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To report the incidence of cancer after renal transplantation at a referral center in a developing country. Consecutive patients receiving renal transplantations during a 48-year period at Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran were analyzed. The standardized incidence ratio (SIR) was calculated based on data from GLOBOCAN 2012. From 1257 patients, 98 (8%) developed 143 malignancies. The SIR of all the cohort was 4.1 (95% CI 3.2–5.1). The relative risks of male and female transplant recipients were 4.6 and 3.5 times greater than the risk of cancer of the general population, respectively. The most common malignancy was non-melanoma skin cancer (52%). The malignancy that associated with the greater relative risk was Kaposi sarcoma (SIR: 200), followed by lymphomas (SIR: 30). A multivariate analysis comparing patients with cancer and controls confirmed that receiving a three-drug regimen as final treatment, prolonged immunosuppression, and patients undergoing a second renal transplantation were factors associated with increased cancer development. To date, there is paucity of data from developing countries. We reported the results from a National Health Institute in Mexico including a large cohort with a long follow-up, demonstrating differences within frequencies and risks compared to other regions of the world.

Background: Breast cancer in Mexico is the first cause of mortality due to malignant tumors among women. The five-year overall survival among Mexican breast cancer patients (MexBCP)treated at governmental facilities is about 75-80% as a result of an increased access to oncology treatments (WHO 20thmodel list essential medicines) in the Public Health Insurance called "Seguro Popular". Expert systems are computer programs that are derived from a branch of computer Science research called Artificial Intelligence (AI). We do not have a system based on artificial intelligence for MexBCP prognostic and predictive evaluation. The aim was develop an expert system that generates a model based on data mining techniques, which allowed predict the MexBCP survival Patients and Methods: This study was carried out by the methodology currently used in the processes of Knowledge Discovery from Databases (KDD), supported by the WEKA free distribution tool for the modeling of data mining techniques. The breast cancer data of 4,773 were provided by INCAN cohort of 4300 patients diagnosed from 2006 to 2013 with a median follow-up of 40.5 months and by INCMNSZ cohort of 473 patients from 2011 to may 2018 with a median follow-up of 39 months. The clinical and pathologic variables were: age, TNMc stage, hormonal status (pre or perimenopause or postmenopause), ER, PR, HER2, Ki67, nuclear grade. Date of histological diagnosis, date of recurrence or last medical consultation, date of death, date of death, specific cancer were used for Survival analysis. Results: The knowledge base for the expert system was based on the rules generated by the different data mining techniques. The rules used were generated by the Prism classification algorithm, which classify with a 97% percentage of instances correctly and a Kappa statistic of 0.9208. These rules obtained characteristics in each of the attributes, as well as the percentage of certainty of each of those rules. In addition to determining the average life of the group of patients that was classified in each of the generated rules. Finally, the basic elements that formed part of the architecture of the expert system carried out were the knowledge base, the inference engine, the database and the interface with the user. An on-line expert system was created, which allows users to interact and thus allow decision-making based on the results presented. Conclusion: As far as we know this is the first expert system that allows calculate prognosis according to clinical-pathological variables. It is of great relevance know the survival of a Mexican patient with breast cancer in the public health system with access to essential treatment. The applications of the system can be multiple in the usual clinical practice, education and in the taking of public policies for breast cancer in Mexico. We are currently working on a predictive model of oncological treatment benefit based also on an expert system. Citation Format: Armengol-Alonso A, Villalobos-Castaldi FM, Cabrera-Galeana P, Bargallo-Rocha E, Reynoso-Noverón N, Mohar A, Melo-Morin JP. OncoproMex®: An intelligent decision support system for Mexican breast cancer patients [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P2-07-13.

Introduction. Public health insurance called Seguro Popular (SP) for breast cancer treatment (BCT) was instituted in Mexico in 2007. Our third level center was enrolled until 2011. SP covers systemic BCT (WHO 20th model list essential medicines). The aims were: 1) Describe frequency and type of breast cancer recurrence (BCR), 2) compare which factors were contributing to recurrence of breast cancer patients (pts) before and after the implementation of SP. Methods. Pts with diagnosis of breast cancer (BC) from 2004 to 2018 were analyzed and pts with BCR whom primary tumor (PBC) was treated and followed at INCMNSZ were recruited. They were divided into two groups according to access to SP: pts without Seguro Popular (non-SP) and, pts with SP. Xi-square, non-parametric tests and Kaplan-Meier curves (log-rank test) were used. Logistic regression was done for multivariate analysis. A p-value Citation Format: Mejía-Fernández L, Medina-Franco H, Armengol-Alonso A. Impact of public health insurance “Seguro Popular” on breast cancer recurrence at Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Mexico City [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-13-11.

A cohort of patients with breast cancer HER2 positive are exposed to chemotherapy with cardiotoxic drugs like anthracyclines (A) and trastuzumab (T). The decrease in longitudinal strain is a helpful tool to predict clinical cardiotoxicity. The purpose of this paper is to determine if echocardiographic parameters like longitudinal strain with speckle tracking predict subclinical cardiotoxicity compared to conventional echocardiographic parameters. This was a retrospective, observational cohort study that involved 20 patients with breast cancer HER2+ who were treated with a chemotherapy reverse sequence (TH-A). We made a basal echocardiogram, 3, 6, 9 and 12 months after chemotherapy with a cumulative dose of 240mg/m2 of doxorrubicin. Cardiotoxicity was defined as a decrease in left ventricular ejection fraction of 10% below 53%, and subclinical cardiotoxicity as a decline of >15% of longitudinal strain. 5 patients (25%) developed decline in longitudinal strain (subclinical cardiotoxicity) 3 months after initiation of chemotherapy, despite 2 of them had normal LVEF (p = 0.01), with the use of heart failure medication they showed partial reversibility. Lineal regression analysis showed that patients with GLS >-19% at baseline did not present cardiotoxicity during the follow up (p = 0.03). Changes in GLS were independent of left ventricular mass, E/A and peak s’ wave velocity (p = 0.01). The diagnosis of subclinical cardiotoxicity by the decrease of GLS is a useful tool with possible therapeutic implications and possible reversibility of cardiotoxicity in patients with reverse chemotherapy sequence. Significant results Binary analysis of echocardiographic variables Value LVEF p GLS p Basal 62.4 ± 6.7 -19.8 ± 1.8 3 months 59.4 ± 11.1 0.615 -18.1 ± 3.9 0.01 6 months 60.2 ± 8.7 0.354 -18.9 ± 3.3 0.185 9 months 61.6 ± 6.0 0.862 -19.65± 1.9 0.408 12 months 61.1 ± 5.7 0.379 -19.8 ± 1.9 0.859 Binary analysis of echocardiographic variables Abstract P1773 Figure. Sequence of chemotherapy

Background: The number of cancer survivors has increased worldwide during the last decade as a result of improvements in the Clinical Oncology Practice. Last year, more than 15.5 million cancer survivors were alive in the United States;3.5 million were breast cancer survivors (BCS). According to GLOBOCAN 2012, breast cancer incidence in Mexico was 24.8 per 100.000. Studies in Mexican breast cancer patients have reported a five-year overall survival of 80%, expecting 16.000 BCS and 66% of unemployment rates, however, associated factors remain unknown. The aim of this study was to associate symptom burden with employment and quality of life (QOL) in long-term breast cancer survivors (LTBCS) Patients and methods: A cross-sectional cohort study was performed including 54 patients with history of non-metastatic invasive breast cancer. Inclusion criteria were: ≤ 65 years and ≥ 2 years from diagnosis and off treatment and exclusion criteria was illiteracy. A written questionnaire (Quality of Life-Cancer Survivors, QOL-CS) developed by City of Hope National Medical Center (Spanish version) was used to measure QOL, including 41 items representing four domains: psychological well-being (18 items), physical well-being (8 items), social well-being (8 items), and spiritual well-being (7 items). Items were rated on a scale of 0 (worst outcome) to 10 (best outcome). Information was analyzed using SPSS v.21. A logistic regression was done to predict the impact of the independent variables. Results: Median age at diagnosis and at the time of the questionnaire application was 50 and 56 years, respectively. The median survival time from diagnosis was 5 years (percentile 25-75 = 3-8.2 years). Stages were: cTNM stage I 18 (33%), stage II 28 (52%), and stage III 8 (15%). Patients received the following treatment: 26 (48%) underwent conservative surgery, 28 (52%) mastectomy; 40 (74%) chemotherapy, 34 (63%) radiotherapy, and 41 (76%) hormonal therapy. Educational attainment was less than college completion in 38 (70%) patients; disease-related work loss in 15 (27.8%), 26 (48.1%) were unemployed, and 18 (33.3%) worked half time. In employed patients the average monthly self-reported income was US $ 300 dollars. A univariate comparison between QOL-CS scores from the National Coalition from Cancer Survivorship (NCCS) and our study found significant differences. Cancer treatment distress (OR 30.5 CI 95% 2.1-437.6 p=0.01) and family distress (OR 16.4 CI 95% 1.0-260.6 p=0.04) were associated with a worst score in the QOL-CS tool. Symptoms such as menstrual change/fertility (OR 1.36 CI 95% 1.04-1.77 p=0.02), physical appearance (OR 1.36 CI 95% 1.01-1.82 p=0.03), and self-concept (OR 1.36 CI 95% 1.00-1.84 p=0.04), were associated with disease-related work loss. Conclusion:This is one of the first studies that associates symptom burden with employment and QOL in LTBCS in Mexico. Although its limitations (small sample size), the present study highlights the need to carry out specific research to investigate the local needs in order to design public policies to subsequently improve the impact on QOL and employment in these patients in Latin America. Citation Format: Remolina-Bonilla YA, León-Rodríguez E, Armengol-Alonso A. Impact of symptom burden on employment and quality of life in long-term Mexican breast cancer survivors treated in a tertiary referral center [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P6-12-20.

Background Chronic myelomonocytic leukemia (CMML) is the most aggressive of chronic leukemias, with short overall survival and a high transformation rate to acute leukemia. We investigated the factors related to blastic transformation in a Mexican population treated at a tertiary referral center. Patients and Methods The records of patients with a diagnosis of CMML from 2000 to 2015 were reviewed. A total of 54 patients were included, with a median age of 71 years and an overall survival of 16 months. The patients with incomplete data were excluded. IBM SPSS Statistics, version 21.0, software was used to perform the statistical analysis. Results The rate of blastic transformation was 33% (18 patients), and the interval time to progression was 9 months (range, 0-87 months). Comparing the patients who did not undergo blastic transformation to those who did, those with progression to acute leukemia tended to be younger (age, 58 vs. 71 years; P = .001), to have a greater peripheral blood blast count (≥ 2% vs. 0%; P = .003), and were more likely to have immature myeloid precursors circulating in the peripheral blood (94% vs. 64%; P = .02). On multivariate analysis, younger age continued to be a statistically significant factor for progression (hazard ratio, 0.97; 95% confidence interval, 0.929-0.987). Conclusion Mexican patients with CMML that progressed to overt acute leukemia were considerably younger, with a higher tumor burden and short overall survival. In this population, it is important to consider more aggressive treatment at diagnosis, focusing on high-dose chemotherapy and hematopoietic stem cell transplantation within a short period.

Background: Even when there are free schemes of anthracyclines, the biological subtype HER2+ can be exposed to cardiotoxic drugs anthracyclines (A) and/or trastuzumab(H). It has been demonstrated that the LVEF is not sensitive to detect early cardiac changes and could be within normal ranges but with irreversible cardiac dysfunction. 2D speckle tracking and cardiac biomarkers (TnI and NT-proBNP) have shown more sensitivity to define early myocardial damage. Adjuvant trial FinHER suggests lower cardiotoxicity (0.5%) when taxanes (T)+H are given before A. Our objectives were: 1)To show higher sensitivity of the longitudinal strain in the echo to detect cardiotoxicity compared to the LVEF 2)To describe if there are any differences in the cardiotoxicity in relation with the chemotherapy sequence used. Patients and methods: A retrospective cohort of patients diagnosed with breast cancer from February 2008 to January 2016 was obtained, in which 46 patients with HER2 positive breast cancer were included, most in the context of neoadjuvant or adjuvant chemotherapy treated with sequential chemotherapy (A→T+H vs T+H→A), with a cumulative dose of 240 mg/m2 of doxorubicin. A basal echo was done, as well at 3, 6, 9, 12 months after the beginning of the chemotherapy to determine LVEF and early cardiac damage parameters, such as longitudinal strain. Cardiotoxicity was determined with a symptomatic HF with a decline of LVEF >5% or LVEF ≤55% or asymptomatic HF with a decline ≥10% or in LVEF or LVEF ≤55%. A fall ≥15% was considered a significant decline of the longitudinal strain Results: 1 patient (2.1%)presented symptomatic HF (NYHA III). Asymptomatic cardiotoxicity was present in 9 patients (19.6%), 9 (19.6%), 11 (23.9%), and 13 (28.3%) at the 3, 6, 9, and 12 months respectively. The mean LVEF were (66±6.6), (63±9.0), (65±7.0), (65±6.4), and (63±6.9) at the basal, 3, 6, 9, and 12 months measurements respectively, with a non-significant “p” value. Significant decline in the longitudinal strain was observed in 10 patients (21.7%, p=0.012), in 13 patients (28.3%, p=0.034), in 15 patients (32.6%, p=0.95), and in 18 patients (39.1%, p=0.07), at the 3, 6, 9, and 12 months measurements respectively. When comparing the cardiotoxicity group vs the non cardiotoxicity groups no significant differences were observed with other risk factors as: HTN, dyslipidemia, carbohydrate intolerance, DM, radiotherapy, weight, cumulative doses of A, systolic-diastolic BP, glc levels, HDL, TG, and BMI. In the logistic regression analysis the longitudinal strain decline (≥15%) basal vs 3 months measurement had a OR 7.63 CI 95%(1.04-55.86) and the A→T + H sequence OR 7.7 CI 95%(1.076-55.43), were kept as independent variables for cardiotoxicity. Conclusions: As reported in literature the decline in the longitudinal strain was more sensitive than the LVEF to predict cardiotoxicity, thus this would allow to identify the highest risk individuals and to start a cardioprotective intervention. Due to the retrospective character of our study, we believe that in the neoadjuvant or adjuvant chemotherapy setting of sequential chemotherapy there is the need of prospective studies that evaluate the subclinical cardiotoxicity with more sensitive parameters to confirm our data. Citation Format: Pérez-Montessoro V, Poblano-Aguilar I, Galindo-Uribe J, Vásquez-Ortiz Z, Armengol-Alonso A. HER2 positive breast cancer and subclinical cardiotoxicity by echocardiogram 2D Strain, Do chemotherapy sequence matter? [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P2-11-06.

The discovery that the metabolism of cancer cells is different from non-malignant cells is not new, this finding was described more than a century ago by O. Warburg. Nevertheless, in the last decade the technologies such as capillary electrophoresis, mass spectroscopy (MS), and proton nuclear magnetic resonance spectroscopy (H-NMR) have allowed deciphering the complexity and heterogeneity underlying the cancer metabolism. These high-performance technologies are generating a large amount of data that requires conceptual schemes and approaches to efficiently extract and physiologically interpret the dynamic spectrum of the metabolome data in cancer samples. Breast cancer is a disease that highlights the need to develop computational schemes to systematically explore the metabolic alterations that support the malignant phenotype in human cells. Hence, systems biology approaches with capacities to integrate in silico modeling and high-throughput data are very attractive for clinicians to make oncological treatment decisions combined with static parameters such as clinical and histopathological variables. In this chapter we present a cutting-edge review, perspectives and scope of how metabolic approaches in breast cancer studies can be used not only to integrate the local and systemic response of the host, but also as a technique to look for metabolic biomarkers by non-invasive and simpler sample procedure in biofluids such as serum, saliva, urine, pleural fluid, breath, and ascites. We discuss how the “metabolic phenotype” approach could contribute to developing a personalized medicine by combining metabolome data and computational modeling to evaluate some clinical variables such as detection of relapses, monitoring and response prediction to treatment and toxicity prediction in patients. Even though some advances have been accomplished, in practice there are many challenges and limits that will have to be broken before the metabolomics can be integrated into the day-to-day clinic. Despite this situation, it is evident that the translational multidisciplinary approach combined with the rapid technological development and the correct data interpretation will bring in the future tools for improving outcomes in the clinical area.

Background: In Mexico 60% of newly diagnosed BC patients present with locally advanced disease. In the United States, 88-95% of patients present with early stage disease, however in Mexico, only 10% of patients are diagnosed at this stage. The Seguro Popular (SP), a national insurance scheme for Mexico's poor and uninsured population, was implemented for BC in 2007. The SP covers diagnostics, local and systemic treatment for BC patients. The INCMNSZ is a third level hospital where patients receive diagnosis and treatment for non-malignant diseases, and also routinely conducts BC annual mammography screening for women ≥ 50 years old. We aimed to evaluate BC outcomes in our patients following the implementation of SP at our institution. Methods: From January 2011 to May 2013, we prospectively evaluated a cohort of 93 patients with BC included in the SP program at the INCMNSZ. A retrospective cohort of 99 patients without SP access who received neoadjuvant chemotherapy from January 2007 to December 2009 was used for comparative analysis. Complete pathologic response (pCR) was defined as complete absence of invasive tumor in breast and axillary nodes. We used Fisher's exact test to compare pCR between groups. Results: A total of 93 patients were diagnosed with BC and included in the SP program. 10 patients were excluded from the analysis- (5 were lost to follow-up and 5 had missing data. Median age was 52 (46-59) years and 37 patients (45%) were premenopausal at diagnosis), median follow up 11.8 months. 20 patients (24%) had stage I, 36 (43%) stage II, 7 (8%) stage III, and 20 (24%) stage IV. 55 (66%) patients had hormone receptor (HR) positive (ER + and/or PR+), 15 (18%) HER2+ and 13 (16%) had triple negative (TN) tumors. Thirty-two (39%) patients received neoadjuvant chemotherapy. 27% of patients achieved pCR (17% in HR positive, 20% in TN and 50% in HER2+ tumors) compared to 15% in the non SP cohort (11% in HR positive, 22% in TN and 14% in HER2+ tumors). HER2+ tumors from the SP cohort reached significantly higher pCR rates than in the non SP cohort (p = 0.029). Discussion: Our results confirmed that about half of our patients were diagnosed with early stage BC, which highlights the importance of a screening program at our institution. Increased pCRs in the HER2+ subgroup may reflect wider access to trastuzumab after implementation of SP. Although we acknowledge a short period of follow-up in our cohort, our results in pCR are comparable to those previously reported in the literature. We believe the SP had a positive impact on access to care and outcomes in our patients. Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-09-08.

PTP1B is involved in the oncogenesis of breast cancer. In addition, neoadjuvant therapy has been widely used in breast cancer; thus, a measurement to assess survival improvement could be pathological complete response (pCR). Our objective was to associate PTP1B overexpression with outcomes of breast cancer patients who underwent neoadjuvant chemotherapy. Forty-six specimens were included. Diagnostic biopsies were immunostained using anti-PTP1B antibody. Expression was categorized as negative (

122 Background: Worldwide there is an increasing number of cancer survivors (CS); in the United States in 2016 there were more than 15 million CS and are predicted to increase to 20 million in 2026. In Mexico (GLOBOCAN 2012), new cancer cases were 148.000 and at least 69.000 will survive. Therefore, it is necessary to focus on cancer survivor’s quality of life (QOL) and its effects in social aspects. Methods: A cross-sectional study was performed including 205 CS with history of non-metastatic cancer (aged ≤65 years, ≥ 2 years from diagnosis and off chemo- or radiotherapy). The QOL-CS questionnaire developed by City of Hope Medical Center was used to measure QOL. Participants reported employment and marital status changes during or after cancer treatment. The aim of this study was to evaluate QOL in CS and its association with employment and marital status. A multivariate logistic regression analysis was conducted to estimate odds ratios (OR). Results: Of the 205 CS 70.2% were women and 29.8% men. Median age at the time of the study was 56 years. Median survival time from diagnosis was 83.6 months. 37.1% had history of invasive breast, 18% colorectal and 8.8% testicular cancers. Disease-related marital status changes presented in 15.6%, 26.8% lost or changed work and 36.6% decreased their work hours. Distress about initial diagnosis, cancer treatment, family and financial burden had the worst score in the QOL-CS. We found no differences in QOL between gender, income, age at diagnosis or type of tumor, but having received chemotherapy was associated with worst QOL (OR 7.33 CI 95% 1.99-26.96 p = 0.003) as well as self-reported neuropathy (OR 2.34 CI 95% 1.06-5.19 p = 0.032). Those with low QOL-CS scores (≤6) were more likely to have a disease-related change in employment (OR 2.34 CI 95% 1.19-4.61 p = 0.014). Disease-related marital status changes were higher in who experienced work status variations (OR 3.87 CI 95% 1.21-12.4 p = 0.023). Conclusions: this is one of the first studies in Mexican CS that associate QOL with relevant social roles. In this cohort having received chemotherapy has the greatest impact in QOL. CS with low QOL were more likely to have changes in employment and therefore, in the marital status.

Lymphomas are a heterogeneous group of lymphoproliferative disorder. Treatment of these patients includes chemotherapy and bone marrow transplantation depending on the disease’s sub-type and clinical stage. Autologous bone marrow transplantation has been performed in Mexico at the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran in Non Hodgkin Lymphomas (NHL) and Hodgkin Lymphomas (HL) patients with a poor prognosis during the past 11 years, with a modified BEAM conditioning regimen. The estimated 5-year survival was 65% (91% in HL and 78% in NHL) and disease-free survival 51%, values similar to other published series. T-cell lymphomas were analyzed separately, yielding a DFS and OS of 73% and 73%, respectively. These results are higher to that reported by other groups. In summary, patients with high risk lymphoma can be salvaged with HSCT with a modified conditioning regimen that allows minimize cost and time in developing countries.

e18566 Background: Chronic myelomonocytic leukemia (CMML) is the most aggressive of chronic leukemias, with a short overall survival and a high transformation rate to acute leukemia. We investigated factors related to blastic transformation in Mexican population treated in a tertiary referral center Methods: Records of patients diagnosed with CMML between 2000-2015 were reviewed; patients with incomplete data were excluded. IBM SPSS Statics 21.0 software was used to perform statistical analysis. Results: 54 patients were included, with a median age of 71 years and an overall survival of 16 months. The rate of blastic transformation found was 33% (18 patients), with a time to progression of 9 (0-87) months. Comparing patients who didn’t underwent blastic transformation to those who did, those who progress to acute leukemia tend to be younger (58 vs. 71 years, p = 0.001), have a higher peripheral blood blast count (2% vs. 0%, p = 0.003), where more likely to have immature myeloid precursors circulating in peripheral blood (94% vs. 64%, p = 0.02). In multivariate analysis, age continued to be statistically significant (HR 0.97, 95% IC = 0.929-0.987). There where no statistical difference in the two groups regarding hemoglobin levels (8.2g/dL vs. 10.1g/dL) platelets count (115 X 109 vs. 93 X 109), absolute neutrophil count (5.83 X 109 vs. 5.18 X 109), absolute monocyte count (3.09 X 109 vs. 2.680 X 109), and bone marrow blast count (0 vs. 2%). Cytogenetic considered as high risk was not predictor of blastic progression. Intensive chemotherapy was offered to 7(38.9%) patients, with a complete response rate of 0%, the overall survival was 1.4 months (0-9). Conclusions: Contrary to other reported series;Mexican patients with CMML that progresses to overt acute leukemia were considerably younger, with a higher tumor burden and a very short overall survival. In this population, it is important to consider more aggressive treatments at diagnosis, focusing in high dose chemotherapy and hematopoietic stem cell transplantation in a short term ratter than watching and waiting or using agents that do not impact in disease natural history.

e18166 Background: Watson for Oncology (WFO) is a Memorial Sloan Kettering trained cognitive computing system designed to extract structured and unstructured data from medical records; ingest a large body of published evidence and guidelines; and provide evidence-based treatment options tailored to an individual patient. In Mexico, 160,000 new cases of cancer are diagnosed per year, causing almost 80,000 deaths. 70% of cases are diagnosed at a late stage (Secretariat of Health, 2016). Given the burden of cancer on morbidity and mortality in Mexico, WFO was evaluated as a potential tool to help oncologists select treatment options for their patients. Our objective was to gain feedback on the experience of using WFO in a Mexican population by a panel of local oncology experts, retrospectively comparing their treatment recommendations to the options provided by WFO. Methods: Patient cases with lung, breast, gastric, colon and rectal cancer diagnosed within the last 5 years were included. Physician users were asked to describe the perceived utility of WFO and to compare the treatment options proposed by WFO with local treatment decisions and guidelines. Results: A total of 100 cases were processed using WFO. Oncologists found WFO to be very useful. They felt that it would be particularly beneficial in clinics that lack subspecialist expertise, and for training medical students and residents. Differences between WFO recommendations and those of the Mexican oncologists were attributed primarily to limited access to high-cost therapies in Mexico and differences between U.S. and Mexican cancer treatment guidelines. Conclusions: WFO is a cognitive computing tool that has the potential to improve the consistency, efficiency, and overall quality of cancer care in Mexico. By surfacing relevant literature and evidence, WFO may provide support for coverage of effective yet high-cost therapies.

Background: Breast cancer (BC) Her2 + patients are exposed to cardiotoxic drugs [Trastuzumab (T) and/or Anthracyclines (A)]. LVEF is not sensitive to detect early cardiac changes related to cardiotoxicity (Ctx). 2D speckle tracking and cardiac biomarkers have shown more sensitivity to detect early

The natural history of HR+ breast cancer tends to be different from hormone receptor-negative disease in terms of time to recurrence, site of recurrence and overall aggressiveness of the disease. The developmental strategies of hormone therapy for the treatment of breast cancer have led to the classes of selective estrogen receptor modulators, selective estrogen receptor downregulators, and aromatase inhibitors. These therapeutic options have improved breast cancer outcomes in the metastatic setting, thereby delaying the need for chemotherapy. However, a subset of hormone receptor-positive breast cancers do not benefit from endocrine therapy (intrinsic resistance), and all HR+ metastatic breast cancers ultimately develop resistance to hormonal therapies (acquired resistance). Considering the multiple pathways involved in the HR network, targeting other components of pathologically activated intracellular signaling in breast cancer may prove to be a new direction in clinical research. This review focuses on current and emerging treatments for HR+ metastatic breast cancer.

Hepatocellular carcinoma (HCC) is one of the most common malignancies leading to high mortality rates in the general population; in cirrhotic patients, it is the primary cause of death. The diagnosis is usually delayed in spite of at-risk population screening recommendations, i.e., patients infected with hepatitis B or C virus. Hepatocarcinogenesis hinges on a great number of genetic and molecular abnormalities that lead to tumor angiogenesis and foster their dissemination potential. The diagnosis is mainly based on imaging studies such as computed tomography and magnetic resonance, in which lesions present a characteristic classical pattern of early arterial enhancement followed by contrast medium “washout” in late venous phase. On occasion, when imaging studies are not conclusive, biopsy of the lesion must be performed to establish the diagnosis. The Barcelona Clinic Liver Cancer staging method is the most frequently used worldwide and recommended by the international guidelines of HCC management. Currently available treatments include tumor resection, liver transplant, sorafenib and loco-regional therapies (alcoholization, radiofrequency ablation, chemoembolization). The prognosis of hepatocarcinoma is determined according to the lesion’s stage and in cirrhotic patients, on residual liver function. Curative treatments, such as liver transplant, are sought in patients diagnosed in early stages; patients in more advanced stages, were not greatly benefitted by chemotherapy in terms of survival until the advent of target molecules such as sorafenib.

Aim: The IR has been associated with increased risk of breast cancer (BC) and as a poor prognostic factor for relapse and survival. There is a lack of prospective studies that have reviewed the impact of IR across the NAC time and the likelihood of pCR. We determined the association between IR by HOMA2 (homeostasis model assessment) and pCR in LIBC. Methods: It was a prospective cohort, multicenter study. From 2012 to 2013, 64 patients were enrolled. Metabolic syndrome (MS) diagnosis was made by ATP III criteria. Insulin and glucose were measured at baseline and every 3 weeks during NAC. The IR was calculated by HOMA2 –IR.® Cut off value to define IR: HOMA2 ≥1.9. pCR (breast + nodes) was defined as no residual IBC. Results: Median age was 49 years. Axillary nodes were involved in 37 (57.8%). cTNM stage was II 50 (78.1%) and III 14 (21.8%). pCR (full cohort) was 37.5%. pCR in luminal A/B-like, triple negative and HER2 was 15.6%, 61.1% and 57.1% respectively. 25% had MS at baseline and up to 40% (final evaluation). At baseline 29 (45.3%) had IR and in final 34 (53.1%) (p = 0.005). We observed a gradual and almost linear increase of IR during the NAC time (p = 0.019). The group without IR (baseline) had a higher likelihood of pCR (HR 3.1, 95% CI 1.3-7.3). In the pCR group the HOMA2 remained below or slightly above 1.9 and with no changes over time (p = 0.225). Inversely in the no pCR group the IR increased over time and almost with a linear trend (p = 0.013). In a repeated measures analysis of HOMA2 over NAC time in the three biological subgroups, differences were observed only in luminal-like (p = 0.044). Comparing quartiles (Q1-2 vs Q3-4), basal insulin (p =0.018) and basal HOMA2 (p = 0.032) were significantly associated with pCR. In an adjusted logistic regression analysis for pCR, the IR remained as an independent factor for pCR (p = 0.018). Conclusions: We found a strong association between the status of IR and the likelihood of pCR in neoadjuvant setting of BC. To our knowledge this is the first prospective study describing the natural history of IR across time of the NAC. The IR increased over time of the NAC and the pCR likelihood is inversely associated with IR. Our findings suggest that the increase in central adiposity during NAC time produces a greater insulin resistance and thereby a cell proliferative environment resulting in a lower response to NAC. Disclosure: All authors have declared no conflicts of interest.

Background The BMI is a clinical parameter that although not perfect is often used to measure adiposity. In breast cancer there are multiple studies indicating that overweight/obesity (O/O) is related with lower survival and increased risk of relapse. It has been also reported less likely to achieve a pathological complete response (pCR) after neoadjuvant chemotherapy (NAC) in O/O patients. Methods We retrospectively reviewed the records of 108 patients diagnosed with invasive locally advanced breast cancer (ILABC) who had been treated with NAC (anthracycline + taxane ± trastuzumab). The aim of our study was to review the impact of BMI on the pCR and the possibility of recurrence. pCR was defined as the criterion of strict pCR breast+nodes. Results From 2004 to 2011, 108 patients received NAC. Based on their weight and height at baseline we divided into two groups; group 1: underweight/normal (BMI Conclusions Despite the retrospective nature of this study we can conclude that the patients with ILABC and O/O have a high risk for relapse and decreased response to NAC. It requires well-designed prospective studies to control confounding factors (dose intensity, chemotherapy regimens, changes in BMI) to get clear answers of these associations. Disclosure All authors have declared no conflicts of interest.

e15567 Background: Primary debulking surgery is considered the standard of treatment in advanced ovarian cancer (AOC) while neoadjuvant chemotherapy is used in non resectable stages. Methods: We retrospectively analyzed 68 AOC cases from January 2000 to December 2011. 35 received neoadjuvant chemotherapy (NAC) while 33 were resected primarily and received adjuvant chemotherapy (AC). To compare both groups we used T standard test and 2 sided chi -squared. Non parametric variables were analyzed with U Mann – Whitney. Overall survival(OS) was analyzed using Kaplan Meier method with log rank test. We considered statistically significant p-26 months for neoadjuvant and 27+/- 35 months for primary surgery (p=0.56). In a subgroup analysis of patients who received 6 neoadjuvant cycles vs perioperatory chemotherapy (3 pre and 3 postoperatory) we observed a significant survival difference, with a median of 62 months (95% CI 12-38) vs 12 months (95% CI 54 – 178) respectively (p=0.010). Conclusions: Non inferior survival or differences in surgical outcomes were observed with neoadjuvant therapy. Significant survival increase was observed in patients who received complete chemotherapy schedule before surgery, this evidence allowed to design a prospective trial in our Institution.

e11048 Background: Literature documents the relationship between diabetes mellitus (DM) and obesity (OB) with poor outcome in breast cancer. On the other hand, larger retrospective studies support ...