Monitoring Of Breast Cancer Patients Research Articles

Abstract PO5-20-06: Paraneoplastic cerebellar degeneration in anti-Yo antibody and HER2-positive metastatic breast carcinoma

Abstract Paraneoplastic cerebellar degeneration (PCD) in the context of breast carcinoma affects less than 1% of patients. In most cases, breast cancer diagnosis follows several months or even years after the onset of neurological symptoms. The first association between PCD and occult gynecologic cancers (breast or ovarian) was identified in 1938 with the discovery of antibodies directed against cytoplasmic antigens of Purkinje cells (“anti-Yo antibodies”). Since then, evidence has grown significantly to support anti-Yo antibodies as excellent diagnostic markers of PCD with underlying gynecologic and breast carcinoma. This case study evaluates a 57-year-old female who initially presented with headache and subacute cerebellar ataxia. Her symptoms progressed over a period of three months with multiple falls, onset of speech difficulties, and diplopia. She also reported 30-pound weight loss, which she attributed to dieting and starting semaglutide. Magnetic resonance imaging (MRI) of the brain and spine were unremarkable and autoimmune workup was normal. Cerebral spinal fluid (CSF) and serum studies demonstrated positive anti-Yo antibodies. Computed tomography (CT) of the abdomen and pelvis showed an enlarged left axillary lymph node concerning for metastatic disease with a 1.2cm focus of asymmetric density in the central inferior left breast parenchyma. Diagnostic mammogram one year prior was reportedly normal. Ataxia symptoms improved after a course of empiric intravenous immunoglobulins and steroids. Ultrasound-guided biopsy of the left axillary lymph node revealed metastatic mammary carcinoma: estrogen and progesterone receptor negative and human epidermal growth factor receptor 2 (HER2)-positive, cT0N2aM0, ypTxN1aM0, stage IIIa (AJCC 8th edition). She underwent further metastatic workup, including repeat CSF studies and MRI. MRI of the spine was remarkable for multiple hemangiomas throughout the cervical, thoracic, and lumbar spine, with subsequent unremarkable bone scan. MRI of the abdomen was remarkable for right hepatic lobe hemangioma and a right adrenal nodule. CSF studies showed no sign of metastases. After multidisciplinary discussion, TCHP (docetaxel, carboplatin, trastuzumab, and pertuzumab) neoadjuvant therapy was initiated and repeat imaging demonstrated favorable treatment response with a shrinking axillary mass; no primary breast mass was identified. The patient underwent left sentinel lymph node biopsy with a positive frozen section intraoperative for invasive cancer, therefore proceeded with left axillary lymph node dissection. She was offered a mastectomy but elected for only axillary surgery. Pathology revealed 1 of 14 lymph nodes were positive for metastatic ductal carcinoma. She remains in a rehabilitation center and her ataxia is improving, but her functional status remains below baseline. She is undergoing radiation to whole breast and regional lymph nodes. With this case, we aim to continue to build upon the limited base of the exceedingly rare presentation of breast cancer-associated paraneoplastic syndrome. In addition, several studies and case reports have demonstrated a strong correlation between HER2 overexpression and anti-Yo associated PCD. As we continue to diagnose and monitor breast cancer patients, we could consider starting to screen for anti-Yo antibodies in HER2-positive patients to gain insight into a patient’s prognosis and development of PCD. Citation Format: You Kim, Alison Coogan, Andrea Madrigrano. Paraneoplastic cerebellar degeneration in anti-Yo antibody and HER2-positive metastatic breast carcinoma [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO5-20-06.

Comprehensive Assessment of Cardiac Function in Breast Cancer Patients: Integrating Multiparametric Speckle Tracking Imaging and Conventional Echocardiography Parameters.

Purpose The purpose of this study is to comprehensively evaluate the role of different echocardiography parameters in breast cancer patients undergoing chemotherapy. While echocardiography examination with calculation of ejection fraction (EF), is pivotal for patient monitoring, its operator dependence and insensitivity to subtle changes in left ventricular (LV) contractility present challenges. Global longitudinal strain (GLS), derived from speckle tracking, is more sensitive and stable than EF. Our research aimed to delineate supplementary echocardiography measurements beneficial for the cardiological monitoring of breast cancer patients. Methods Patients were followed up with echocardiography at baseline, during, and after the chemotherapy. Conventional echocardiography and multiple speckle tracking imaging parameters including myocardial work index, atrial strain, twist, and automatic EF were investigated. Results A total of 25 patients were recruited. A subset (15/25) exhibited pronounced GLS reduction, associated with decreased EF and altered cardiac mechanics. Patients with unchanged GLS were often hypertensive and on specific medications, in particular angiotensin-converting enzyme inhibitors (ACE inhibitors)/angiotensin II receptor blockers (ARBs), potentially indicating protective effects. Despite stability in other parameters, GLS and EF sensitivity highlight their importance. A strong correlation between manual and automated EF measurement methods was also observed. Conclusion Despite the small sample size, across diverse echocardiography parameters, GLS and EF are primarily affected by chemotherapy. Hypertensive individuals exhibited lower susceptibility to chemotherapy-induced damage, likely attributed to the cardioprotective properties of ACE inhibitors and angiotensin II receptor blockers. A strong correlation between automatic and Simpson-based EF was found.

Molecular monitoring by CDKN2A/p16INK4A and RB1 gene methylation in breast cancer.

This prospective study aimed to provide a comprehensive analysis of the methylation status of two pivotal genes, CDKN2A/p16INK4A (cyclin-dependent kinase inhibitor 2A) and RB1 (retinoblastoma transcriptional corepressor 1), in breast cancer patients. Samples were obtained from 15 women diagnosed with breast cancer and who underwent a total mastectomy. DNA was extracted from the tumor, non-tumor tissue, and peripheral blood (circulating cell-free DNA). The methylation pattern of cell-free DNA extracted from blood collected on the day of mastectomy was compared with the methylation pattern of cell-free DNA from blood collected 1 year post-surgery. The methylation analysis was carried out by sodium bisulfite conversion and polymerase chain reaction, followed by electrophoresis. Methylation of CDKN2A/p16INK4A was identified in 13 tumor samples and 12 non-tumor tissue samples. Two patients exhibited CDKN2A/p16INK4A methylation in the cell-free DNA of the first blood collection, while another showed methylation only in the cell-free DNA of the subsequent blood collection. Regarding RB1, 11 tumors and 8 non-tumor tissue samples presented methylation of the gene. This study presents a novel approach for monitoring breast cancer patients through the analysis of cell-free DNA methylation. This analysis can detect changes in methylation patterns before any visible sign of cancer appears in breast tissue and could help predict the recurrence of malignant breast tumors.

Impact of Chemotherapy Regimens on Body Composition of Breast Cancer Women: A Multicenter Study across Four Brazilian Regions.

This study aimed to investigate the effect of chemotherapy (CT) and its different types of regimens on the anthropometry and body composition of women with breast cancer. Three-hundred-and-four women with breast cancer were enrolled in this multicenter study. The participants were evaluated before the infusion of the first cycle of CT (pre-CT), and until two weeks after CT completion (post-CT), regarding body weight, body mass index (BMI); waist circumference (WC); waist-to-height ratio (WHtR); conicity index (C-index); fat mass index (FMI); and fat-free mass index (FFMI). CT regimens were classified as anthracycline-based (AC-doxorubicin or epirubicin); anthracyclines and taxane (ACT); cyclophosphamide, methotrexate, and 5-fluorouracil (CMF); or isolated taxanes (paclitaxel or docetaxel). Women significantly increased BMI and FMI post-CT (p < 0.001 and p = 0.007, respectively). The ACT regimen increased FMI (p < 0.001), while FFMI increased after AC (p = 0.007). It is concluded that the CT negatively impacted body composition and the type of regime had a strong influence. The ACT regimen promoted an increase in FMI compared to other regimens, and the AC increased FFMI. These findings reinforce the importance of nutritional monitoring of breast cancer patients throughout the entire CT treatment.

Consequences of coronavirus disease in women with breast cancer.

The ongoing coronavirus (COVID-19) pandemic produces widespread concerns, fear and stress throughout the world, and our country is no exception in that regard, which is a natural and normal human reaction to this inconsistent and uncertain situation for us all. For the purpose of this study a sociodemographic questionnaire was devised as well as a Serbian version of the self-reported Depression, anxiety and stress scale-21. The average age±[standard deviation (SD)] of the participants in the study was 49.20±11.2years. Regarding the depression score, 55/93 examinees (59.13%) had a normal score in the first examination, whereas in the second it rose to 57/93 (61.29%) and in the third it was 52/93 (58.06%). A normal anxiety score in March 2020 was seen in 52/93 (55.91%), whereas in September that year it was 53/93 (56.98%) and in March 2021 it was 39/93 (41.93%). The average value of stress score at the measurement in March 2020 was 5.51, lower in September (4.92) and in March 2021 it was 5.63. The results of this study refer to the process of clinical assessment and monitoring of breast cancer patients with evident symptoms of depression, anxiety and stress. Adequate counseling about COVID-19 is therefore a priority in an attempt to alleviate its psychological impact in these patients.

Molecular Characterization of Exosomes for Subtype-Based Diagnosis of Breast Cancer.

Breast cancer is very heterogeneous and the most frequently diagnosed cancer worldwide, and precise therapy targeting specific subtypes may improve the survival rates of breast cancer patients. In this study, we designed a biomimetic vesicle by camouflaging catalytic DNA machinery with a breast cancer cell membrane, which enabled the molecular classification of circulating exosomes for subtype-based diagnosis through homotypic recognition. In addition, the vesicles specifically targeted and fused with breast cancer exosomes with phenotypic homology and manipulated the DNA machinery to amplify electrochemical signaling using exosomal RNA as an endogenous trigger. The biomimetic vesicles prepared with MCF-7 cancer cell-derived membranes were shown to recognize estrogen receptor-positive breast cancer exosomes and exhibited a low detection limit of 557 particles mL-1 with microRNA-375 used as the endogenous biomarker. Furthermore, the biomimetic vesicles prepared with MDA-MB-231 cancer cell-derived membranes displayed satisfactory performance in a homotypic analysis of triple-negative breast cancer exosomes with a potential therapeutic target, PD-L1 mRNA, used as the endogenous biomarker. Most importantly, cross-validation experiments confirmed the high accuracy and selectivity of this homotypic recognition-driven analysis for molecular subtyping of breast cancer. When applied to clinical samples of breast cancer patients, the vesicles demonstrated feasibility and reliability for evaluating the molecular features of cancer cell-derived exosomes and enabled stage-specific monitoring of breast cancer patients because the electrochemical signals showed a positive correlation with disease progression. Therefore, this work may provide new ideas for the precise diagnosis and personalized treatment of breast cancer patients throughout the whole disease process.

Abstract P3-23-05: Evaluation of CDK 4/6 inhibitor practice patterns and institutional versus national adherence to palbociclib laboratory monitoring in breast cancer patients

Abstract Background: Cyclin dependent kinase (CDK) 4/6 inhibitors (CDK 4/6i) can improve outcomes in ER-positive/HER2-negative (ER+/HER2-) breast cancer. The choice of CDK 4/6i selection and dose depends on clinical context and/or potential side effect of profile of each unique CDK 4/6i. The objective of this study was to evaluate practice patterns in patients initiated on CDK 4/6i and assess adherence to recommended laboratory monitoring in breast cancer patients in both an institutional and national dataset. Methods: The institutional cohort (IC) involved a retrospective chart review of patients newly initiated on palbociclib between May 8, 2018 - June 4, 2019 at Mayo Clinic, Rochester. The national cohort (NC) reviewed medical and pharmacy claims data from the OptumLabs Data Warehouse (OLDW) and included patients who were initiated on palbociclib (P), ribociclib (R) or abemaciclib (A) between February 6, 2015 - September 30, 2019. NC patients were required to have a minimum of 6 months baseline coverage, 6 months coverage after first prescription and Day 1 labs drawn. For both cohorts, patients were ≥18 years old with metastatic ER+/HER2- breast cancer. Data was collected for up to 6 cycles of treatment and included cycle start dates, doses, dates of lab draws and dose changes. Laboratory adherence was defined as a complete blood count being drawn +/- 3 days of the defined timepoint for the IC and +/- 5 days for the NC with a l4-day window for Cycle 1, Day 1 labs. Results: The IC included 81 patients and the NC 2600. In the NC, the most prescribed CDK 4/6i was P (90%), followed by A (6%) and R (4%). Prescription breakdown by geographic region was Midwest (26%), Northeast (14%), South (47%), West (13%). Ethnic breakdown of the group was White (68%), Black (15%), Hispanic (8%), Asian (3%) and unknown (6%). P practice pattern data were available for both the IC and NC, but R and A data in the NC only. In the IC, the initial P dose was 125 mg (95%), 100 mg (1%) and 75 mg (4%). In the NC, P (n=2329) dose was 125 mg (81%), 100 mg (15%) and 75 mg (4%). Dose reductions were common with 25% and 28% of patients requiring one dose reduction and 16% and 9% of patients requiring two dose reductions in the IC and NC, respectively. In NC patients initially treated with P, 5% were subsequently treated with A and 2% with R. In the NC, A (n=163) was initiated at 200 mg (7%), 150 mg (79%), 100 mg (10%) and 50 mg (4%). One dose reduction was required in 25% of patients and 6% required two dose reductions. Of those initially treated with A, 16% were subsequently treated with P and 1% with R. In the NC, R (n=108) was initiated at 600 mg (81%), 400 mg (8%) and 200 mg (11%). One dose reduction was required in 17% of patients and 2% required two dose reductions. Of those initially treated with R, 7% each were subsequently treated with P and 10% with A. Laboratory adherence was assessed for P only. For the IC, a total of 81 patients were included (mean age 61±13 years, 98% female and 95% White). The NC included 2329 patients (mean age 66±12 years, 99% female and 69% White). Laboratory adherence is listed in the table below: Conclusions: P was the most commonly prescribed CDK 4/6i. Dose reductions were less common with R. Adherence to laboratory monitoring was higher in our institutional cohort than in a national administrative claims database. Initiatives to ensure that labs are drawn at recommended timepoints during P therapy will be important for safety. ICNCC1D193%100%C1D1589%61%C2D191%71%C2D1558%55%C3D199%62%C4D190%55%C5D184%53%C6D178%50%C = cycle, D = day. Citation Format: Jodi Taraba, Kavya Swarna, Allison Golbach, Lindsey Sangaralingham, Kathryn Ruddy, Kristin Mara, Matthew Smith, Tufia Haddad, Karthik Giridhar. Evaluation of CDK 4/6 inhibitor practice patterns and institutional versus national adherence to palbociclib laboratory monitoring in breast cancer patients [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P3-23-05.

Abstract P2-14-11: Immune response monitoring in breast cancer patients treated with neoadjuvant chemotherapy combined with dendritic cell vaccines

Abstract INTRODUCTION. Breast cancer (BC) is one of the most frequent cancers in women worldwide. Lack of therapeutic efficacy in some BC subtypes makes it necessary to develop new strategies. It is known that immune system plays a key role in the tumour control. Moreover, BC is immunogenic and the intensity of the immune response influences the clinical efficacy, and is correlated with a good prognosis. For that, manipulating the immune system to make it more effective could be an option. We design a clinical trial (NCT01431196) to evaluate the clinical efficacy of the combination of standard treatment with monocyte-derived dendritic cells vaccines preloaded with autologous tumour lysate (DCV) in stage I-III BC patients without HER2 overexpression. An in-depth immunological study was carried out. OBJECTIVES. To evaluate the immune response induced by the combination of neoadjuvant chemotherapy ± DCV ± radiation ± endocrine therapy in BC patients. METHODS. Serum and peripheral blood mononuclear cells (PBMCs) were collected from 20 luminal and triple negative BC patients before and after treatment. In serum, the presence of anti-tumour antibodies was studied by flow cytometry. PBMCs phenotype was evaluated by flow cytometry. In addition, functional studies were performed by incubating PBMCs with dendritic cells preloaded with autologous tumour lysate to evaluate specific immune response; specifically, T cell proliferation assay by [3H] thymidine incorporation and IFN-γ-producing cell assays by ELISPOT were done. Finally, the TCR clonality was assessed by flow cytometry. RESULTS. We identified IgG and IgM antibodies specific for breast cancer cell lines in the serum of 20 % and 40% of patients. Myeloid-derived suppressor cells decreased and NK cells increased with the treatment. Moreover, activation markers, such as HLADR, significantly increased in CD4+ and CD8+ lymphocytes after treatment, whereas PD1 and TIM3 decreased. In addition, an increase in the proliferation of specific T cells and in the number of IFN-γ producing cells after stimulation with tumor lysate pulsed DC was detected after treatment. Finally, very good clinical responders (pT4/5 with Miller&amp;Payne classification and pN0) had higher TCR diversity index (DI) in CD4+ and CD8+ T cells in pretreatment samples: in CD8+ T cells, diversity index decreased in both groups after treatment, with higher difference in the VGCR group. CONCLUSION. Our study provides strong support that combined treatment induce humoral and cellular immune responses. We observed an activation of the immune system and a decrease in some immune checkpoints and MDSC. Finally, patients with a higher TCR-DI initially have a better clinical response and treatment induced oligoclonal activation of T cells. Citation Format: Laura Hato, Susana Inogés, Belén Pérez, Luis Mejías, Rodrigo Sánchez-Bayona, Marta Santisteban, Ascensión López. Immune response monitoring in breast cancer patients treated with neoadjuvant chemotherapy combined with dendritic cell vaccines [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P2-14-11.

Real-world Evidence of Implementing eHealth Enables Fluent Symptom-based Follow-up of a Growing Number of Patients with Breast Cancer with the Same Healthcare Resources

BackgroundThe growing number of new breast cancer (BC) patients has indicated an urgent need for better tools to monitor patients. Due to the increasing number of unscheduled patient calls, two digital applications were implemented: a callback application (CA) and a digital cancer follow-up application (CFUA). The aim of this study was to evaluate the implementation and added value of digital applications for healthcare professionals in monitoring BC patients from 2012 to 2020. Materials and MethodsAs of the end of 2020, 1420 follow-up BC patients were enrolled in the CFUA, which covered 70% of the BC patients in the follow-up phase in the clinic. All unscheduled telephone calls and digital contacts were recorded from January 2015 to December 2020. ResultsThe implementation of the CA revealed low telephone accessibility (56%), which was improved by 55% by the end of 2020 due to the implementation of the CFUA. In 2019, 59% of all phone service contacts were digitally prepared, and contact reasons were classified by the patients. One of the most important findings was that BC patient contacts more than tripled during the nine-year study period, and these patients could be treated by the same number of nurses due to the implementation of the CA and CFUA. Feedback from two nurses' surveys favored the use of the CFUA. ConclusionOur study clearly demonstrates that new digital tools are useful in the challenge of a growing number of BC patients in surveillance who should be handled with limited health care resources.

An Exploration of Heart Failure Risk in Breast Cancer Patients Receiving Anthracyclines with or without Trastuzumab in Thailand: A Retrospective Study.

Anthracycline-based regimens with or without anti-human epidermal growth factor receptor (HER) 2 agents such as trastuzumab are effective in breast cancer treatment. Nevertheless, heart failure (HF) has become a significant side effect of these regimens. This study aimed to investigate the incidence and factors associated with HF in breast cancer patients treated with anthracyclines with or without trastuzumab. A retrospective cohort study was performed in patients with breast cancer who were treated with anthracyclines with or without trastuzumab between 1 January 2014 and 31 December 2018. The primary outcome was the incidence of HF. The secondary outcome was the risk factors associated with HF by using the univariable and multivariable cox-proportional hazard model. A total of 475 breast cancer patients were enrolled with a median follow-up time of 2.88 years (interquartile range (IQR), 1.59–3.93). The incidence of HF was 3.2%, corresponding to an incidence rate of 11.1 per 1000 person-years. The increased risk of HF was seen in patients receiving a combination of anthracycline and trastuzumab therapy, patients treated with radiotherapy or palliative-intent chemotherapy, and baseline left ventricular ejection fraction <65%, respectively. There were no statistically significant differences in other risk factors for HF, such as age, cardiovascular comorbidities, and cumulative doxorubicin dose. In conclusion, the incidence of HF was consistently high in patients receiving combination anthracyclines trastuzumab regimens. A reduced baseline left ventricular ejection fraction, radiotherapy, and palliative-intent chemotherapy were associated with an increased risk of HF. Intensive cardiac monitoring in breast cancer patients with an increased risk of HF should be advised to prevent undesired cardiac outcomes.

Accuracy of echocardiography for detecting cancer therapeutics-related cardiac dysfunction

The survival rate of breast cancer patients has been improved thanks to the progress accomplished in chemotherapy therapeutics and targeted therapies. However, cardiovascular side effects have increased. Cancer therapeutics-related cardiac dysfunction (CTRCD) is a serious side effect of anti-cancer treatment. The aim of our study was to determinate the role of echocardiography in the detection of CTRCD. This was a longitudinal, prospective and monocentric study. Eighty female patients diagnosed with breast cancer and addressed to the echocardiography lab of Ariana hospital, were enrolled between 2017 and 2019. An echocardiographic monitoring were realised according to the chemotherapy protocol. CTRCD is defined as a drop of left ventricular ejection fraction (LVEF) by > 10 percentage points from baseline to a value < 50%. A new entity named subclinical systolic dysfunction, is defined by drop of global longitudinal strain (GLS) by > 15% from baseline, however, LVEF remains > 50%. The average age of our patients was 49.9 ± 10.8 years. The mean LVEF was at 64 ± 4.4%. The incidence of CTRCD was 6% (5 patients). It was reversible in 3 cases after the initiation of a cardioprotective treatment. The incidence of subclinical cardiac dysfunction was 25%. Cardioprotective treatment was administered in this case and none of them evolved to CTRCD. At univariate analysis, baseline LVEF between 50 and 55% (P < 0.001), GLS decrease (P < 0.001) and adriamycin administration (P = 0.01) were predictive factors of cardiotoxicity. At multivariate analysis, only borderline baseline LVEF between 50% and 50% was a predictive factor of CTRCD (P = 0.002). Echocardiographic monitoring of breast cancer patients revealed a CTRCD in 5 cases (6%). GLS allowed the diagnosis of a subclinical cardiac dysfunction in 25% of cases. In breast cancer patients, both Simpson biplane LVEF and GLS should be assessed.

The impact of different preanalytical methods related to CA 15-3 determination in frozen human blood samples: a systematic review

BackgroundThe determination of CA 15-3 is useful for monitoring breast cancer patients. Several retrospective studies determined CA 15-3 levels in frozen samples to evaluate the sensitivity and specificity of novel biomarkers in relation to breast cancer; however, freeze-thaw cycles, as well as preanalytical variables before sample storage, are not always reported. Here, we analyzed the current scientific literature to identify possible critical aspects related to CA 15-3 determination in frozen-stored human serum/plasma samples.MethodsWe obtained data from 4 different bibliographic databases: Web of Science, Embase, PubMed, and Cochrane Library. We followed the PRISMA guidelines to screen and select the eligible articles discussed in the final revision.ResultsInitially, 674 scientific papers were evaluated, and after the application of the screening and eligibility criteria, 18 studies were included in the qualitative synthesis. The analysis reported an important level of heterogeneity concerning the preanalytical phase before sample storage.ConclusionAlthough advances in healthcare have been achieved using certified workflows in medical diagnostics, standardized preanalytical processes are not always applied when referring to frozen-stored biosamples. Biobanks will guarantee the best possible conditions for the storage of human biological samples to be used in clinical research. The use of certified bioresources will favor the optimal development and introduction of new disease biomarkers.

Breast edema, from diagnosis to treatment: state of the art

IntroductionBreast edema can arise from different etiologies; however, it is mostly seen after breast conserving surgery and/or radiotherapy. Combining breast conserving surgery and radiotherapy can cause damage to the lymphatic system and reactions to surrounding tissues, which can lead to breast edema; hereby, the breast size can increase by more than one cup size. Swelling of the breast is not the only criterion associated with breast edema. Other common criteria found in literature are peau d’orange, heaviness of the breast, skin thickening, breast pain, redness of the skin, hyperpigmented skin pores and a positive pitting sign. Despite the benefits of breast conserving surgery, breast edema can be uncomfortable, and can negatively influence quality of life in suffering patients. In contrast to lymphedema of the arm, which is well known in clinical practice and in research, breast edema is often underestimated and far less explored in literature. Currently, many aspects still need to be reviewed.Purpose and importance to practiceThis masterclass aims at providing the state of the art of breast edema for all health care workers and researchers involved in the treatment and monitoring of breast cancer patients. It includes current and future perspectives on its diagnosis, longitudinal course and treatment. Furthermore, recommendations for clinical practice and future research are discussed.Clinical implicationsIt is recommended to closely monitor those patients in whom breast edema symptoms do not decline within 6 months after termination of radiotherapy and provide them with the appropriate therapy. Since evidence concerning the treatment of breast edema is currently lacking, we recommend the complex decongestive therapy (CDT) to the utmost extent, by analogy with the lymphedema treatment of the extremities. This treatment involves skin care, exercise therapy and compression. Additionally, all patients should be informed about the normal course of breast edema development.Future research prioritiesA consensus should be reached among clinicians and researchers concerning the definition, assessment methods and best treatment of breast edema. Furthermore, high quality studies are necessary to prove the effectiveness of the CDT for breast edema.

Standardization of cardiac monitoring practices in patients receiving cardiotoxic cancer therapy at an ambulatory oncology center.

251 Background: A significant number of cancer-directed therapies are associated with cardiotoxicity. This adverse effect is well-established in anthracyclines and anti-HER2 agents. At our ambulatory oncology practice, the recent availability of echocardiograms with strain imaging has prompted an evaluation of current practices for cardiotoxicity monitoring. A review of the electronic health record (EHR) in 2019 found that although our institution maintains high rates of baseline monitoring, follow-up monitoring is not standardized and not consistent between different practices. Methods: A multidisciplinary team was formed to conduct a quality improvement project with the aim of increasing the rate of follow-up monitoring in patients who receive anthracyclines or infusional anti-HER2 agents. A survey of providers identified the potential reasons that follow-up cardiac monitoring was not completed. A Pareto chart showed that lack of familiarity with clinical necessity and appropriate timing were the most common barriers to follow-up monitoring. Our first plan-do-study-act focused on addressing these barriers, and a pilot in breast cancer treatment plans was started. Cardiac monitoring orders were added to curative intent protocols containing doxorubicin, trastuzumab, or pertuzumab. Education was provided to physician and nursing teams regarding utility and timing of cardiotoxicity monitoring. Collaboration with the cardiology group ensured timely access and result turnaround time. Results: An initial review of the EHR was conducted to identify current trends in cardiac monitoring. The review showed that there was an increase in the use of echocardiograms with strain imaging for baseline and follow-up monitoring in our patients. From January to April 2020, there was a total of 102 echocardiogram orders which was a 23% increase compared to the same timeframe in the previous year. The majority (61%) of those echocardiogram orders included strain imaging compared to 8% in the previous year. Review of treatment plan utilization and appropriate timing of cardiac monitoring in breast cancer patients is ongoing. Conclusions: This quality improvement project suggests that efforts to standardize cardiac monitoring practices can be achieved through provider education and workflow modifications. Further long-term review of the EHR will be needed to determine whether the timing of follow-up monitoring is appropriate and to identify what changes to the intervention should be made.

ΔKi67 proliferation index as independent predictive and prognostic factor of outcome in luminal breast cancer: data from neoadjuvant letrozole-based treatment.

A key tool for monitoring breast cancer patients under neoadjuvant treatment is the identification of reliable predictive markers. Ki67 has been identified as a prognostic and predictive marker in ER-positive breast cancer. Ninety ER-positive, HER2 negative locally advanced breast cancer patients received letrozole (2.5 mg daily) and cyclophosphamide (50 mg daily) with/without Sorafenib (400 mg/bid daily) for 6 months before undergoing surgery. Ki67 expression and tumor size measured with caliber were determined at baseline, after 30 days of treatment and at the end of treatment. Patients were assigned to a clinical response category according to Response Evaluation Criteria in Solid Tumors, both at 30 days and before surgery and further classified as high-responder and low-responder according to the median variation of Ki67 values between biopsy and 30 days and between biopsy and surgery time. The predictive role of Ki67 and its changes with regard to clinical response and survival was analyzed. No differences in terms of survival outcomes emerged between the arms of treatment, while we observed a higher percentage of women with progression or stable disease in arm with the combination containing Sorafenib (20.5% vs 7.1%, p = 0.06). Clinical complete responders experienced a greater overall variation in Ki67 when compared with partial responders and patients with progressive/stable disease (66.7% vs 30.7%, p = 0.009). High responders showed a better outcome than low responders in terms of both disease-free survival (p = 0.009) and overall survival (p = 0.002). ΔKi67 score evaluated between basal and residual tumor at definitive surgery showed to be highly predictive of clinical complete response, and a potential parameter to be used for predicting disease-free survival and overall survival in luminal breast cancer treated with neoadjuvant endocrine-based therapy.

PROSTATE-SPECIFIC ANTIGEN AND ITS MOLECULAR FORMS IN BLOOD SERUM OF HEALTHY WOMEN AND WOMEN WITH BREAST DISEASE

The purpose of the study was to provide data on the sources of prostate-specific antigen (Psa) in women, as well as on serum Psa levels in healthy women and in women with benign and malignant breast cancer. Material and methods. We analyzed 50 publications available from PubMed, Medline, Google scholar concerning non-prostatic sources of Psa and its use as a serum tumor-associated marker for benign and malignant breast tumors. Results. In our study, we focus on the recent findings on non-prostatic sources and regulation of Psa synthesis in women as well as on changes in serum concentrations of this marker in patients with benign and malignant breast tumors. Various Psa isoforms (total Psa and free Psa) and free/total ratio for the detection of breast cancer and the assessment of treatment response and early detection of breast cancer recurrence were analyzed. Conclusion . the results obtained highlight the value of the assessment of Psa isoforms for early detection, prediction of therapy response and detection of breast cancer relapse. However, further studies are needed to identify the role of Psa isoforms in the diagnosis and monitoring of breast cancer patients.

Genetic Markers of Circulating Tumor DNA for Monitoring Breast Cancer Patients in Costa Rica

Genetic Markers of Circulating Tumor DNA for Monitoring Breast Cancer Patients in Costa Rica

Are Circulating Tumor Cells (CTCs) Ready for Clinical Use in Breast Cancer? An Overview of Completed and Ongoing Trials Using CTCs for Clinical Treatment Decisions.

In recent years, breast cancer treatment has become increasingly individualized. Circulating tumor cells (CTCs) have the potential to move personalized medicine another step forward. The prognostic relevance of CTCs has already been proven both in early and metastatic breast cancer. In addition, there is evidence that changes in CTC numbers during the course of therapy can predict treatment response. Thus, CTCs are a suitable tool for repeated treatment monitoring through noninvasive liquid biopsy. The next step is to evaluate how this information can be used for clinical decision making with regard to the extension, modification, or abandonment of a treatment regimen. This review will summarize the completed and ongoing clinical trials using CTC number or phenotype for treatment decisions. Based on current knowledge, CTCs can be regarded as a useful prognostic and predictive marker that is well suited for both risk stratification and treatment monitoring in breast cancer patients. However, there is still the need to provide sufficient and unequivocal evidence for whether CTCs may indeed be used to guide treatment decisions in everyday clinical practice. The results of the ongoing trials described in this review are eagerly awaited to answer these important questions.

Monitoring of breast cancer patients under pre and post treated conditions using Raman spectroscopic analysis of blood plasma

This study is aimed to monitor the therapeutic response in breast cancer patients, by using the Raman spectra of liquid blood plasma of biopsy proved 19 breast cancer patients under pre and post treatment conditions and also by comparing them with the spectra of control group, consisting of 26 normal subjects (with no significant history of illness) in the same age group. The results indicate that there exists a statistical significance in the spectral signatures between the normal and breast cancer patient’s blood plasma as well as between pre treated and post treated plasma, which may be attributed to the changes in the vibrational characteristics of some of the key biomolecules viz tyrosine, phenylalanine, methionine, tryptophan, lipids/phospholipids, amides, DNA base pairs(adenine and guanine) etc. Further, it is found that the spectral signatures of post treated plasma (after completion of the entire course of treatment) are almost matching with that of normal subjects. The results of the study indicates the possibility of using Raman Spectroscopy for diagnosis as well as for monitoring of treatment response in breast cancer patients.

CN42 - Nursing model for a breast cancer unit at the Catalan Institute of Oncology

BackgroundInternational recommendations for cancer control support the organization of breast cancer care with a multidisciplinary approach in Breast Units (BU). The BU of the Catalan Institute of Oncology (ICO) is a functional unit for breast cancer with oncologists, gynecologists, surgeons and cancer nurses specialized in for diagnosis, treatment and monitoring breast cancer patients. Pathologists and radiologists are also working with the BU. Several international guidelines include nurse as essential part of BU and defined their model of care, management and functions.The objective is to describe care nurse model and activity of the Breast Unit in a cancer center. MethodsRetrospective cross-sectional study. Population cancer patients attended at the BU of the ICO during 2016 to 2017 were included. Variables collected were socio-demographic, clinical - pathology and treatment and nursing interventions for patients. Data was extracted from the clinical record. Data analysis was descriptive using the statistical package SPSS v15. ResultsTotal of 382 patients. Nursing interventions in patients with early stage breast cancer were: 321 (98.85%) visits before the start of treatments; 322 (99.1%) visits during treatments; 230 (70.8%) visits after finishing treatments; 319 (98.2%) coordination activities for the continuity of care and 136 (14.8%) consultations and derivations to professionals of other services.Nursing interventions in patients with advanced stage breast cancer: 32 (56.1%) visits before the start of treatments; 33 (57.9%) visits during treatments; 17 (29.8%) coordination activities for the continuity of care; and 12 (21.8%) consultations and derivations to professionals of other services. ConclusionsAccording to this multidisciplinary model of care, patients with breast cancer in the early stages have a high level of clinical contacts with the nurse along the cancer care process. However, there is a high percentage of patients with advanced disease that could not benefit from an early and continued access to nurse. Legal entity responsible for the studyThe authors. FundingGeneralitat of Catalonia, Department of Health. DisclosureAll authors have declared no conflicts of interest.