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ASCO: Radiotherapy not needed for all women post mastectomy
Postmastectomy radiotherapy should not be routinely recommended for breast cancer patients with microscopic nodal metastases (N1mic) and T1-2 tumors, according to new findings presented at the symposium.
In patients with T1-2, N1 disease who were treated with standard therapies, the study authors found that overall, there were low rates of locoregional failure. Dr. Lonika Majithia of Ohio State University, Columbus, and colleagues, reported that “patients with N1mic disease had no locoregional failure events and improved overall survival, compared with patients with macrometastases.”
The indications for postmastectomy radiotherapy have expanded to include patients with one to three axillary nodal metastases, note the authors, and with improvements in diagnostic evaluation, an increasing number of N1mic are being detected. Therefore, the challenge facing oncologists now is if the risk posed by N1mic warrants routine delivery of postmastectomy radiotherapy.
The authors identified 550 eligible patients from a prospectively maintained cancer registry, who had a 5-year median follow-up. All patients had pathologic T1-2N1 breast cancer and were treated with an initial mastectomy and adjuvant systemic therapy from 2000 to 2013.
The primary endpoint of the study was locoregional failure, defined as a recurrence in either the ipsilateral chest wall or regional lymphatics (axillary, internal mammary, or supraclavicular). Secondary endpoints included disease-free survival and overall survival.
The majority of patients in the cohort had received chemotherapy (78%; n = 428) and antiendocrine therapy (70%; n = 385), while 15% (n = 82) had received postmastectomy radiation. Among the patients with N1mic disease, 81 had 1+ node, 13 had 2+ nodes, and 1 had 3+ nodes.
The 5-year rate of locoregional failure was 0% for patients with N1mic disease, as compared with 4.6% for those with macrometastases (P = .84). For the entire patient cohort, the 5-year locoregional failure rate was 3.9%. For patients with 1+, 2+, and 3+ nodes, the 5-year rate was 2.6%, 4.7%, and 6.4%, respectively (P = .79).
The authors observed that patients with N1mic disease had a trend towards improved disease-free survival (91.6% vs. 82.3%; P = .07) as well as significantly improved overall survival (96.9% vs. 87.6%; P = .03), as compared with patients with macrometastases.
Postmastectomy radiotherapy should not be routinely recommended for breast cancer patients with microscopic nodal metastases (N1mic) and T1-2 tumors, according to new findings presented at the symposium.
In patients with T1-2, N1 disease who were treated with standard therapies, the study authors found that overall, there were low rates of locoregional failure. Dr. Lonika Majithia of Ohio State University, Columbus, and colleagues, reported that “patients with N1mic disease had no locoregional failure events and improved overall survival, compared with patients with macrometastases.”
The indications for postmastectomy radiotherapy have expanded to include patients with one to three axillary nodal metastases, note the authors, and with improvements in diagnostic evaluation, an increasing number of N1mic are being detected. Therefore, the challenge facing oncologists now is if the risk posed by N1mic warrants routine delivery of postmastectomy radiotherapy.
The authors identified 550 eligible patients from a prospectively maintained cancer registry, who had a 5-year median follow-up. All patients had pathologic T1-2N1 breast cancer and were treated with an initial mastectomy and adjuvant systemic therapy from 2000 to 2013.
The primary endpoint of the study was locoregional failure, defined as a recurrence in either the ipsilateral chest wall or regional lymphatics (axillary, internal mammary, or supraclavicular). Secondary endpoints included disease-free survival and overall survival.
The majority of patients in the cohort had received chemotherapy (78%; n = 428) and antiendocrine therapy (70%; n = 385), while 15% (n = 82) had received postmastectomy radiation. Among the patients with N1mic disease, 81 had 1+ node, 13 had 2+ nodes, and 1 had 3+ nodes.
The 5-year rate of locoregional failure was 0% for patients with N1mic disease, as compared with 4.6% for those with macrometastases (P = .84). For the entire patient cohort, the 5-year locoregional failure rate was 3.9%. For patients with 1+, 2+, and 3+ nodes, the 5-year rate was 2.6%, 4.7%, and 6.4%, respectively (P = .79).
The authors observed that patients with N1mic disease had a trend towards improved disease-free survival (91.6% vs. 82.3%; P = .07) as well as significantly improved overall survival (96.9% vs. 87.6%; P = .03), as compared with patients with macrometastases.
Postmastectomy radiotherapy should not be routinely recommended for breast cancer patients with microscopic nodal metastases (N1mic) and T1-2 tumors, according to new findings presented at the symposium.
In patients with T1-2, N1 disease who were treated with standard therapies, the study authors found that overall, there were low rates of locoregional failure. Dr. Lonika Majithia of Ohio State University, Columbus, and colleagues, reported that “patients with N1mic disease had no locoregional failure events and improved overall survival, compared with patients with macrometastases.”
The indications for postmastectomy radiotherapy have expanded to include patients with one to three axillary nodal metastases, note the authors, and with improvements in diagnostic evaluation, an increasing number of N1mic are being detected. Therefore, the challenge facing oncologists now is if the risk posed by N1mic warrants routine delivery of postmastectomy radiotherapy.
The authors identified 550 eligible patients from a prospectively maintained cancer registry, who had a 5-year median follow-up. All patients had pathologic T1-2N1 breast cancer and were treated with an initial mastectomy and adjuvant systemic therapy from 2000 to 2013.
The primary endpoint of the study was locoregional failure, defined as a recurrence in either the ipsilateral chest wall or regional lymphatics (axillary, internal mammary, or supraclavicular). Secondary endpoints included disease-free survival and overall survival.
The majority of patients in the cohort had received chemotherapy (78%; n = 428) and antiendocrine therapy (70%; n = 385), while 15% (n = 82) had received postmastectomy radiation. Among the patients with N1mic disease, 81 had 1+ node, 13 had 2+ nodes, and 1 had 3+ nodes.
The 5-year rate of locoregional failure was 0% for patients with N1mic disease, as compared with 4.6% for those with macrometastases (P = .84). For the entire patient cohort, the 5-year locoregional failure rate was 3.9%. For patients with 1+, 2+, and 3+ nodes, the 5-year rate was 2.6%, 4.7%, and 6.4%, respectively (P = .79).
The authors observed that patients with N1mic disease had a trend towards improved disease-free survival (91.6% vs. 82.3%; P = .07) as well as significantly improved overall survival (96.9% vs. 87.6%; P = .03), as compared with patients with macrometastases.
FROM THE 2015 ASCO BREAST CANCER SYMPOSIUM
Key clinical point: Radiotherapy following mastectomy should not be routinely recommended for breast cancer patients with microscopic nodal metastases (N1mic) and T1-2 tumors.
Major finding: The 5-year rate of locoregional failure was 0% for patients with N1mic disease vs. 4.6% in those with macrometastases (P = .84).
Data source: 550 eligible patients who met the inclusion criteria were identified from a prospectively maintained cancer registry.
Disclosures: No conflicts of interest were disclosed.
ASCO: Racial disparity in HER2+ breast cancer survival subsided after trastuzumab approval
Well-documented racial disparities in survival of patients with HER2+ breast cancer diminished after FDA approval of trastuzumab, according to research presented at the 2015 ASCO breast cancer symposium.
A retrospective study identified 32,597 cases of HER2+ breast cancer from the California Cancer Registry, and divided them into early (diagnosed 2000-2006) and late (diagnosed 2006-2012) cohorts. In the early cohort, diagnosed before trastuzumab was available, black patients had an increased risk of mortality (hazard ratio, 1.32; 95% confidence interval, 1.16-1.49), compared with whites. In the late cohort there were no survival differences based on race.
“Although we were unable to document use of anti-HER2 treatment, the era of adjuvant trastuzumab appears to have attenuated the black/white disparity in HER2-positive breast cancer,” wrote Dr. Vincent Caggiano, hematologist at Sutter Medical Center Sacramento, California, and colleagues in a meeting abstract.
The study analyzed risk of mortality, adjusted for stage, grade, age, and socioeconomic status, for African Americans, Hispanics, Asian/Pacific Islanders, and American Indians, compared with white patients. Considering estrogen-receptor and progesterone-receptor status, the combination of all HER2+ subtypes (ER+/PR+/HER2+, ER-/PR+/HER2+, ER+/PR-/HER2+, ER-/PR-/HER2+), showed increased risk for black patients before 2006. The ER-/PR-/HER2+ subtype showed no racial disparities for either cohort. The highest risk (HR, 1.43; 95% CI, 1.17-1.75) was observed for black patients of the ER+/PR+/HER2+ subtype diagnosed before 2006.
Well-documented racial disparities in survival of patients with HER2+ breast cancer diminished after FDA approval of trastuzumab, according to research presented at the 2015 ASCO breast cancer symposium.
A retrospective study identified 32,597 cases of HER2+ breast cancer from the California Cancer Registry, and divided them into early (diagnosed 2000-2006) and late (diagnosed 2006-2012) cohorts. In the early cohort, diagnosed before trastuzumab was available, black patients had an increased risk of mortality (hazard ratio, 1.32; 95% confidence interval, 1.16-1.49), compared with whites. In the late cohort there were no survival differences based on race.
“Although we were unable to document use of anti-HER2 treatment, the era of adjuvant trastuzumab appears to have attenuated the black/white disparity in HER2-positive breast cancer,” wrote Dr. Vincent Caggiano, hematologist at Sutter Medical Center Sacramento, California, and colleagues in a meeting abstract.
The study analyzed risk of mortality, adjusted for stage, grade, age, and socioeconomic status, for African Americans, Hispanics, Asian/Pacific Islanders, and American Indians, compared with white patients. Considering estrogen-receptor and progesterone-receptor status, the combination of all HER2+ subtypes (ER+/PR+/HER2+, ER-/PR+/HER2+, ER+/PR-/HER2+, ER-/PR-/HER2+), showed increased risk for black patients before 2006. The ER-/PR-/HER2+ subtype showed no racial disparities for either cohort. The highest risk (HR, 1.43; 95% CI, 1.17-1.75) was observed for black patients of the ER+/PR+/HER2+ subtype diagnosed before 2006.
Well-documented racial disparities in survival of patients with HER2+ breast cancer diminished after FDA approval of trastuzumab, according to research presented at the 2015 ASCO breast cancer symposium.
A retrospective study identified 32,597 cases of HER2+ breast cancer from the California Cancer Registry, and divided them into early (diagnosed 2000-2006) and late (diagnosed 2006-2012) cohorts. In the early cohort, diagnosed before trastuzumab was available, black patients had an increased risk of mortality (hazard ratio, 1.32; 95% confidence interval, 1.16-1.49), compared with whites. In the late cohort there were no survival differences based on race.
“Although we were unable to document use of anti-HER2 treatment, the era of adjuvant trastuzumab appears to have attenuated the black/white disparity in HER2-positive breast cancer,” wrote Dr. Vincent Caggiano, hematologist at Sutter Medical Center Sacramento, California, and colleagues in a meeting abstract.
The study analyzed risk of mortality, adjusted for stage, grade, age, and socioeconomic status, for African Americans, Hispanics, Asian/Pacific Islanders, and American Indians, compared with white patients. Considering estrogen-receptor and progesterone-receptor status, the combination of all HER2+ subtypes (ER+/PR+/HER2+, ER-/PR+/HER2+, ER+/PR-/HER2+, ER-/PR-/HER2+), showed increased risk for black patients before 2006. The ER-/PR-/HER2+ subtype showed no racial disparities for either cohort. The highest risk (HR, 1.43; 95% CI, 1.17-1.75) was observed for black patients of the ER+/PR+/HER2+ subtype diagnosed before 2006.
FROM THE 2015 ASCO BREAST CANCER SYMPOSIUM
Key clinical point: The well-documented disparity in survival between black and white patients with HER2+ breast cancer was not observed during a time period after 2006, when the FDA approved trastuzumab.
Major finding: Among patients diagnosed from 2000 to 2006, black patients had an increased risk of mortality, compared with white patients (HR, 1.32; 95% CI, 1.16-1.49); from 2006-2012 there were no survival differences based on race/ethnicity.
Data source: The retrospective study used the California Cancer Registry to identify 32,597 cases of HER2+ breast cancer diagnosed from 2000 to 2012, and divided them into early (2000-2006) and late (2006-2012) cohorts.
Disclosures: The authors reported having no disclosures.
ASCO: Overall survival similar regardless of distant relapse site in breast cancer
The initial distant relapse site had little influence on overall survival rates among women with metastatic breast cancer who underwent surgery and definitive radiotherapy, according to a study presented at the 2015 ASCO Breast Cancer Symposium.
In total, 3,417 patients with breast cancer treated with surgery and definitive radiotherapy in Tokyo between 1980 and 2014 were included in the study, with a median follow up of 113 months. Metastatic progression was a first relapse event in 370 patients, and median duration of OS after initial metastatic relapse was 69 months.
Tumors were classified as luminal A, luminal-human epidermal growth factor receptor 2 (HER2), luminal B, and triple negative. OS after distant relapse for patients whose initial tumor was luminal was significantly longer than triple negative and HER2 subtypes (P = .003).
OS was similar for all subtypes after initial bone or nonbone/brain relapse.
Despite the fact that bone metastasis as the initial distant relapse is commonly considered to have better prognosis than other sites in metastatic breast cancer, “OS rates of bone and non-bone/brain metastasis groups… were almost identical,” wrote Kenshiro Shiraishi of the University of Tokyo Hospital, Japan, and colleagues in a meeting abstract.
The initial distant relapse site had little influence on overall survival rates among women with metastatic breast cancer who underwent surgery and definitive radiotherapy, according to a study presented at the 2015 ASCO Breast Cancer Symposium.
In total, 3,417 patients with breast cancer treated with surgery and definitive radiotherapy in Tokyo between 1980 and 2014 were included in the study, with a median follow up of 113 months. Metastatic progression was a first relapse event in 370 patients, and median duration of OS after initial metastatic relapse was 69 months.
Tumors were classified as luminal A, luminal-human epidermal growth factor receptor 2 (HER2), luminal B, and triple negative. OS after distant relapse for patients whose initial tumor was luminal was significantly longer than triple negative and HER2 subtypes (P = .003).
OS was similar for all subtypes after initial bone or nonbone/brain relapse.
Despite the fact that bone metastasis as the initial distant relapse is commonly considered to have better prognosis than other sites in metastatic breast cancer, “OS rates of bone and non-bone/brain metastasis groups… were almost identical,” wrote Kenshiro Shiraishi of the University of Tokyo Hospital, Japan, and colleagues in a meeting abstract.
The initial distant relapse site had little influence on overall survival rates among women with metastatic breast cancer who underwent surgery and definitive radiotherapy, according to a study presented at the 2015 ASCO Breast Cancer Symposium.
In total, 3,417 patients with breast cancer treated with surgery and definitive radiotherapy in Tokyo between 1980 and 2014 were included in the study, with a median follow up of 113 months. Metastatic progression was a first relapse event in 370 patients, and median duration of OS after initial metastatic relapse was 69 months.
Tumors were classified as luminal A, luminal-human epidermal growth factor receptor 2 (HER2), luminal B, and triple negative. OS after distant relapse for patients whose initial tumor was luminal was significantly longer than triple negative and HER2 subtypes (P = .003).
OS was similar for all subtypes after initial bone or nonbone/brain relapse.
Despite the fact that bone metastasis as the initial distant relapse is commonly considered to have better prognosis than other sites in metastatic breast cancer, “OS rates of bone and non-bone/brain metastasis groups… were almost identical,” wrote Kenshiro Shiraishi of the University of Tokyo Hospital, Japan, and colleagues in a meeting abstract.
FROM THE 2015 ASCO BREAST CANCER SYMPOSIUM
Key clinical point: In patients with metastatic breast cancer, initial distant relapse site had little influence on overall survival rates.
Major finding: Overall survival (OS) rates for patients whose initial relapse site was bone were similar to those whose initial site was nonbone/brain. OS after distant relapse for patients whose initial tumor was luminal was significantly longer than triple negative and HER2 subtypes (P = .003).
Data source: In total, 3,417 patients with breast cancer treated with surgery and definitive radiotherapy in Tokyo between 1980 and 2014 were included in the study.
Disclosures: The authors reported having no disclosures.
Treating women with metastatic breast cancer takes toll
Medical oncologists empathize with their patients and feel responsible for providing them emotional/psychological support, but many experience the negative emotional impact of their work when treating women with metastatic breast cancer, according to survey results presented at the symposium.
Medical oncologists with less experience appeared to be more impacted by their emotions as compared to physicians with more experience, and the study authors noted that “acknowledging medical oncologists’ emotions is important and underscores their own need for psychological/emotional support.”
Dr. Adam M. Brufsky, associate chief, division of hematology/oncology and codirector, Comprehensive Breast Cancer Center at the University of Pittsburgh, and his colleagues surveyed medical oncologists who treat five or more women per month with metastatic breast cancer, and surveys were also completed by patients with the disease. The goal of the study was to evaluate the emotional impact on the oncologist. The surveys were conducted from June to August 2014.
A total of 359 patients (median age 53 years) and 252 medical oncologists (median age 49 years and a median of 15 years in practice) completed the survey.
At the initial diagnosis of metastatic breast cancer, a larger proportion of oncologists as compared with patients reported that showing care and compassion (81% vs. 72%) and helping patients cope with their diagnosis (63% vs. 51%) were very important. A smaller percentage of respondents felt that referring patients to support services (24% vs. 38%) was very important, but a greater number of oncologists who were practicing less than 15 years, as compared to those in practice longer, stated that referrals to support services were very important at first diagnosis (30% vs. 19%). Dr. Brufsky and his team also found that a slightly higher number of more experienced oncologists perceived emotions like anxiety, commitment, hopefulness, and determination in their patients at their initial diagnosis.
A large proportion of medical oncologists (42%) reported that treating women with this diagnosis generated a great deal of negative emotion, but a majority (81% strongly/somewhat) agreed that it is unprofessional to let emotions impact treatment recommendations. However, nearly a quarter (23%) reported that emotions kept them from providing some information to patients.
The vast majority of respondents (93%) said that they did not want to give their patients false hope, but yet 27% reported that in certain situations, they do not discuss the fact that metastatic breast cancer is incurable with their patients.
Medical oncologists empathize with their patients and feel responsible for providing them emotional/psychological support, but many experience the negative emotional impact of their work when treating women with metastatic breast cancer, according to survey results presented at the symposium.
Medical oncologists with less experience appeared to be more impacted by their emotions as compared to physicians with more experience, and the study authors noted that “acknowledging medical oncologists’ emotions is important and underscores their own need for psychological/emotional support.”
Dr. Adam M. Brufsky, associate chief, division of hematology/oncology and codirector, Comprehensive Breast Cancer Center at the University of Pittsburgh, and his colleagues surveyed medical oncologists who treat five or more women per month with metastatic breast cancer, and surveys were also completed by patients with the disease. The goal of the study was to evaluate the emotional impact on the oncologist. The surveys were conducted from June to August 2014.
A total of 359 patients (median age 53 years) and 252 medical oncologists (median age 49 years and a median of 15 years in practice) completed the survey.
At the initial diagnosis of metastatic breast cancer, a larger proportion of oncologists as compared with patients reported that showing care and compassion (81% vs. 72%) and helping patients cope with their diagnosis (63% vs. 51%) were very important. A smaller percentage of respondents felt that referring patients to support services (24% vs. 38%) was very important, but a greater number of oncologists who were practicing less than 15 years, as compared to those in practice longer, stated that referrals to support services were very important at first diagnosis (30% vs. 19%). Dr. Brufsky and his team also found that a slightly higher number of more experienced oncologists perceived emotions like anxiety, commitment, hopefulness, and determination in their patients at their initial diagnosis.
A large proportion of medical oncologists (42%) reported that treating women with this diagnosis generated a great deal of negative emotion, but a majority (81% strongly/somewhat) agreed that it is unprofessional to let emotions impact treatment recommendations. However, nearly a quarter (23%) reported that emotions kept them from providing some information to patients.
The vast majority of respondents (93%) said that they did not want to give their patients false hope, but yet 27% reported that in certain situations, they do not discuss the fact that metastatic breast cancer is incurable with their patients.
Medical oncologists empathize with their patients and feel responsible for providing them emotional/psychological support, but many experience the negative emotional impact of their work when treating women with metastatic breast cancer, according to survey results presented at the symposium.
Medical oncologists with less experience appeared to be more impacted by their emotions as compared to physicians with more experience, and the study authors noted that “acknowledging medical oncologists’ emotions is important and underscores their own need for psychological/emotional support.”
Dr. Adam M. Brufsky, associate chief, division of hematology/oncology and codirector, Comprehensive Breast Cancer Center at the University of Pittsburgh, and his colleagues surveyed medical oncologists who treat five or more women per month with metastatic breast cancer, and surveys were also completed by patients with the disease. The goal of the study was to evaluate the emotional impact on the oncologist. The surveys were conducted from June to August 2014.
A total of 359 patients (median age 53 years) and 252 medical oncologists (median age 49 years and a median of 15 years in practice) completed the survey.
At the initial diagnosis of metastatic breast cancer, a larger proportion of oncologists as compared with patients reported that showing care and compassion (81% vs. 72%) and helping patients cope with their diagnosis (63% vs. 51%) were very important. A smaller percentage of respondents felt that referring patients to support services (24% vs. 38%) was very important, but a greater number of oncologists who were practicing less than 15 years, as compared to those in practice longer, stated that referrals to support services were very important at first diagnosis (30% vs. 19%). Dr. Brufsky and his team also found that a slightly higher number of more experienced oncologists perceived emotions like anxiety, commitment, hopefulness, and determination in their patients at their initial diagnosis.
A large proportion of medical oncologists (42%) reported that treating women with this diagnosis generated a great deal of negative emotion, but a majority (81% strongly/somewhat) agreed that it is unprofessional to let emotions impact treatment recommendations. However, nearly a quarter (23%) reported that emotions kept them from providing some information to patients.
The vast majority of respondents (93%) said that they did not want to give their patients false hope, but yet 27% reported that in certain situations, they do not discuss the fact that metastatic breast cancer is incurable with their patients.
FROM THE ASCO BREAST CANCER SYMPOSIUM
Key clinical point: Many medical oncologists experience the negative emotional impact of their work when treating patients with metastatic breast cancer.
Major finding: Medical oncologists’ emotions are important and these practitioners should acknowledge their own need for psychological/emotional support.
Data source: A survey was conducted of 359 patients and 252 medical oncologists.
Disclosures: The investigators had no relevant disclosures.
NLR correlates with survival in advanced breast cancer
After treatment begins, an increased neutrophil lymphocyte ratio (NLR) can be correlated with poor disease-specific survival in stage IV breast cancer, according to research presented at the symposium. In addition, the change in NLR might be an index of response to systemic treatment.
Inflammatory response exacerbates mechanisms linked to tumor growth and dissemination, note the study authors, led by Dr. Hae-na Shin of the University of Ulsan, Seoul, South Korea. Used as an index of systemic inflammatory status, the NLR could be a predictive biomarker for both prognosis and treatment response.
To test their hypothesis, Dr. Shin and his colleagues evaluated the baseline NLR prior to beginning treatment, and then the change in posttreatment NLR, to assess if the initial NLR and its change after therapy would be predictive of disease outcome in stage IV breast cancer patients.
The study cohort included 250 women with stage IV breast cancer who were diagnosed at the Asan Medical Center between 1997 and 2012. The NLR was evaluated at their first visit to the center, and a posttreatment NLR was obtained during the first follow-up appointment after patients received their first treatment.
The authors divided the pretreatment NLR by quartile, and the change in NLR was calculated by dividing posttreatment NLR by pretreatment NLR. If the value was greater than or equal to 1.2, NLR change was increased, and if not, then it was considered to be unchanged or reduced. The prognostic value of NLR was then evaluated by comparison with Cancer Specific Survival (CSS).
When comparing pretreatment NLR and posttreatment NLR, the NLR was elevated in 85 patients (34%) but remained the same or decreased in 165 others (66%). There were no significant differences between these two groups in baseline characteristics. However, in CSS, there were differences between the two groups but they did not reach statistical significance (log rank P = 0.052). The 1-, 3-, 5-year CSS rate was 78.8%, 35.7%, 20.5% in the group with an increased NLR, and 87.1%, 49.3%, 26.9% in the other patient group.
Upon multivariate analysis, the results suggested that an increased NLR change (post/pre NLR greater than or equal to 1.2) had statistical significance as a prognostic factor of stage IV breast cancer patients after treatment (hazard ratio, 1.750; 95% confidence interval, 1.130-2.709; P = 0.012).
After treatment begins, an increased neutrophil lymphocyte ratio (NLR) can be correlated with poor disease-specific survival in stage IV breast cancer, according to research presented at the symposium. In addition, the change in NLR might be an index of response to systemic treatment.
Inflammatory response exacerbates mechanisms linked to tumor growth and dissemination, note the study authors, led by Dr. Hae-na Shin of the University of Ulsan, Seoul, South Korea. Used as an index of systemic inflammatory status, the NLR could be a predictive biomarker for both prognosis and treatment response.
To test their hypothesis, Dr. Shin and his colleagues evaluated the baseline NLR prior to beginning treatment, and then the change in posttreatment NLR, to assess if the initial NLR and its change after therapy would be predictive of disease outcome in stage IV breast cancer patients.
The study cohort included 250 women with stage IV breast cancer who were diagnosed at the Asan Medical Center between 1997 and 2012. The NLR was evaluated at their first visit to the center, and a posttreatment NLR was obtained during the first follow-up appointment after patients received their first treatment.
The authors divided the pretreatment NLR by quartile, and the change in NLR was calculated by dividing posttreatment NLR by pretreatment NLR. If the value was greater than or equal to 1.2, NLR change was increased, and if not, then it was considered to be unchanged or reduced. The prognostic value of NLR was then evaluated by comparison with Cancer Specific Survival (CSS).
When comparing pretreatment NLR and posttreatment NLR, the NLR was elevated in 85 patients (34%) but remained the same or decreased in 165 others (66%). There were no significant differences between these two groups in baseline characteristics. However, in CSS, there were differences between the two groups but they did not reach statistical significance (log rank P = 0.052). The 1-, 3-, 5-year CSS rate was 78.8%, 35.7%, 20.5% in the group with an increased NLR, and 87.1%, 49.3%, 26.9% in the other patient group.
Upon multivariate analysis, the results suggested that an increased NLR change (post/pre NLR greater than or equal to 1.2) had statistical significance as a prognostic factor of stage IV breast cancer patients after treatment (hazard ratio, 1.750; 95% confidence interval, 1.130-2.709; P = 0.012).
After treatment begins, an increased neutrophil lymphocyte ratio (NLR) can be correlated with poor disease-specific survival in stage IV breast cancer, according to research presented at the symposium. In addition, the change in NLR might be an index of response to systemic treatment.
Inflammatory response exacerbates mechanisms linked to tumor growth and dissemination, note the study authors, led by Dr. Hae-na Shin of the University of Ulsan, Seoul, South Korea. Used as an index of systemic inflammatory status, the NLR could be a predictive biomarker for both prognosis and treatment response.
To test their hypothesis, Dr. Shin and his colleagues evaluated the baseline NLR prior to beginning treatment, and then the change in posttreatment NLR, to assess if the initial NLR and its change after therapy would be predictive of disease outcome in stage IV breast cancer patients.
The study cohort included 250 women with stage IV breast cancer who were diagnosed at the Asan Medical Center between 1997 and 2012. The NLR was evaluated at their first visit to the center, and a posttreatment NLR was obtained during the first follow-up appointment after patients received their first treatment.
The authors divided the pretreatment NLR by quartile, and the change in NLR was calculated by dividing posttreatment NLR by pretreatment NLR. If the value was greater than or equal to 1.2, NLR change was increased, and if not, then it was considered to be unchanged or reduced. The prognostic value of NLR was then evaluated by comparison with Cancer Specific Survival (CSS).
When comparing pretreatment NLR and posttreatment NLR, the NLR was elevated in 85 patients (34%) but remained the same or decreased in 165 others (66%). There were no significant differences between these two groups in baseline characteristics. However, in CSS, there were differences between the two groups but they did not reach statistical significance (log rank P = 0.052). The 1-, 3-, 5-year CSS rate was 78.8%, 35.7%, 20.5% in the group with an increased NLR, and 87.1%, 49.3%, 26.9% in the other patient group.
Upon multivariate analysis, the results suggested that an increased NLR change (post/pre NLR greater than or equal to 1.2) had statistical significance as a prognostic factor of stage IV breast cancer patients after treatment (hazard ratio, 1.750; 95% confidence interval, 1.130-2.709; P = 0.012).
AT THE ASCO BREAST CANCER SYMPOSIUM
Key clinical point: Neutrophil lymphocyte ratio (NLR) can be correlated with poor disease-specific survival in stage IV breast cancer and the change in NLR might be an index of response to systemic treatment.
Major finding: The results suggest that an increased NLR change (post/pre NLR greater than or equal to 1.2) had statistical significance as a prognostic factor of stage IV breast cancer patients after treatment (HR, 1.750; 95% CI, 1.130-2.709; P = .012).
Data source: The cohort was comprised of 250 stage IV breast cancer patients diagnosed at a single center and pre and post treatment NLR were evaluated.
Disclosures: The investigators had no relevant disclosures.
Histologic information can’t replace recurrence score
Combining routine histologic information, including tumor size, grade, and cellular proliferation marker Ki67, failed to accurately reflect the recurrence score produced by the commercial diagnostic test, Oncotype Dx, according to researchers.
Although each variable individually was significantly correlated with Oncotype Dx, the combination of variables had a percentage of variance (R2) of 0.35 on the recurrence score and did not accurately predict the result generated by the 21-gene reverse-transcriptase polymerase chain reaction (RT-PCR) diagnostic test.
The single-institution study included 252 patients, (248 females and 4 males, median age 56 years) with early-stage, estrogen receptor–positive breast cancer. All patients had Oncotype Dx testing performed between 2007 and 2014. The median tumor size was 2.1 cm, and 49% were grade 2, 28% grade 3, and 23% grade 1.
Investigators examined baseline patient demographic data, such as age, race, and sex, and routine pathologic features, such as histologic grade, Ki-67, tumor size, and histologic type. The combination of three variables that individually were highly correlated to the Oncotype Dx score did not produce values that could substitute for the recurrence score.
Furthermore, the prediction capability of the three-variable combination decreased for tumors with high-recurrence scores.
“Therefore, we conclude the RS [recurrence score] can provide additional valuable information and should not be replaced by analysis of routine histologic variables alone,” wrote Dr. Kate Lathrop of the Cancer Therapy and Research Center at the University of Texas Health Science Center in San Antonio, and her colleagues.
Combining routine histologic information, including tumor size, grade, and cellular proliferation marker Ki67, failed to accurately reflect the recurrence score produced by the commercial diagnostic test, Oncotype Dx, according to researchers.
Although each variable individually was significantly correlated with Oncotype Dx, the combination of variables had a percentage of variance (R2) of 0.35 on the recurrence score and did not accurately predict the result generated by the 21-gene reverse-transcriptase polymerase chain reaction (RT-PCR) diagnostic test.
The single-institution study included 252 patients, (248 females and 4 males, median age 56 years) with early-stage, estrogen receptor–positive breast cancer. All patients had Oncotype Dx testing performed between 2007 and 2014. The median tumor size was 2.1 cm, and 49% were grade 2, 28% grade 3, and 23% grade 1.
Investigators examined baseline patient demographic data, such as age, race, and sex, and routine pathologic features, such as histologic grade, Ki-67, tumor size, and histologic type. The combination of three variables that individually were highly correlated to the Oncotype Dx score did not produce values that could substitute for the recurrence score.
Furthermore, the prediction capability of the three-variable combination decreased for tumors with high-recurrence scores.
“Therefore, we conclude the RS [recurrence score] can provide additional valuable information and should not be replaced by analysis of routine histologic variables alone,” wrote Dr. Kate Lathrop of the Cancer Therapy and Research Center at the University of Texas Health Science Center in San Antonio, and her colleagues.
Combining routine histologic information, including tumor size, grade, and cellular proliferation marker Ki67, failed to accurately reflect the recurrence score produced by the commercial diagnostic test, Oncotype Dx, according to researchers.
Although each variable individually was significantly correlated with Oncotype Dx, the combination of variables had a percentage of variance (R2) of 0.35 on the recurrence score and did not accurately predict the result generated by the 21-gene reverse-transcriptase polymerase chain reaction (RT-PCR) diagnostic test.
The single-institution study included 252 patients, (248 females and 4 males, median age 56 years) with early-stage, estrogen receptor–positive breast cancer. All patients had Oncotype Dx testing performed between 2007 and 2014. The median tumor size was 2.1 cm, and 49% were grade 2, 28% grade 3, and 23% grade 1.
Investigators examined baseline patient demographic data, such as age, race, and sex, and routine pathologic features, such as histologic grade, Ki-67, tumor size, and histologic type. The combination of three variables that individually were highly correlated to the Oncotype Dx score did not produce values that could substitute for the recurrence score.
Furthermore, the prediction capability of the three-variable combination decreased for tumors with high-recurrence scores.
“Therefore, we conclude the RS [recurrence score] can provide additional valuable information and should not be replaced by analysis of routine histologic variables alone,” wrote Dr. Kate Lathrop of the Cancer Therapy and Research Center at the University of Texas Health Science Center in San Antonio, and her colleagues.
FROM THE ASCO BREAST CANCER SYMPOSIUM
Key clinical point: A combination of three histologic variables (tumor size, grade, and cellular proliferation marker Ki67) failed to accurately predict the Oncotype Dx recurrence score.
Major finding: Based on the Oncotype Dx recurrence score, the score predicted by the three-variable combination had a percentage of variance (R2) of 0.35.
Data source: The retrospective, single-institution study evaluated data from 252 patients with early-stage estrogen receptor–positive breast cancer who had Oncotype Dx testing performed between 2007 and 2014.
Disclosures: The authors reported having no disclosures.
A qualitative exploration of supports and unmet needs of diverse young women with breast cancer
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Click on the PDF icon at the top of this introduction to read the full article.
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Implementation of the 21-Gene Risk Score Assay, OncotypeDx Breast, Within the VA
Background: The number of veterans diagnosed and treated for breast cancer within the VHA is increasing. The VA Central Cancer Registry (VACCR) reported 504 and 624 newly diagnosed patients in 2011 and 2012, respectively. Molecular testing for cancer treatment is also increasing, but there are few studies evaluating utilization and health outcomes of testing. This study examined utilization of OncotypeDx breast (Genomic Health Inc., Redwood City, CA), a prognostic 21-gene expression genomic test within the VA.
Methods: Patient-level test orders and results from January 2011 until December 2014 were provided by Genomic Health. Data for years 2011 and 2012 were merged with the VACCR. We identified OncotypeDx-eligible patients using reported clinical and pathologic stage of I or II, hor-mone receptor/HER2 (HR/HER) status, and 10-year life expectancy (aged < 75 years). Bivariate analyses were conducted to compare distributions of characteristics by status of testing. A multivariate logistic regression model was developed to identify patient, site of care, and regional factors that predict testing.
Results: There were 585 OncotypeDx breast assays ordered by VA and non-VA providers from 2011 until 2014. Testing increased from 65 tests in 2011 to 199 in 2014. Characteristics of patients tested were 97% female; median age 58 years (range 26-85 years ; 24% aged < 50 years). Of the 204 tests that were performed by Genomic Health during 2011/2012 time frame, 104 veterans were matched to VACCR data. Of 418 eligible veterans, 21.05% (88) were tested. There were 16 veterans who underwent testing but were not eligible due to age, stage, or HR/HER status. There were no statistically significant differences in use of testing by age or race. Recurrence score for veterans tested ranged from 0-50 (median = 17.40, SD 10.91); 58 (55.77%) low, 35 (33.65%) moderate, and 11 (10.58%) high risk of recurrence. Chemotherapy was used by 26 (25%) veterans who underwent testing and by 395 (38.16%) veterans not tested (P < .025).
Conclusions: There has been a rapid increase in use of the 21-gene risk score test among patients with breast cancer within the VA. Ongoing research will examine regional/site of care variations in access, and we will analyze the influence of testing on health outcomes.
Background: The number of veterans diagnosed and treated for breast cancer within the VHA is increasing. The VA Central Cancer Registry (VACCR) reported 504 and 624 newly diagnosed patients in 2011 and 2012, respectively. Molecular testing for cancer treatment is also increasing, but there are few studies evaluating utilization and health outcomes of testing. This study examined utilization of OncotypeDx breast (Genomic Health Inc., Redwood City, CA), a prognostic 21-gene expression genomic test within the VA.
Methods: Patient-level test orders and results from January 2011 until December 2014 were provided by Genomic Health. Data for years 2011 and 2012 were merged with the VACCR. We identified OncotypeDx-eligible patients using reported clinical and pathologic stage of I or II, hor-mone receptor/HER2 (HR/HER) status, and 10-year life expectancy (aged < 75 years). Bivariate analyses were conducted to compare distributions of characteristics by status of testing. A multivariate logistic regression model was developed to identify patient, site of care, and regional factors that predict testing.
Results: There were 585 OncotypeDx breast assays ordered by VA and non-VA providers from 2011 until 2014. Testing increased from 65 tests in 2011 to 199 in 2014. Characteristics of patients tested were 97% female; median age 58 years (range 26-85 years ; 24% aged < 50 years). Of the 204 tests that were performed by Genomic Health during 2011/2012 time frame, 104 veterans were matched to VACCR data. Of 418 eligible veterans, 21.05% (88) were tested. There were 16 veterans who underwent testing but were not eligible due to age, stage, or HR/HER status. There were no statistically significant differences in use of testing by age or race. Recurrence score for veterans tested ranged from 0-50 (median = 17.40, SD 10.91); 58 (55.77%) low, 35 (33.65%) moderate, and 11 (10.58%) high risk of recurrence. Chemotherapy was used by 26 (25%) veterans who underwent testing and by 395 (38.16%) veterans not tested (P < .025).
Conclusions: There has been a rapid increase in use of the 21-gene risk score test among patients with breast cancer within the VA. Ongoing research will examine regional/site of care variations in access, and we will analyze the influence of testing on health outcomes.
Background: The number of veterans diagnosed and treated for breast cancer within the VHA is increasing. The VA Central Cancer Registry (VACCR) reported 504 and 624 newly diagnosed patients in 2011 and 2012, respectively. Molecular testing for cancer treatment is also increasing, but there are few studies evaluating utilization and health outcomes of testing. This study examined utilization of OncotypeDx breast (Genomic Health Inc., Redwood City, CA), a prognostic 21-gene expression genomic test within the VA.
Methods: Patient-level test orders and results from January 2011 until December 2014 were provided by Genomic Health. Data for years 2011 and 2012 were merged with the VACCR. We identified OncotypeDx-eligible patients using reported clinical and pathologic stage of I or II, hor-mone receptor/HER2 (HR/HER) status, and 10-year life expectancy (aged < 75 years). Bivariate analyses were conducted to compare distributions of characteristics by status of testing. A multivariate logistic regression model was developed to identify patient, site of care, and regional factors that predict testing.
Results: There were 585 OncotypeDx breast assays ordered by VA and non-VA providers from 2011 until 2014. Testing increased from 65 tests in 2011 to 199 in 2014. Characteristics of patients tested were 97% female; median age 58 years (range 26-85 years ; 24% aged < 50 years). Of the 204 tests that were performed by Genomic Health during 2011/2012 time frame, 104 veterans were matched to VACCR data. Of 418 eligible veterans, 21.05% (88) were tested. There were 16 veterans who underwent testing but were not eligible due to age, stage, or HR/HER status. There were no statistically significant differences in use of testing by age or race. Recurrence score for veterans tested ranged from 0-50 (median = 17.40, SD 10.91); 58 (55.77%) low, 35 (33.65%) moderate, and 11 (10.58%) high risk of recurrence. Chemotherapy was used by 26 (25%) veterans who underwent testing and by 395 (38.16%) veterans not tested (P < .025).
Conclusions: There has been a rapid increase in use of the 21-gene risk score test among patients with breast cancer within the VA. Ongoing research will examine regional/site of care variations in access, and we will analyze the influence of testing on health outcomes.
Testing for BRCA1/BRCA2 in the VA
Background: BRCA 1/2 genes have a critical role in DNA repair and genome stability. BRCA mutations are responsible for the majority of hereditary breast and ovarian cancer (HBOC) syndromes, and BRCA mutations increase susceptibility to several cancers, including male breast cancer, ovarian, prostate, pancreatic, and possibly glioblastoma and melanoma. BRCA2 mutations are responsible for about 5% to 10% of all breast cancers. With a growing number of laboratories offering BRCA testing and as clinicians move toward multigene panels for testing, we sought to assess the baseline use of BRCA testing in the VHA.
Methods: Data identifying veterans who underwent BRCA testing were obtained from Ambry, GeneDX, Myriad, and Quest. We merged these data with the VA corporate data warehouse to identify patient and site of characteristics associated with testing.
Results: There were 868 veterans who underwent BRCA testing from January 2012 until December 2013. Of those tested, 141 were male and 727 were female veterans. The age of men tested ranged from 24 years to 80 years; the mean was 62 years. The age of women tested ranged from 21 years to 77 years; the mean was 46 years. Credentials of clinicians ordering the tests included advanced practice nurses (8%), physicians (87%), physician assistants (2%), and genetic counselors (3%). Veterans were tested in 46 of the 52 states. However, the number of veterans per state ranged from a high in California of 43 to just 1 veteran tested in many states. Ongoing analysis is examining clinical characteristics and diagnosis codes of veterans tested to identify whether testing was concordant with guidelines.
Background: BRCA 1/2 genes have a critical role in DNA repair and genome stability. BRCA mutations are responsible for the majority of hereditary breast and ovarian cancer (HBOC) syndromes, and BRCA mutations increase susceptibility to several cancers, including male breast cancer, ovarian, prostate, pancreatic, and possibly glioblastoma and melanoma. BRCA2 mutations are responsible for about 5% to 10% of all breast cancers. With a growing number of laboratories offering BRCA testing and as clinicians move toward multigene panels for testing, we sought to assess the baseline use of BRCA testing in the VHA.
Methods: Data identifying veterans who underwent BRCA testing were obtained from Ambry, GeneDX, Myriad, and Quest. We merged these data with the VA corporate data warehouse to identify patient and site of characteristics associated with testing.
Results: There were 868 veterans who underwent BRCA testing from January 2012 until December 2013. Of those tested, 141 were male and 727 were female veterans. The age of men tested ranged from 24 years to 80 years; the mean was 62 years. The age of women tested ranged from 21 years to 77 years; the mean was 46 years. Credentials of clinicians ordering the tests included advanced practice nurses (8%), physicians (87%), physician assistants (2%), and genetic counselors (3%). Veterans were tested in 46 of the 52 states. However, the number of veterans per state ranged from a high in California of 43 to just 1 veteran tested in many states. Ongoing analysis is examining clinical characteristics and diagnosis codes of veterans tested to identify whether testing was concordant with guidelines.
Background: BRCA 1/2 genes have a critical role in DNA repair and genome stability. BRCA mutations are responsible for the majority of hereditary breast and ovarian cancer (HBOC) syndromes, and BRCA mutations increase susceptibility to several cancers, including male breast cancer, ovarian, prostate, pancreatic, and possibly glioblastoma and melanoma. BRCA2 mutations are responsible for about 5% to 10% of all breast cancers. With a growing number of laboratories offering BRCA testing and as clinicians move toward multigene panels for testing, we sought to assess the baseline use of BRCA testing in the VHA.
Methods: Data identifying veterans who underwent BRCA testing were obtained from Ambry, GeneDX, Myriad, and Quest. We merged these data with the VA corporate data warehouse to identify patient and site of characteristics associated with testing.
Results: There were 868 veterans who underwent BRCA testing from January 2012 until December 2013. Of those tested, 141 were male and 727 were female veterans. The age of men tested ranged from 24 years to 80 years; the mean was 62 years. The age of women tested ranged from 21 years to 77 years; the mean was 46 years. Credentials of clinicians ordering the tests included advanced practice nurses (8%), physicians (87%), physician assistants (2%), and genetic counselors (3%). Veterans were tested in 46 of the 52 states. However, the number of veterans per state ranged from a high in California of 43 to just 1 veteran tested in many states. Ongoing analysis is examining clinical characteristics and diagnosis codes of veterans tested to identify whether testing was concordant with guidelines.
Molecular Imaging of ER Status in Breast Cancer: A Preclinical Study
Background: Currently there are no FDA-approved imaging biomarkers capable of accurately identifying and quantitatively differentiating estrogen receptor (ER) status in breast cancer. The current preclinical study evaluated the ability of a Ga-68 positron emission tomography (PET) imaging biomarker and the analogous Lu-177 theranostic peptide construct to target and determine the status of ER expression.
Methods: Five human breast cancer cell line xenograft models were established in severe combined immunodeficiency mice. Western blot analysis confirmed the BB2r expression. The BB2r antagonist peptide construct was radiolabeled with Ga-68 and Lu-177, using fully automated radiochemistry labeling techniques. Pharmacokinetic, micro-SPECT/CT, and micro-PET/CT studies were performed.
Results: Pharmacokinetic studies confirmed that the Lu-177 construct targeted BB2r positive tissue in ER+ tumor xenograft models to a much greater extent than in ER- tumor xenograft models. In contrast, the ER-tumor xenografts demonstrated low initial uptake, followed by nearly complete washout from all tumor tissue within 24-hours after injection. The variances in tracer uptake by the tumor tissue correlated with BB2r expression via western blot analysis. Ga-68 micro-PET/CT data also correlated with the Lu-177 pharma-cokinetic studies, demonstrating visualization of BB2r+ tumor tissue with trends in standardized uptake values correlating directly with BB2r expression and ER status.
Conclusions: In summary, our study demonstrates selective tumor targeting for both a Ga-68 PET imaging biomarker and a Lu-177 theranostic agent in all breast cancer models studied. The Ga-68 PET SUV data suggest that PET imaging with this tracer or an analog of this tracer may have the potential to noninvasively differentiate ER status in vivo. Further studies are required involving an expanded panel of human cell lines and correlation with BB2 receptor expression/ER status obtained from biopsy data to confirm the potential validity of this finding.
Background: Currently there are no FDA-approved imaging biomarkers capable of accurately identifying and quantitatively differentiating estrogen receptor (ER) status in breast cancer. The current preclinical study evaluated the ability of a Ga-68 positron emission tomography (PET) imaging biomarker and the analogous Lu-177 theranostic peptide construct to target and determine the status of ER expression.
Methods: Five human breast cancer cell line xenograft models were established in severe combined immunodeficiency mice. Western blot analysis confirmed the BB2r expression. The BB2r antagonist peptide construct was radiolabeled with Ga-68 and Lu-177, using fully automated radiochemistry labeling techniques. Pharmacokinetic, micro-SPECT/CT, and micro-PET/CT studies were performed.
Results: Pharmacokinetic studies confirmed that the Lu-177 construct targeted BB2r positive tissue in ER+ tumor xenograft models to a much greater extent than in ER- tumor xenograft models. In contrast, the ER-tumor xenografts demonstrated low initial uptake, followed by nearly complete washout from all tumor tissue within 24-hours after injection. The variances in tracer uptake by the tumor tissue correlated with BB2r expression via western blot analysis. Ga-68 micro-PET/CT data also correlated with the Lu-177 pharma-cokinetic studies, demonstrating visualization of BB2r+ tumor tissue with trends in standardized uptake values correlating directly with BB2r expression and ER status.
Conclusions: In summary, our study demonstrates selective tumor targeting for both a Ga-68 PET imaging biomarker and a Lu-177 theranostic agent in all breast cancer models studied. The Ga-68 PET SUV data suggest that PET imaging with this tracer or an analog of this tracer may have the potential to noninvasively differentiate ER status in vivo. Further studies are required involving an expanded panel of human cell lines and correlation with BB2 receptor expression/ER status obtained from biopsy data to confirm the potential validity of this finding.
Background: Currently there are no FDA-approved imaging biomarkers capable of accurately identifying and quantitatively differentiating estrogen receptor (ER) status in breast cancer. The current preclinical study evaluated the ability of a Ga-68 positron emission tomography (PET) imaging biomarker and the analogous Lu-177 theranostic peptide construct to target and determine the status of ER expression.
Methods: Five human breast cancer cell line xenograft models were established in severe combined immunodeficiency mice. Western blot analysis confirmed the BB2r expression. The BB2r antagonist peptide construct was radiolabeled with Ga-68 and Lu-177, using fully automated radiochemistry labeling techniques. Pharmacokinetic, micro-SPECT/CT, and micro-PET/CT studies were performed.
Results: Pharmacokinetic studies confirmed that the Lu-177 construct targeted BB2r positive tissue in ER+ tumor xenograft models to a much greater extent than in ER- tumor xenograft models. In contrast, the ER-tumor xenografts demonstrated low initial uptake, followed by nearly complete washout from all tumor tissue within 24-hours after injection. The variances in tracer uptake by the tumor tissue correlated with BB2r expression via western blot analysis. Ga-68 micro-PET/CT data also correlated with the Lu-177 pharma-cokinetic studies, demonstrating visualization of BB2r+ tumor tissue with trends in standardized uptake values correlating directly with BB2r expression and ER status.
Conclusions: In summary, our study demonstrates selective tumor targeting for both a Ga-68 PET imaging biomarker and a Lu-177 theranostic agent in all breast cancer models studied. The Ga-68 PET SUV data suggest that PET imaging with this tracer or an analog of this tracer may have the potential to noninvasively differentiate ER status in vivo. Further studies are required involving an expanded panel of human cell lines and correlation with BB2 receptor expression/ER status obtained from biopsy data to confirm the potential validity of this finding.