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OBJECTIVE. The purpose of this study was to compare breast cancer characteristics and treatment regimens among women undergoing annual versus nonannual screening mammography. MATERIALS AND METHODS. In this retrospective, institutional review board-approved, HIPAA-compliant cohort study, a breast cancer database was queried for patients who received a mammographic or clinical diagnosis of breast cancer during 2016-2017. Annual versus biennial and annual versus nonannual (biennial and triennial) mammography screening cohorts were compared using t tests or Wilcoxon rank sum tests for continuous variables and chi-square or Fisher exact tests for categoric variables. RESULTS. A total of 490 patients were diagnosed with breast cancer during 2016-2017. Among these women, 245 had an assignable screening frequency and were 40-84 years old (mean, 61.8 ± 9.9 [SD] years; median, 62 years). Screening frequency was annual for 200 of these 245 patients (81.6%), biennial for 32 (13.1%), and triennial for 13 (5.3%). Annual screening resulted in fewer late-stage presentations (AJCC stage II, III, or IV in 48 of 200 patients undergoing annual [24.0%] vs 14 of 32 undergoing biennial [43.8%; p = .02] and vs 20 of 45 undergoing nonannual screening [44.4%; p = .006]), fewer interval cancers (21 of 200 for annual [10.5%] vs 12 of 32 for biennial [37.5%; p < .001] and vs 15 of 45 for nonannual [33.3%; p < .001]), and smaller mean tumor diameter (1.4 ± 1.2 cm for annual vs 1.8 ± 1.6 cm for biennial [p = .04] and vs 1.8 ± 1.5 cm nonannual [p = .03]). Lower AJCC stage, fewer interval cancers, and smaller tumor diameter also persisted among postmenopausal women undergoing annual screening. Patients undergoing biennial and nonannual screening showed nonsignificant greater use of axillary lymph node dissection (annual, 24 of 200 [12.0%]; biennial, 6 of 32 [18.8%]; nonannual, 7 of 45 [15.6%]) and chemotherapy (annual, 55 of 200 [27.5%]; biennial, 12 of 32 [37.5%]; nonannual, 16 of 45 [35.6%]). CONCLUSION. Annual mammographic screening was associated with lower breast cancer stage and fewer interval cancers than biennial or nonannual screening.

Purpose: T-DM1 is an antibody drug conjugate with proven efficacy in metastatic breast cancer for progressive disease refractory to trastuzumab. Drug-induced pneumonitis is a rare serious potential adverse effect. The purpose of this review was to estimate the incidence of pulmonary toxicity at our institution. Methods: A retrospective analysis of electronic medical record data inclusive of all women and men aged 18 years and older treated with T-DM1 at out institution was undertaken. The records were reviewed for clinical symptoms and/or radiographic evidence concerning for pneumonitis. We identified variables of interest with regard to potential risk factors for toxicity. Results: A total of 50 patients were included, 6 (12%) of whom had radiographic and/or clinical symptoms concerning for T-DM1-induced pneumonitis. All 6 patients had metastatic or unresectable breast cancer. Of the 6 patients, 5 (83%) had suspected pulmonary metastases, 1 (17%) had a history of underlying lung disease, and 5 (83%) had a history of prior taxane therapy. Pulmonary metastases (p = 0.38), the median number of treatment cycles (p = 0.29), prior taxane therapy (p = 0.99), underlying lung disease (p = 0.99), and hormone receptor positivity (p = 0.66) did not have any statistical significance for an association with pneumonitis. Conclusion: Pneumonitis is a recognized toxic effect of T-DM1. While our sample size was small, the number of events was higher than described in the literature, which may be an artifact of referral bias. Future studies with a larger sample population may detect potential risk factors for toxicity.

Objective: Few studies have examined toxicity from potentially curative chemotherapy in ovarian cancer patients at risk for breast cancer susceptibility (BRCA) mutation. Methods/Results: Ninety-four of the 482 patients appeared at risk for a mutation based on family history and 23 had a confirmed mutation. Hospitalization or emergency department visits were not increased based on family history with odds ratios (95% confidence intervals) of 0.88 (0.52, 1.45) (p =.62) and 0.90 (0.49, 1.58) (p =.71), respectively; similar findings were observed with confirmed mutations. Trends favored improved survival. Conclusions: Concern for a BRCA mutation should not preclude full dose chemotherapy in ovarian cancer patients treated with curative intent.

Objective: To gain a better understanding of the role of pemetrexed in ovarian cancer patients, we conducted a systematic review of the published literature and evaluated a consecutive, single-institution series of non-study pemetrexed-treated patients. Methods/Results: Thirteen published articles met this study's eligibility criteria, providing a total of 376 unique and evaluable ovarian cancer patients. This systematic review demonstrated tumor response rates with pemetrexed-based chemotherapy from 9 to 84%; the agent appeared to be well tolerated. Similarly, 13 consecutive patients with ovarian, fallopian tube, or primary peritoneal cancer were treated with pemetrexed at the Mayo Clinic, Rochester, Minn., USA, from 2004 through 2013. The median number of previous chemotherapy regimens was 4; most patients received single-agent pemetrexed (n = 9). Patients received a median of 2 cycles of pemetrexed-based chemotherapy; 1 patient received 10 cycles (7 months' worth) with treatment ongoing at the time of this report. The median survival from the start of pemetrexed was 4.8 months (95% confidence interval 1.2, 15 months). Two patients manifested a 50% drop in Ca-125 levels. Again, pemetrexed was relatively well tolerated. Conclusion: Pemetrexed has antineoplastic activity in patients with ovarian cancer - even among those who have been heavily pretreated - and therefore merits further study.

BACKGROUND: Approximately 5% of all patients with breast cancer develop breast cancer brain metastases (BCBM). Medical and legal guidance on health conditions associated with driving may vary by state. The paucity of data to guide clinicians’ recommendations on driving in the setting of BCBM prompted this review of clinical practice. The primary objective is to determine the frequency of provider-documented driving recommendations with secondary objectives to define associated clinical factors. METHODS: University of Michigan’s (UM) DataDirect tool retrospectively searched records dated 11/30/2012 to 11/30/2018 using ICD 9 and 10 codes for breast cancer (C50.912, C50.911, C50.919, 174.9, 175.9) and for brain metastases (C79.31, D49.6, D43.2, 198.3, 239.6). Eligibility criteria were: age ≥ 18, BCBM, UM pathology confirmation of breast cancer, CNS imaging at time of diagnosis performed or reviewed at UM, and UM consultation with medical oncology, radiation oncology, neuro-oncology, neurosurgery, or neurology within 4 weeks of BCBM diagnosis. Chart abstraction included clinical and demographic factors for descriptive analysis. RESULTS: Only 87 of the 188 identified subjects (46%) met eligibility criteria. The most common exclusions were non-breast cancer brain lesion (n=40), neither UM imaging nor pathology (n=23) and no intra-parenchymal brain metastases (n=22). Of the 87 eligible subjects, 21 (24%) had documented recommendations against driving. Five of the 7 subjects with documented seizure history within 4 weeks of diagnosis also had documented recommendations against driving. There were 32 of 87 subjects on anti-epileptics of which 13 had documented driving recommendations. CONCLUSIONS: The minority of patients (24%) with newly diagnosed BCBM had a documented recommendation against driving. Seizure activity was strongly associated with documentation of driving recommendations. Other than seizure activity, general parameters regarding the safety of driving with newly diagnosed BCBM are not well defined. Prospective study is indicated to provide data supported recommendations regarding driving with BCBM.

e23018 Background: As the treatment for early-stage breast cancer continually evolves, there has been a pragmatic shift with regard to standard treatment placing a high-value on multidisciplinary management. Recent studies have shown that sentinel lymph node biopsy (SLNB) and adjuvant radiation (RT) can be omitted in a subset of older women with early-stage hormone receptor positive breast cancer who plan to take adjuvant endocrine therapy (ET). Prior analyses estimate a wide range of discontinuation rates, with studies citing 31-73%. The primary aim of this analysis is to estimate the discontinuation rate of endocrine therapy in women ages 70 and older with early stage breast cancer who omit radiation therapy at our institution. Methods: We performed a retrospective review of institutional cancer registry and EMR data to identify all women with breast cancer, ages 70 or older, AJCC 7 stage I or II, hormone receptor positive, HER2 negative, who underwent lumpectomy at the University of Michigan inclusive of years 2014 through 2017. Multiple variables of interest were collected and analyzed. Results: 174 women met initial inclusion criteria for ER/PR positive, HER2 negative, Stage I/II disease, who underwent lumpectomy. Of these, N = 10 pursued adjuvant radiation therapy with omission of ET, and N = 19 declined both ET and RT upfront. The remaining 145 women chose to pursue ET alone (N = 78) or ET+RT (N = 67). 30/145 (21%) discontinued endocrine therapy, 22% (N = 15) in the ET+RT, 19% (N = 15) in the ET alone groups. There was no statistically significant difference between groups with regard to the discontinuation of ET upon comparison, log-rank p-value 0.4. The primary reason for ET discontinuation, N = 27 (90%) was secondary to side effects. Conclusions: This review demonstrated that a significant number (54%) of older women opt to omit radiation in favor of ET alone after multidisciplinary discussion, in accordance with NCCN guidelines. Endocrine therapy discontinuation rates among older women at our institution were comparable to rates in the literature for women of all ages, and the reason for discontinuation was attributed to side effects. The pivotal clinical trials (PRIME II and CALGB 9343) exploring ET alone versus ET+RT did not report on ET discontinuation rates. In our analysis, almost 20% of women receiving ET alone discontinued ET therapy, calling into question a missed radiation treatment opportunity in a curative setting.

e13004Background: T-DM1 is an antibody drug conjugate with proven efficacy in metastatic breast cancer for progressive disease refractory to trastuzumab. FDA prescribing information cites a pneumon...