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Background - Involvement of internal mammary lymph nodes (IMLN) in early breast cancer (EBC) leads to an upstaging of the disease anatomically. Unrecognized involvement of IMLNs leading to under-staging and under-treatment has been a hypothesis of studies demonstrating worse outcomes for medial tumours. Since surgery for removal of IMLNs is associated with high morbidity and radical surgical excision does not improve survival, surgical excision of IMLNs is not part of routine EBC treatment. Recent NCCN guidelines recommend IMLN irradiation for high risk EBC patients to reduce mortality. Metastasis to IMLNs may have a different impact on prognosis and management according to whether detected at the time of primary diagnosis, or later. Aims - The primary aim was to document the incidence of IMLN involvement in an EBC cohort - who underwent autologous deep inferior epigastric perforator (DIEP) flap reconstruction with unplanned sampling of 1 or more IMLNs - to ascertain the incidence of IMLN involvement. Our secondary aim was to ascertain whether IMLN involvement had an impact on management and/or prognosis. Materials and methods -We analyzed retrospectively collected data from a prospectively maintained database of patients who underwent DIEP flap reconstruction at the Royal Marsden Hospital, from April 2006 to March 2018. We used Freeman - Halton extension for Fisher’s test to assess association of IMN involvement with overall survival. Results - Of the 1471 women who underwent free flap reconstruction (1729 flaps) during this time period, 300 with EBC had their IMLNs sampled at the time of DIEP surgery. Of these, 36 had metastasis to their IMLN (incidence of 12%). The median age was 47 years and mean follow up was 34.5 months. Based on timing from initial diagnosis, 17 women had immediate DIEP flap reconstruction, 9 had delayed reconstruction (mean time from primary surgery 25 months) and 10 had reconstruction after mastectomy for loco-regional recurrence (7 at time of mastectomy for recurrence, 3 delayed). We compared outcomes for these 3 groups. Of these 36 patients, 19 had no preoperative staging and were staged only after they were found to have involved IMLNs. Four (2 in the delayed and 2 in the reconstruction after local recurrence group) of these 19 were found to have more widespread metastatic disease. Apart from these 4, based on IMLN involvement, treatment was altered in 17 others (total 21/36, 58.3%) - 8/17 in the immediate group, 7/9 in the delayed group and 2/8 for DIEP after local recurrence. The commonest alteration in treatment was addition of IMLN chain RT in 7 followed by change in endocrine therapy in 5; three had both. One patient who underwent immediate reconstruction had a negative SLN and had systemic adjuvant chemotherapy based solely on the involved IMLN. At a median follow up of 14 months, 12 patients (all either delayed or after local recurrence) of 19 relapsed with metastatic disease and 8 of them died due to disease progression. The local recurrence group had the highest rate of cancer-related mortality (p value < 0.0001) Conclusion - IMLN involvement leads to upstaging of the disease resulting in more significant change in treatment in those undergoing delayed autologous reconstruction. Local recurrence carries the worst prognosis. Staging prior to delayed DIEP surgery purely for reconstruction should be based on risk (from primary diagnosis) and all patients planned for DIEP reconstruction after local recurrence should undergo appropriate pre-operative staging investigations. Multivariate survival analysis using Cox’ proportional hazards model for those with involved versus uninvolved IMLNs to ascertain their prognostic significance will also be reported. Citation Format: Pooja Padmanabhan, Tania Policastro, Natalie To, Jennifer E Rusby, Stuart E James, Paul A Harris, Peter A Barry. The relevance of internal mammary lymph nodes found during autologous breast reconstruction [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P3-08-44.

Aim: This study aimed to identify predictive/prognostic factors in castration-resistant prostate cancer patients treated with cabazitaxel. Patients & methods: Patients were enrolled from March 2011 to December 2011 in an international expanded access program. In January 2012, when cabazitaxel became commercially available, a prospective study was initiated at University Federico II of Naples and at Rionero in Vulture Hospital. Results: Forty-seven patients were enrolled in this study. Patients received a median of nine cycles of cabazitaxel. Median progression-free survival was 7.0 months (95% CI: 5.7–8.0). Seventeen patients were still alive at the time of the analysis, with a median overall survival of 14 months (95% CI: 11–16). At multivariate analysis, a higher Gleason score (≥8) appeared to be associated with prolonged progression-free survival (hazard ratio: 0.36; 95% CI: 0.18–0.72); however, the higher Gleason score showed no statistical impact on overall survival. Conclusion: We hypothesize that the Gleason score has the potential to be incorporated in the clinical decision-making process for definition of treatment strategy in docetaxel-pretreated castration-resistant prostate cancer patients. We encourage further experimentation in this setting.

ABSTRACT: Aims: Carboplatin plus etoposide has modest efficacy in docetaxel-pretreated castration-resistant prostate cancer patients. We hypothesized that carboplatin–etoposide could still exert some therapeutic activity after docetaxel, cabazitaxel and either abiraterone or enzalutamide. Patients & methods: We enrolled 15 patients in the first step of a Phase II trial. The target sample size is 46 patients. The primary end point of the study was progression-free survival after 12 weeks. Results: The median progression-free survival was 11 weeks (range: 8–18), while median overall survival was 18 weeks (range: 12–26). Of seven patients with measurable disease, two had a partial response, two showed stable disease and the remaining three had progressive disease as the best radiological response. Five patients were considered progression-free after 12 weeks, prompting continuation of the trial. Conclusion: Our preliminary findings support the hypothesis that carboplatin plus etoposide may yield some clinical benefit in a population of patients who failed all currently approved therapeutic options for prostate cancer.

Prostate cancer is the most common non-cutaneous malignancy for men. The skeleton is the most common metastatic site but, following an improvement in survival, metastases in uncommon sites are being found more frequently in clinical practice, especially brain metastases. Despite the new drugs now available for metastatic castration resistant prostate cancer, no clinical evidence exists about their effectiveness on brain metastases. We describe the clinical history of 3 patients treated with cabazitaxel plus whole brain radiotherapy. These case reports demonstrate that cabazitaxel is highly active and well tolerated in brain metastases.

To evaluate the outcomes and potential prognostic factors in patients with non-acquired immunodeficiency syndrome (AIDS)-related Kaposi's sarcoma (KS).Patients with histologically proven non-AIDS-related KS treated with systemic chemotherapy were included in this retrospective analysis. In some cases, the human herpes virus 8 status was assessed by immunohistochemistry. The patients were staged according to the Mediterranean KS staging system. A multivariable model was constructed using a forward stepwise selection procedure. A P value0.05 was considered statistically significant, and all tests were two-sided.Thirty-two cases were included in this analysis. The average age at diagnosis was 70 years, with a male/female ratio of approximately 2:1. Eighty-four percent of the cases had classic KS. All patients received systemic chemotherapy containing one of the following agents: vinca alkaloid, taxane, and pegylated liposomal doxorubicin. Ten patients (31.5%) experienced a partial response, and a complete response was achieved in four patients (12.4%) and stable disease in sixteen cases (50%). Two patients (6.2%) were refractory to the systemic treatment. The median progression-free survival (PFS) was 11.7 mo, whereas the median overall survival was 28.5 mo. At multivariate analysis, the presence of nodular lesions (vs macular lesions only) was significantly related to a lower PFS (hazard ratio: 3.09; 95%CI: 1.18-8.13, P = 0.0133).Non-AIDS-related KS appears mostly limited to the skin and is well-responsive to systemic therapies. Our data show that nodular lesions may be associated with a shorter PFS in patients receiving chemotherapy.

e21500 Background: Classic Kaposi Sarcoma (CKS) is a rare and mild form of the disease that primarily affects men, older than 50 years in the endemic areas. Iatrogenic KS (IKS) is associated with the use of steroids, immunosuppressive agents in patients with autoimmune diseases, inflammatory disorders, or organ transplantation. We have conducted a retrospective analysis from January 2008 to December 2012 for CKS and IKS to evaluated outcomes and potential prognostic factors in this rare disease. Methods: Patients with histologically proven KS lesions of the skin and negative HIV-1/2 were enrolled. In some cases diagnosis was completed by immunohistochemical tests for HHV-8 staining. Eligible patients received different systemic chemotherapy for disease at stage IIb and in all variants of stage III and IV, according Mediterranean KS staging. Results: 32 cases of non-AIDS KS were identified in this study. Mean age at diagnosis of the group was 70 year-old. Approximate male/female ratio was 2:1. 78.2% of cases was classic KS. All patients received systemic chemotherapy containing one of this agent: alkaloid of vinca, taxane, pegylated lyposomial doxorubicin. Ten patients (31.5%) experienced a partial response, a complete response was achieved in 4 patients (12.4%) and stability in 16 cases (50%). Two patients (6.2%) developed multiple local recurrences. PFS was 11.7 months while OS resulted 28.5 months. At multivariate analysis nodular lesions were related to lower PFS compared to macular lesions (HR: 2,5817, 95% CI 1,2911 to 5,1624; p: 0,0049), and HHV8 status (positive vs. negative) had a statistically significant correlation with a worse response to treatment (HR: 5,0289 95% CI 1,6540 to 15,2901; p: 0,0046). Conclusions: Classic and iatrogenic KS patients appears less aggressive, mostly limited to the skin and well-responsive on local or systemic therapeutic strategies. Our data show as positivity to HHV8 and nodular lesions correlate with a worse response to treatment.

In the case presented here, everolimus was administered after first line therapy with sunitinib in a patient with metastatic renal cell carcinoma. The safety profile was excellent. The prolonged progression-free survival (PFS) obtained with everolimus in this case is of peculiar interest, as it is a multiple of the median PFS obtained in with everolimus in the regulatory trial. Such finding suggests that a subset of patients with renal cell carcinma may particularly benefit from everolimus.