BackgroundTriple negative breast cancer (TNBC) represents 15–20% of breast cancers. Due to its heterogeneity and high rates of relapse, there is a need to optimize treatment efficacy. Platinum chemotherapy is still controversial and currently not recommended as first-line treatment for TNBC. Recent studies have shown promising activity of this regimen. This study was done to evaluate the effect of platinum chemotherapy on pathologic complete response (pCR) after neoadjuvant treatment for early TNBC and progression-free survival (PFS) in metastatic TNBC.MethodsA systematic search of Pubmed, Embase, Cochrane, Clinical trials databases and hand search were done to identify randomized controlled trials (RCTs) investigating the use of platinum-based chemotherapy in adults with TNBC. Studies were appraised using the Cochrane Collaboration tool. Using the random effects model, pooled Odds ratios (ORs) with 95% confidence intervals (CI) for pCR, and Hazard Ratios (HRs) with 95%CI for PFS were analyzed.ResultsEleven RCTs were included (N = 2946). Platinum-based chemotherapy showed pCR benefit of 40%vs27% (OR1.75,95% CI 1.46–2.62,p < 0.0001) in the neo-adjuvant setting. Subgroup analysis showed increased pCR rates (44.6%vs27.8%) with platinum plus taxane regimen (p < 0.0001). In metastatic TNBC, three RCTs were analyzed (N = 531), platinum treatment did not show PFS advantage (HR1.16,95%CI 0.90–1.49,p = 0.24).ConclusionPlatinum chemotherapy is associated with increased pCR rates in TNBC, hence it is a viable option for patients in the neoadjuvant setting. Subgroup analysis showed that the combination of platinum and taxanes (Carboplatin/Paclitaxel) improved pCR. However, no PFS advantage was seen in metastatic TNBC. Given the current conflicting data in metastatic TNBC, further exploration with additional powered studies is needed.
Methods: A retrospective cohort of 300 patients, was used to develop 'CanAssist-Breast'(CAB)-an immunohistochemistry based test comprising 5 biomarkers plus three clinical parameters (Tumor size, node status and grade) using machine learning based algorithm. Retrospective clinical validation on 850þ cases was performed and Kaplan Meier survival analysis, multivariate analysis was performed to assess robustness of the test. Results: CanAssist-Breast classifies patients into 'low or high' risk of recurrence based on recurrence score on a scale of 1-100 with a cut off at 15.5. Clinical validation of CAB showed distant metastasis-free survival (DMFS) was significantly different between low-(DMFS: 95%) and high-risk (DMFS 80%) groups in the validation cohort treated with hormone therapy alone (n ¼ 195) and in the entire validation cohort of 857 patients as well. In multivariate analysis, CAB risk score was the most significant independent predictor of distant recurrence with a hazard ratio of 4.25 (P ¼ 0.009). Patients stratified as high-risk by CAB have 19% chemotherapy benefit. We also show that CAB can further identify discrete low-and high-risk sub-groups within IHC4 intermediate risk group and also in a node and age independent manner. Conclusions: To our knowledge, CAB is the first machine learning based prognostic risk of recurrence prediction classifier using a combination of unique biomarkers and clinicopathological parameters. We believe that CAB enables accurate treatment planning in early stage HRþ/HER2-breast cancer patients in low-resource settings.Legal entity responsible for the study: OncoStem Diagnostics.
Background: The COVID-19 pandemic is a rapidly evolving crisis worldwide. Cancer patients represent a highly vulnerable group during this pandemic and are facing the most severe and critical consequences of this outbreak. To date, the data on clinical characteristics and outcomes of COVID-19 infected are largely unknown and limited to case reports and small cohorts. This study aims to contribute to our existing knowledge on the clinical impact of this novel disease on cancer patients. In our local setting, there are currently no known published data on this topic. Methods: We conducted a retrospective, single-center, cohort study of 19 patients with laboratory-confirmed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and with a pathologic diagnosis of a malignant tumor admitted in a tertiary hospital in Quezon City, Philippines, from March to May 2020. Clinical characteristics, laboratory data, and treatment histories were compared between patients with mild and severe outcomes. Quantitative variables were presented as medians, and qualitative variables were presented by frequencies and percentages. Chi-square test and Fisher’s exact test were applied to analyze the differences between groups. Results: Between March 15 to May 15, 2020, 19 patients with cancer and COVID-19 infection were included. Median age was 69 (range 37-81), 63.2% were elderly (≥ 60 years), and 57.8% were female. The most common tumor types were breast (26.3%), lung (21%), and genitourinary cancer (10.5%), and the majority had early-stage cancer (63.2%). Fifteen patients (78.9%) had recent anticancer treatment within 2 weeks prior to admission, most commonly cytotoxic (21.05%) and targeted therapy (21.05%). Most common symptoms presented were fever (52.6%), fatigue (36.8%), and cough (31.6%). More than half (57.9%) developed severe outcomes (ARDS, septic shock, acute kidney injury), 10 patients (52.6%) were admitted at the ICU, and 8 patients (42.1%) died. Among patients who developed severe outcomes, most had lung cancer, stage IV disease, recent anticancer treatment, and higher levels of inflammatory markers. Findings of bilateral opacities on chest x-ray (p=0.009) and ground-glass densities on chest CT scan (p = 0.002) were significantly associated with having severe complications. Having nosocomial-acquired infection was also associated with severe outcomes (p=0.004). Conclusions: Patients with cancer have a high probability of severe illness and mortality when diagnosed with COVID-19. We found that those with recent anticancer treatment, particularly chemotherapy, have higher rates of severe complications and that hospital-acquired infection is common among cancer patients and is associated with severe illness. Our study is limited by its small population, though our findings are consistent with other published studies. Our findings suggest that cancer patients require urgent and special attention during the pandemic, especially those who are receiving anticancer treatment. Citation Format: Jessa Gilda P. Pandy, Michelle Joane Alcantara, Frances Victoria Que, Marie Belle Francia. Clinical characteristics and outcomes of cancer patients with COVID-19 infection: A retrospective study in a single center in the Philippines [abstract]. In: Proceedings of the AACR Virtual Meeting: COVID-19 and Cancer; 2020 Jul 20-22. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(18_Suppl):Abstract nr PO-078.
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