermo, Italy)
- Helmut Prosch (HOUSTON, Austria)
Abstract
Background
Non-mass enhancing breast lesions pose a diagnostic dilemma and a clinical challenge that are encountered commonly in clinical practice. Suspicion of breast cancer makes it an important entity for a radiologist and medical oncologist.
Methods
All patients with clinical suspicion of Breast disease were included in the study. MRI reveals MR-BIRADS 4 and 5 non mass enhancing lesions and further underwent biopsy/post MRM/BCS/lumpectomy in our hospital. After inclusion/exclusion criteria clinically meaningful 128 non-mass lesions were assessed further for distribution pattern, internal enhancement pattern and kinetics.
Results
128 non-mass lesions were analyzed in n= 127 patients. 83 lesions were malignant and MR-BIRADS 5 category dominated (66/128, 51.5 %). Most common pattern of distribution/internal enhancement/curve type were segmental (47, 36.72%), clumped (64, 50%) and washout curve type (99, 77.34%) respectively. Regarding association with malignancy, odds ratio of lesions with segmental/regional/multiple regional distribution pattern was 13.5 (95% CI= 5.6-32.5), clumped/clustered ring internal enhancement pattern was 43.07 (95% CI= 14.3-129.6) and washout curve type was 17.8 (95% CI= 6.0-52.3). The sensitivity of the washout curve type for diagnosis of malignancy was 93.9%. The specificity of clumped/clustered ring internal enhancement pattern was 88.9%.
Conclusions
Segmental/regional/multiple regional distribution patterns, clumped/clustered ring internal enhancement pattern and washout curve type was the most powerful indicator for malignant pathology in non-mass enhancing lesions. The study envisaged the unmet need for consensus on the characterization of non-mass enhancing lesions in most of the previously done studies.
Legal entity responsible for the study
Rajiv Gandhi Cancer Institute and Research Center.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
PROMISing ways to measure QoL
- David Cella (Chicago, United States of America)
- David Cella (Chicago, United States of America)
Welcome and Introduction
- Rebecca Dent (Singapore, Singapore)
121P - Can axillary surgery be avoided in patients with breast pathologic complete response after neoadjuvant systemic therapy? A real-world study in China
- Rui Chen (Nanjing, China)
- Rui Chen (Nanjing, China)
- Yan Li (Nanjing, China)
- Shuo Li (Nanjing, China)
- Qiannan Zhu (Nanjing, China)
- Xiaoqing Shi (Nanjing, China)
- Xiaoming Zha (Nanjing, China)
- Jue Wang (Nanjing, China)
Abstract
Background
Some breast cancer patients can achieve pathologic complete response (pCR) for breast and/or axillary lymph node after neoadjuvant systemic therapy (NST). If the breast achieved pCR confirmed by extensive biopsy, the necessity of breast surgery has been questioned. Whereas, the appropriate management of the axilla in breast pCR patients is rarely studied. This cohort study was designed to retrospectively evaluate the status of axillary lymph nodes in relation to breast pCR and identify patients who may be eligible for omission of axillary surgery.
Methods
This study in a single institution concluded operable breast patients who received NST followed by standard breast and nodal surgery from 2015 to 2019. The rates of axillary pCR (ypN0) were compared between patients who did or did not achieve breast pCR (ypT0/is).
Results
Among 258 patients, 70 (27.1%) patients achieved ypT0/is, and there was no statistical difference according to patients’ age, menopausal status, clinical tumor size and lymph node status when compared with non-ypT0/is patients. Patients with HER2-positive and triple-negative (TN) subtypes have a higher incidence of ypT0/is than patients with luminal subtype (P<0.001). Overall, the rate of ypN0 in ypT0/is group was higher than in non-ypT0/is group (87.1% vs 34.6%, P<0.0001). For cN0 (clinically assessed negative lymph node before NST) patients, although there was no difference of ypN0 rates between ypT0/is group and non-ypT0/is group (100% vs. 85.7%, P=0.1534), the high value of ypN0 rate in ypT0/is group (100%) provided evidence of axillary surgery omission. In addition, for cN+ (clinically assessed positive lymph node before NST) patients, the ypT0/is group population was more likely to achieve ypN0 than non-ypT0/is population (82.7% vs 22.9%, P<0.0001). Moreover, more cN+ patients achieved ypN0 in ypT0 group than in ypTis group (94.3% vs 58.8%, P= 0.0034), and the high rate number (94.3%) also indicated possibility of axillary surgery omission.
Conclusions
Evidence supported that, for cN0 patients who achieved ypT0/is, and cN+ patients who achieved ypT0, axillary surgery may be omitted.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Medical treatment of HER2-positive patients
- Ana Mafalda Antunes De Melo e Oliveira (Barcelona, Spain)
- Ana Mafalda Antunes De Melo e Oliveira (Barcelona, Spain)
Tailoring follow-up and survivorship care
- Ines Vaz Luis (Villejuif, Portugal)
- Ines Vaz Luis (Villejuif, Portugal)
150P - Eligibility of real-world patients with metastatic breast cancer in clinical trials
- Atul Batra (New Delhi, Delhi, India)
- Atul Batra (New Delhi, Delhi, India)
- Shiying Kong (Calgary, Canada)
- Rodrigo Rigo (Calgary, Canada)
- Winson Cheung (Calgary, Canada)
Abstract
Background
The results of clinical trials in metastatic breast cancer (MBC) are often generalized to real-world patients. However, clinical trials have stringent inclusion and exclusion criteria, which can potentially lead to poor generalizability of results and slow accrual. This study was conducted to determine the proportion of real-world patients with MBC who would be eligible for clinical trials based on common eligibility criteria and to compare outcomes in eligible and ineligible patients.
Methods
Patients diagnosed with MBC in 2004-2015 from the Alberta cancer registry were included. Patients with one of the following criteria were deemed ineligible: age >75 years, comorbid conditions (uncontrolled diabetes, heart disease, liver disease, and kidney disease), anemia, and history of immunosuppression or a prior malignancy. The likelihood of receiving any therapy was analyzed using logistic regression and factors affecting overall survival (OS) were assessed by Cox model.
Results
A total of 1585 patients with MBC were identified with median age at diagnosis was 63 years (interquartile range: 53-75 years). Approximately 44% (693) patients were deemed trial-ineligible and the most common reasons for ineligibility were advanced age (24%), renal dysfunction (17%), and cardiac disease (8%), respectively. In the real-world, 87% of eligible patients received hormonal or chemotherapy as compared to 72% of ineligible patients [odds ratio 2.65; 95% confidence interval, 2.04-3.42; P< 0.0001]. The 5-year OS of trial-ineligible patients who received any therapy was significantly better than those who did not (Table).
Group 5-year OS Hazard ratio 95% CI P-value Ineligible and no therapy (n=195) 2.1% -- -- -- Ineligible and received therapy (n=498) 24.7% 0.75 0.59-0.96 0.02 Eligible (n=892) 34.8% 0.69 0.53-0.9 0.006
Conclusions
Despite being ineligible for clinical trials by the common eligibility criteria, most of the patients still derive benefit from treatment. Relaxation of an arbitrary upper limit of age as an inclusion criteria for clinical trials is likely to enhance the representation of real-world patients leading to faster accrual and increase in generalizability of results of such trials.
Legal entity responsible for the study
The authors.
Funding
Has not received any funding.
Disclosure
All authors have declared no conflicts of interest.
Concluding remarks
- Javier Cortés (Barcelona, Spain)