Introduction: Adult T cell leukemia lymphoma (ATLL) is a rare T cell neoplasm caused by the human T-lymphotropic virus (HTLV-1) virus. Although there are indolent subtypes it is often a highly aggressive and chemotherapy refractory malignancy. We follow one of the largest cohorts in the United States and in this study, we sought to elucidate the prognostic factors associated with inferior survival. Methods: A retrospective analysis of patients diagnosed with ATLL at Montefiore Medical Center was conducted. Subjects included were censored at last point of contact. Variables collected included age, gender, race, ethnicity, ATLL subtype, white blood cell count (WBC), absolute lymphocyte count (ALC), corrected calcium level, lymphadenopathy (LAD) (two or more non-contiguous sites). Associations between WBC, ALC, corrected calcium level, LAD and median overall survival (mOS) were assessed using the Kaplan-Meier method with log-rank test. A four-point prognostic system was designed assigning one point to each: WBC > 11,000; ALC>4000; Corrected Ca≥10.5 and presence of LAD. Three risk groups were assigned based on the number of risk factors as follows: low (0-1 points), intermediate (2 points) and high (3-4 points) (Table 2). Association between these groups and OS was investigated using the Kaplan-Meier method with log-rank test. Results: A total of 61 ATLL subjects were included in this study (table 1). Hypercalcemia (Ca ≥10.5) was observed in 60.6% of subjects at diagnosis and was associated with inferior mOS (234 days) when compared to calcium < 10.5 (747days) (p=0.046), Figure 1A. WBC >11,000 had a strong association with inferior survival (175 days) compared to patients with a WBC ≤11,000 (666 days) (p= 0.0067) (Figure 1B). ALC > 4000 was also associated with inferior mOS (222 days) compared to ALC ≤4000 (666 days) (p=0.015) (Figure 1C). LAD was associated with mOS (188 days) compared with no LAD (847 days) (p=0.022) (Figure 1D). Based on these observations, we designed a prognostic system (0-4 points) (see above) to risk stratify newly diagnosed ATLL patients into: low (0-1 points), intermediate (2 points) and high (3-4 points) risk (Table 2). We divided our cohort into the above-mentioned risk groups and calculated their mOS. Kaplan Meier analysis (Figure 2) revealed a distinct mOS difference between the groups based on their risk score: Low: 419 days, Intermediate: 234 days and High: 181.5 days (p= 0.0042). Conclusions: We identify hypercalcemia (Ca≥10.5), leukocytosis (WBC> 11,000), lymphocytosis (ALC> 4000) and generalized LAD as poor prognostic factors in newly diagnosed ATLL. Using readily available information from basic laboratory and clinical parameters we propose a prognostic system to identify high risk individuals. Further validation will be needed using larger cohorts of this very rare disease. Disclosures Steidl: Aileron Therapeutics: Consultancy, Membership on an entity's Board of Directors or advisory committees, Research Funding; Stelexis Therapeutics: Consultancy, Current equity holder in private company, Membership on an entity's Board of Directors or advisory committees; Pieris Pharmaceuticals: Consultancy; Bayer Healthcare: Research Funding. Verma:stelexis: Current equity holder in private company; BMS: Consultancy, Research Funding; acceleron: Consultancy, Honoraria; Janssen: Research Funding; Medpacto: Research Funding. Janakiram:Takeda, Fate, Nektar: Research Funding. Shah:Celgene/BMS: Research Funding; Physicians Education Resource: Honoraria.
e13026 Background: BC measurement can distinguish adipose tissue distribution, as well as the quantity and quality of muscle. Dysregulation in the mammalian target of rapamycin (mTOR) signaling pathway is associated with obesity and its related diseases. Everolimus (Eve), an mTOR inhibitor, is used in combination with endocrine therapy (ET) in hormone positive, HER2 negative (HR+/HER2-) MBC. However, there is limited data on the effect of Eve on BC. We aim to assess the effect of Eve on BC in patients (pts) with HR+/HER2- MBC. Methods: Pts with HR+/HER2- MBC who received Eve and ET between 2012 and 2019 at our institution were identified. We collected information about breast cancer diagnosis and treatment, weight (wt), body mass index (BMI), and computed tomography (CT). BC measurements; including skeletal muscle area (SMA), skeletal muscle density (SMD), subcutaneous adipose tissue (SAT), visceral adipose tissue (VAT), and muscle adiposity (MA); were analyzed at the L3 region on CT scans using Tomovision’s SliceOmatic Version 5.0. Total adipose tissue (TAT) was defined as SAT+VAT+MA. To isolate the effect of Eve on BC we also identified a cohort of pts who received ET only. We compared change in wt, BMI, and BC before and after 3 and 6 months of therapy. Wilcoxon signed rank test was used to compare BC parameters. Results: Our study included 42 pts who received Eve plus ET; 43% were Hispanic and 33% were Black. The median number of prior ET and chemotherapy lines were 1 and 0, respectively. The cohort who received ET alone included 63 patients. Median age was 68 years (interquartile range [IQR] 56-74) for the Eve and ET group and 67 years (IQR 55-74) for the ET only group (p = 0.74). Median baseline BMI was 25.8 kg/m2 (IQR 23.1-28.2) for the Eve and ET group and 28.5kg/m2 (IQR 24.2-30.8) for ET only (p = 0.08). Visceral disease was present in 24 (57%) pts on Eve and ET and 41 (65%) pts on ET only (p = 0.54). At month 3 of treatment with Eve and ET, there was a significant decrease in wt (-2.75kg, IQR -4.53-0.40, p < 0.005), BMI (-1.15kg/m2, IQR -1.71-0.14, p < 0.01), SAT (-21.93cm2, IQR -50.13-5.08, p < 0.01), and TAT (-22.34cm2, IQR -69.89-11.98, p = 0.02), which remained statistically significant at month 6 (wt: -5.70kg, IQR –7.75-1.83, p < 0.01; BMI: -2.3kg/m2, IQR -2.83-0.72, p < 0.01; SAT: -43.00cm2, IQR -73.81-10.69, p < 0.01; TAT: -32.56cm2, IQR –92.18-9.61, p = 0.03). These findings were not seen in pts who received ET only at 3 months (wt: 0.00kg, IQR –2.65-2.38, p = 0.99; BMI: 0.00kg/m2, IQR –1.07-0.91, p = 0.94; SAT: -1.82cm2, IQR -26.10-25.15, p = 0.59; TAT: 0.71cm2, IQR -44.39-27.43, p = 0.35), with similar results at 6 months. There were no statistically significant changes in VAT, SMA, SMD, or MA in both groups at 3 or 6 months. Conclusions: Everolimus is associated with decrease in SAT, with no significant change in VAT, SMA, or SMD. Further investigation is required to determine if these changes are associated with disease outcomes or everolimus toxicities.
Background: Neuroendocrine carcinoma of the breast (NECB) is a malignancy. The estimated incidence of this type of tumor ranges from less than 1% to 5%. The scarcity of data about these tumors creates a challenge for treatment. Prior studies have reported that clinically most NECB behave as other type of cancer, being more common in post-menopausal women. Using population-based cancer data, our study aims to describe the baseline characteristics, tumor biology, and prognosis of patients with NECB. Methods: Using the SEER database of the National Cancer Institute, we identified 433 cases of NECB diagnosed between 2000 and 2018. We assessed the patient age, sex, race, stage, grade of the tumor and histologic type. The additional information of estrogen receptor (ER), progesterone receptor (PR) and HER2 status were also included when available. Kaplan-Meir methods were used to estimate overall survival (OS). Cox proportional-hazard model was used to create multivariable analysis for OS. Results: We found that 427 (98.6%) of the patient were female, while only 6 (1.3%) patients were male. The mean age of diagnosis was 64 years[JA1] , (SD : 14.2 years). Most patients were White (n= 353, 82%), while 52 (12%) were black, and 27 (6.2%) were other race. About the tumor histology, 375 (86.6%) cases were neuroendocrine tumor not otherwise specified, 30 (6.9%) cases were large cell neuroendocrine tumors and 28 (6.4%) were carcinoid tumor of the breast. ER was positive in 70%, PR was positive in 57% of the patients in which these receptors were tested. 194 patients were assessed for Her 2, and only 6(3%) were her2 positive. 183 (42%) had any chemotherapy use, while 250 (58%) had no known use of chemotherapy. 326 patients had a documented stage, of those 77 (17%) were AJCC stage I, 140 (32%) stage II, 39 (9%) stage III and 70 (16%) stage IV. The[JA2] median OS for stage I, II, III, and IV were not-reached, 129, 45 and 13 months, respectively[JA3] . In the univariate analysis for OS, only for tumor grade 3 (HR = 2.2; 95% CI: 1.98,2.52; p= 0.002) , ER negative (HR = 2.0; 95% CI: 1.86,3.62; p= <0.001), PR (HR = 2.4; 95% CI: 2.1,2.63; p= <0.001), surgery (HR = 0.26; 95% CI: 0.11,0.40; p= <0.001), metastasis (HR = 0.19; 95% CI: 0.04,0.34; p= <0.001), stage IV cancer (HR = 2.3; 95% CI: 2.0,2.5; p= <0.001) were statistically significantly associated with OS. In a multivariate model, including age, histology, grade, ER, PR, stage group, metastasis, surgery and chemotherapy. We found that large cell histology (HR = 2.0; 95% CI: 1.0,4.3; p= 0.04), negative ER (HR = 2.0; 95% CI: 1.2,3.5; p= 0.01), negative PR (HR = 2.5; 95% CI: 1.4,4.4; p= 0.002), treatment with surgery (HR = 0.39; 95% CI: 0.22,0.69; p= 0.001), receiving chemotherapy (HR = 0.5; 95% CI: 0.31,0.79; p= 0.003), negative metastasis at diagnosis (HR = 0.05; 95% CI: 0.024,0.12; p= <0.001), cancer stage (HR = 2.3 for stage II and 7.2 for stage III, p<0.01. Stage I used as reference); were significantly associated with OS. Conclusion: Our study shows that NECB is a rare malignancy, and that the AJCC cancer staging can be used to adequately assess prognosis. Large cell histology, ER/PR negative, and advanced AJCC stage were inversely associated with survival, whereas chemotherapy use, surgery, and no metastasis at diagnosis, were positively associated with survival. As in other histologies of breast cancer, surgery and chemotherapy need to be strongly considered when treating NECB. Citation Format: Alvaro Alvarez Soto, Jesus Anampa. Baseline characteristics and survival of neuroendocrine carcinoma of the breast- A SEER database analysis [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 P3-12-26.
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