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A B S T R A C T S
increasing. Concurrent chemoradiotherapy (cCTRT) has
proven to increase survival in elderly patients with un-
resectable stage III NSCLC, but there is no consensus on the
therapeutic approach. Geriatric assessment GA is a relevant
tool to classify elderly patients by their frailty profile used to
identify patients whomay benefit fromtolerable combinations
of cCTRT.
Objectives:
The primary objective of this study was to
evaluate the use of geriatric assessment classification and
VES-13 screening tool in predicting survival and toxicity in
order to help on the treatment decision-making process being
able to identify patients that can take benefit from cCTRT.
Methods:
Elderly patients (
75 years) with stage III NSCLC
underwent GA, that incorporated comorbidity, polypharmacy,
functional status, geriatric syndromes, mood, social support,
cognition and Vulnerable Elders Survey (VES-13). According to
GA, patients were classified into fit (F) and medium fit (MF),
who were deemed candidates for antitumoral treatment, and
unfit (UF) patients received best supportive care. Clinical and
follow-up data were prospectively collected. Median overall
survival (mOS) was calculated using Kaplan-Meier method.
Results:
From July 2008 to June 2015, 85 elderly patients with
unresectable stage III NSCLC were identified. Most patients
(88%) were males. Median age of 79.5 years (75-87) and 23
were
80 years. The histological subtype were: squamous cell
carcinoma (58%), adenocarcinoma (22%) and not otherwise
specified (20%). On the basis of GA, 37%, 48% 15% patients
were classified as F, MF and UF, respectively. F and MF had
significantly better mOS (21.1 and 11.6 m, respectively) as
compared with UF (7.7 m, p = 0.041).Vulnerable patients based
on screening-tool VES-13 had significantly shorter mOS (9.6
m vs 22.6 m, p = 0.019). In the multivariate survival analysis,
GA groups and VES-13 had independent prognostic value,
independly of age, gender, stage and weight loss.Some fit and
vulnerable p did not receive concurrent CRT due to patient and
physician decision, tumor not amenable for radiotherapy or
comorbid conditions.F and MF patients receiving cCTRT (73%)
had mOS of 21.1 m (95% CI 12.8–29.4). Adverse events (G3-
4): neutropenia 11 (22%), anemia 2 (4.2%), thrombocytopenia
3 (6%), febrile neutropenia 4 (8%), respiratory infection 13
(24.5%), asthenia 6 (12%), anorexia 1 (2%), diarrhea 1 (2.1%),
radiation pneumonitis, 7 (14%) and oesophagitis 1 (1%). Six
(12%) patients died due to radiation pneumonitis. Higher VES-
13 (
3) was associated with shorter mOS (p
=
0.037) and higher
risk of G3-4 toxicity (p = 0.012).
Conclusion:
Geriatric assessment allows us to select
patients fit enough to be treated with adapted cCTRT with
similar survival benefit from standard concurrent CTRT
as younger ones. The vulnerability screening tool VES-13
had independent prognostic value and was significantly
associated with higher risk of toxicity. The value of the VES-13
to predict oxicity and to assess prognosis should be further
studied.
Disclosure of interest:
None declared
Keywords:
Chemoradiotherapy, Geriatric assessment, lung
cancer
P026
CLUSTERING ANALYSIS OF OESTROGEN RECEPTOR
POSITIVE EARLY OPERABLE PRIMARY BREAST CANCER IN
OLDER WOMEN – A STUDY BASED ON CORE NEEDLE BIOPSY
M. A. Albanghali
1
, G. P. Figueredo
2
, M. A. Aleskandarany
1
,
A. R. Green
1
, E. A. Rakha
1
, C. Nolan
1
, M. Díez-Rodríguez
1
,
J. M. Garibaldi
2
, I. O. Ellis
1
, K. L. Cheung
1,
*
1
School of Medicine,
2
School of Computer Science, University of
Nottingham, Nottingham, United Kingdom
Introduction:
Irrespective of primary treatments,
core
needle biopsy (CNB) is usually available from all patients with
breast cancer (BC). Our group has recently developed a novel
technique to construct tissue microarrays (TMAs) from CNB
samples, allowing the possibility to investigate the biological
profile of BC in details.
Objectives:
This study aimed to delineate the different
subtypes within oestrogen receptor positive (ER+) primary BCs
in older women and to investigate their prognostic significance.
Methods:
From a consecutive series of 1,700+ older (
70
years) women with early operable invasive primary BCs
(with clinical follow-up of 37+ years) managed in a single
institution, 308 patients fulfilled these criteria: having (i) ER+
(defined by Histochemical (H) score
1) disease; and (ii) good
quality CNB samples available for TMA construction and then
immunohistochemical data for a panel of 17 biomarkers (ER,
PgR, Ki67, p53, EGFR, HER2, HER3, HER4, BCL2, CK5/6, CK7/8,
MUC1,VEGF, PTEN, AIB1, LKB1 and BRCA1). Clustering analysis
was then performed utilising unsupervised K-means and
partitioning around medoids algorithms.
Results:
Of these 36% (n=110) underwent primary surgery
and 61% received primary endocrine therapy (PET), with
5-year breast cancer specific survival (BCSS) of 94% and 84%
respectively. Utilising biomarkers expression, three clusters
were identified: the well known luminal A (56%) and B (26%)
clusters, and also a novel ‘low ER luminal’ cluster which was
characterised by low ER expression and high expression of
luminal cytokeratins. These clusters correlated with different
survival outcomes, both overall and in association with
different treatments (Table 1).
Table 1 (abstract P026)
5-year BCSS
All
Surgery
PET
Luminal A
92% [1]
88%
90%
Luminal B
87%
95% [2]
73% [2]
Low ER luminal
73% [1]
80%
70%
Comparisons: [1] p=0.001; [2] p=0.036; Else – ns.
Conclusion:
Using a novel TMA construction technique,
CNB provides a tantalising source for investigating tumour
biology in older women with primary BC. Different subtypes,
including a novel cluster, have shown correlation with clinical
outcomes.This technology and the consequent findings would
help further develop a personalised treatment approach for
this population.
Disclosure of interest:
None declared
Keywords:
Breast cancer, clustering, core needle biopsy, ER
positive, older women