Abstracts / The Breast 22 S3 (2013) S19–S63 S45

19 (range 1-58), respectively. One hundred twenty five patients (75%)

were positive for estrogen receptor. The incidence of SRE after bone

metastasis were 10% in pathological fracture, 2% in spinal compression,

3% in surgery for bone lesion, 16% in radiation therapy and 1% in

hypercalcemia. The one year cumulative incidence of SRE was 13.6% (95%

confidence interval 7.7-19.5) and the two year cumulative incidence

was 19.0% (95% confidence interval 12.1-26.0). Six patients (4.1%) had

osteonecrosis of the jaw after the second year of ZOL administration,

which was the only reason to discontinue ZOL treatment. The median

overall survival after bone metastasis was 54.3 months (range 25-106).

The median time to the first SRE was 48.5 months for higher Ki67 (≥20%)

group versus 63.1 months for lower Ki67 (<20%) group (p=0.04).

Conclusions: ZOL can provide safely long-term treatment for breast

cancer patients with bone metastasis. Most SRE occurs in the first year;

however, osteonecrosis of the jaw occurs after the second year.

PR73

ELECTROCHEMOTHERAPY: AN EFFECTIVE TREATMENT FOR INTRACTABLE CUTANOUS LESIONS SECONDARY TO BREAST CANCER

Bafiq Nizar, M.G. Bourke, Slav Salva

Cork Cancer Research Centre /Mercy University Hospital, Cork, Ireland

Electrochemotherapy (ECT) provides safe, efficient and non-invasive

treatment modality for cutaneous lesions in metastatic breast cancer

that complicates 5% of breast cancers. The safety and efficacy of ECT has

been demonstrated in several clinical trials.

At Cork Cancer Research Centre we have treated 18 patients with

cutaneous metastatic disease secondary to breast cancer from March

2003 to date. They received a total of 56 treatment sessions.

ECT is a non-thermal tumor ablation modality, where an externally

applied electric field induces a transient increase in the permeability

of plasma membranes to otherwise impermeant molecules. We used

bleomycin in our treatment protocol. This combination has a high

efficacy.

Our results showed a complete response rate of 59.7% and a partial

response rate of 20.8%. The objective response rate was 80.5%. ECT was

found to be effective against experimental cancers and human cutaneous

cancers. In the setting of metastatic skin disease from breast cancer ECT

achieves a far greater response rate than current conventional therapies.

ECT achieves objective favorable responses in heavily pre-treated

disease. ECT should be included in the treatment regimen of patients

with metastatic skin disease from breast cancer. There is evidence to

suggest that early ECT inclusion in these regimens may be appropriate.

PO74

NEW TRENDS IN THE SURVIVAL OF PATIENTS WITH LOCALLY ADVANCED BREAST CANCER

Nagi El Saghir, Hussein Assi, Zahi Nachef, Hana Mikdashi,

Nadine El Asmar, Katia Khoury

Breast Center of Excellence, Naef K. Basile Cancer Institute, American

University of Beirut Medical Center, Beirut, Lebanon

Background: Locally advanced breast cancer (LABC) remains a

common daily clinical encounter in many parts of the world including

the Middle East. Improvement in the outcome of patients with breast

cancer is related to both early diagnosis and improved modern therapy.

Improvement in the outcome of patients with LABC is related to

improved modern management. We looked at characteristics and

outcome of patients with LABC treated and followed up at a single

academic institution in Beirut, Lebanon.

Patients and Methods: We reviewed the charts of patients with LABC

treated with multimodality therapy at the American University of Beirut

between 1997 and 2010. The study was approved by IRB of the American

University of Beirut. Data was entered and analyzed using SPSS. Survival

was calculated and estimated according to Kaplan Meier method.

Results: Total number of patients was 161. Median age at diagnosis

was 48 years (range 21-82 years). Average tumor size was 4.6 cm

(SD = 2.6 cm). Estrogen receptors were positive in 113 patients (70.2%).

Progesterone receptors were positive in 103 patients (64%). HER2 was

over-expressed in 44 patients (27.3%). 37.9% of patients had poorly

differentiated tumors. Partial mastectomy was done in 37 (23%) cases.

Modified radical mastectomy (includes completion mastectomy after

a partial mastectomy attempt) was done in 120 patients (74.5%). Neo-

adjuvant chemotherapy was given to 52 patients (32.3%), more so in

later years with 45.3% after 2005 as compared to 21.4% before 2005.

Patients were followed closely every three months. Compliance with

therapy was excellent. Disease-free survival (DFS) was 51.2% at 5 years

and 36.1% at 10 years with a median DFS of 62 months. Overall survival

(OS) was 67.7% at 5 years and 35.5% at 10 years with a median OS of

84 months. Of the 44 patients who had HER2 positive disease, 21

patients were seen after the introduction of adjuvant trastuzumab in

2005 and a 100% OS at 5 years. In contrast, only 50.2% of the 23 patients

who were seen before the introduction of adjuvant trastuzumab in 2005

were alive at 5 years.

Conclusion: Our data shows a significant improvement in the outcome

of patients with LABC treated with modern multimodality therapy.

Further follow-up and improvement in 10-year survival is still needed.

The introduction of trastuzumab for patients with HER2-positive LABC

contributed to 100% survival rates at 5 years.

PO75

IS THE BREAST CANCER GRADED PROGNOSTIC ASSESSMENT TOOL VALID IN SCOTTISH PATIENTS WITH SECONDARY BRAIN METASTASES?

L.A.R. Wells, G. Kerr, M. MacLennan, T.K.A. Evans

Edinburgh Cancer Centre, NHS Lothian, Edinburgh, UK

Background: In patients with breast cancer, brain metastases are

a frequent cause of significant morbidity and mortality. Treatment

options include surgical resection, stereotactic radiotherapy, whole

brain radiotherapy and best supportive care. The Graded Prognostic

assessment tool (GPA) is a validated tool developed to allow prognostic

stratification in breast cancer patients with brain metastases [1]. Each

patient is assigned a GPA score for a number of factors, namely age,

performance status, ER and HER 2 status.

Objective: To establish the validity of the GPA as a prognostic tool in

a cohort of patients treated for brain metastases secondary to breast

cancer at the Edinburgh Cancer Centre (ECC).

Method: The case records of patients diagnosed with cranial metastases

between 2007 and 2008 at the ECC were reviewed retrospectively.

Graded Prognostic Assessment scores were calculated for each patient

at diagnosis of brain metastases. The Kaplan Meier method was used

to estimate overall survival for each GPA subgroup and statistical

comparisons were made using the log-rank test.

Results: Seventy-eight patients were diagnosed with brain metastases

secondary to breast cancer. The average age at diagnosis of cranial

metastases was 58 years (34 to 88 years). Forty-five percent had ER negative

disease and 36% were HER2 positive. Fourteen percent had metastatic

disease at presentation, and of those that didn’t 69% were node positive.

At the time of diagnosis with cranial metastases, 18% had brain

metastases only, of which 23% were solitary. Seventy-eight percent had

extra-cranial disease and 13% patients had dural or meningeal disease.

The majority of patients (78%) went on to have whole brain irradiation,

8 patients (10%) had surgical resection of brain metastases, 1 patient

underwent stereotactic radiotherapy (1%) and 18% were offered best

supportive care. The mean overall survival for the group as a whole was

4 months (range 0-68 months).

There was sufficient information to calculate the GPA for 57 patients.

Eight patients (10%) scored 0-1.0, 17 (22%) patients scored 1.5-2.0,

23 (29%) patients scored 2.5-3.0 and 9 (12%) patients scored 3.5-4.0.

Median overall survival for each group was as follows; GPA (0-1.0)

2 months, GPA (1.5-2.0) 3.1 months, GPA (2.5-3.0) 4.3 months and GPA

(3.5-4.0) 9.3 months.

S46 Abstracts / The Breast 22 S3 (2013) S19–S63

Overall survival correlated very closely with GPA score, and comparison

by the log rank test confirmed this to be highly significant (p=0.0004).

Conclusion: The Graded Prognostic Assessment tool was predictive of

survival in this cohort of patients. The GPA can therefore be used to guide

individual treatment for breast cancer patients with brain metastases.

Reference:[1] PW Sperduto, N Kased, D Roberge et al. The effect of tumor subtype

on survival and the graded prognostic assessment (GPA) for patients

with breast cancer and brain metastases. J Clin Oncol 2011; 29 (suppl

27;abstr 238)

PO76

CLINICOPATHOLOGICAL FEATURES AND SURVIVAL AFTER RECURRENCE IN BREAST CANCER PATIENTS WITH EARLY AND LATE RECURRENCE AFTER ADJUVANT CHEMOTHERAPY

Byung Ho Son, Young Mi Yun, Sei Hyun Ahn, Hee Sung Park, Gui Yun

Son, Hee Jeong Kim, Jong Won Lee, Jong Han Yu, Beom Seok Ko, Yu Ra

Lee, Sae Byul Lee, Yoo Seok Kim, Sung Bae Kim, Gyung Yub Gong

College of Medicine, University of Ulsan, Asan Medical Center, Seoul,

Republic of Korea

Purpose: The objective of this study was to compare clinicopathological

features and survival after recurrence in breast cancer patients with

early and late recurrence after adjuvant chemotherapy.

Method: Total 1,089 recurrent breast cancer patients who registered

in the Asan Medical Center Breast Cancer Registry between year of

July 1989 and February 2010 were divided into three groups, an early

recurrent (within 2 years) and late recurrent groups (2~5 years and after

5 years). Conventional prognostic factors including stage, nodal status,

histologic grade, nuclear grade, hormone receptor, HER2, and tumor

subtype were compared to identify whether any factor would show

significant difference among these recurrent groups. The univariate

survival distributions were estimated by using the method of Kaplan-

Meier and they were compared by using the log rank test. The potential

prognostic factors were analyzed via multivariate analysis with using

Cox’s proportional hazard model.

Result: Stage (p<0.0001), tumor size (p=0.0015), number of lymph

node metastasis (p=0.0007), histologic grade (p<0.0001), nuclear

grade (p<0.0001), estrogen receptor (p<0.0001), progesterone receptor

(p<0.0001), and tumor subtype (p<0.0001) were significantly different

among those early and late recurrent groups. The median survival

time after recurrence of the early recurrence group (18 months)

was significantly shorter than those of the late recurrence group

(49 months). The multivariate analysis showed that early recurrence

(HR=2.54, 95% CI=1.50-4.32, p=0.0005), advanced stage (II, HR=2.10, 95%

CI=1.43-3.07, p=0.0002, III, HR=2.54, 95% CI=1.72-3.74, p<0.0002), high

histologic grade (HR=1.45, 95% CI=1.16-1.81, p=0.001), positive estrogen

receptor (HR=0.60, 95% CI=0.46-0.77, p<0.0001), triple-negative subtype

(HR=2.05, 95% CI=1.50-2.80, p<0.0001) were independent prognostic

factors for overall survival after recurrence.

Conclusion: This study showed that aggressive clinicopathologic

features and tripe-negative subtype were associated with early

recurrence of breast cancer after chemotherapy. The survival after

recurrence of the early recurrent patients was significantly shorter than

those of the late recurrent patients.

PO77

DISEASE CHARACTERISTICS IN HER2-POSITIVE METASTATIC BREAST CANCER PATIENTS ACHIEVING COMPLETE REMISSION DURING TRASTUZUMAB THERAPY

Snezana Susnjar, Radmila Jankovic, Irena Jovanic

Institute for Oncology and Radiology of Serbia, Belgrade, Serbia

Introduction: Metastatic breast cancer (MBC) is an incurable disease

and the aim of therapeutic approach in these patients (pts) is to prolong

survival and improve quality of life. HER2-pos tumors were recently

recognized as a subtype which poor prognosis has been significantly

improved by introducing HER2-directed therapy. Furthermore, a group of

HER2-pos tumors consists of 2 subtypes: HR-pos (luminal B) and HR-neg

(HER2 subtype) BC. We collected the characteristics of HER2-pos MBC pts

with complete remission (CR) achieved during trastuzumab therapy.

Patients and Methods: We analyzed a group of HER2-pos MBC pts

treated with trastuzumab in combination with chemotherapy during

2012 at the Institute for Oncology and Radiology of Serbia and among

them identified those who achieved CR. All o them had their HR (by IHC

and biochemically) and HER2 (by IHC and CISH) status determined in

primary tumors and/or metastatic lesions. HER2-pos status was defined

as IHC 3+ or IHC 2+/CISH+. Response to therapy was determined by

RECIST criteria.

Results: Eight/70 (11.5%) HER2-pos MBC pts achieved CR, median age

of 44 years (range 43-63) at the time of treatment. All of them were

initially treated with curative intent for stage I-IIIB disease and median

disease-free interval (DFI) was 67.5 mos (range 0-187 mos). HR and

HER2 status was determined from metastatic lesions in 7/8 pts; 4/8 had

HR-neg/HER2-pos and 4/8 HR-pos/HER2-pos tumors. The predominant

metastatic sites were as follows: 5/8 pts soft tissues, 2/8 pts liver and

1/8pt lung. All of them initially received a combination of docetaxel

(4/8 pts) and paclitaxel (4/8 pts) and trastuzumab (median number

of cycles 6, range 3-9) before continuing with trastuzumab alone or

with endocrine therapy (ovarian suppression/ablation and/or TAM

and/or AI) in SR-pos pts. Trastuzumab/taxane therapy was introduced

as first line for MBC in 5/8 pts and second line in 3/8 pts. All but one

pts had not received trastuzumab previously. Three/8 pts had disease

progression after median 18 mos (range 16-21): 1/8 liver mets and

2/8 CNS mets (one of them continued with trastuzumab for 5.5 years

after metastazectomy and WBRT w/o PD), and all of them had HR-neg/

HER2-pos tumors. Five/8 pts still did not experienced PD with median

duration of trastuzumab therapy of 45 mos (range 17-56). Four/8 pts

with durable CR (median 47.5mos, range 40-56) had HR-pos BCs and

are receiving endocrine therapy concurrently with trastuzumab. Median

DFI in these pts was 98.5 mos (range 61-197) compared to pts with PD

(median 28 mos, range 0-36).

Conclusion: Our results suggest that probability for achieving durable

CR among HER2-pos MBC pts might be higher in HR-pos BC pts treated

with trastuzumab and endocrine therapy.

PO79

PROLONGED SURVIVAL AFTER BREAST CANCER BRAIN METASTASES (BCBM): WHO HAS A CHANCE?

Zorica Tomasevic, Zeljko Kovac, Zoran Tomasevic, Zorka Milovanovic

Institute for Oncology and Radiology of Serbia, Belgrade, Serbia

Background: BCBM development predicts short survival for majority

of patients. According to the literature, only small percentage of pts

survives for 2 or more years after BM. The aim of this paper is to define

frequency of pts with prolonged survival after BM (BMs) and to analyze

theirs characteristics.

Methods: A 218 consecutive BCBM pts have been registered during 5,5

yrs (January 2008-June 2013). Median age was 50 yrs (range 25-79).

All pts underwent BM directed treatment (WBRT 83%; neurosurgery +

postoperative WBRT 17%). Survival after BM (BMs) was median

6,5 months (range 1-78+ months). Only pts with BMs ≥ 24 months were

considered for this analysis.

Results: 5/218 pts (2,3%) with median BMs of 29 months (range 27-

78+) were identified. Median age of these pts was 43 yrs (range 31-52).

Metastases in other sites are registered in 2 pts and 3 pts had BM as the

only relapse.

BM interval from BC diagnosis ranges from 8-110 months (median 53,4).

Four pts with solitary BM underwent brain surgery, and continued

with systemic treatment afterwards (capecitabine 2; trastuzumab 1;

hormonal th. 1). Molecular characteristics of the primary BC are known

for all pts. Three pts had luminal A BC, one HER2 3+ BC, and one triple

negative BC.