March 2012 Society of Surgical Oncology Poster Presentations

All,

Here is a synopsis of the poster presentations that pertain to our specific cancer. I have taken photos of each poster, and if anyone would like me to email them, please let me know. With an email, I can forward on the detailed data, i.e. graphs, pie charts, scans, etc. or upload to a doc and email the link.

Remember that this is very technical jargon. It is posted as it was found on the presentation materials.
In further postings I will attempt to attach all links for detailed info.

Thank you much!
Karen

<u><b>Poster 229</b></u>

<b>Phase 2 Trial Results for Sunitinib and Transarterial Chemoembolization (TACE) in Inoperable Hepatocellular Carcinoma. (HCC) </b>

Y.V. Wu, C.M. Tomaszewski, G.J. Fetterly, B. Kuvshinoff, A. Groman, N.W. Wilkinson, N.I. Khushalani, R.V. Iyer.
<i>Roswell Park Cancer Institute, Buffalo, NY.</i>

<b>BACKGROUND</b>

Hepatocellular cancer (HCC) is rapidly fatal vascular endothelial growth factor driven cancer. Both TACE and targeted anti-angiogenic therapies have been shown to improve outcomes in patients with inoperable HCC. High intratumoral pressure and vasucal permeability limits delivery of chemo during TACE. High VEGF expression correlates with poor response to TACE and neo angiogenesis occurs after TACE that promotes tumor growth and progression. Sunitinib, a potent inhibitor of VEGF driven antiogenesis, and vascular permeability may allow better delivery of TACE, and prevent neoangiogenesis after TACE.
Sunitinib is an oral small molecule tyrosine kinase inhibitor of VEGFR 1, 2, 3, PDGF alpha and beta, Flt3, KIT, CSF 1R and RET. Binding of sunitinib to VEGFRs has been correlated with decrease in the spliced variant of soluble VEGFR2 and circulating monocyte numbers, we examined these markers and correlated them with sunitinib pharmacokinetics (PK) and other clinical outcomes in this prospective trial.

<b>OBJECTIVES</b>

<b>Primary</b>
To estimate the Progression Free Survival (PFS) in patients with advanced inoperable HCC.
<b>Secondary</b>
To estimate the Overall Survival (OS), radiological response rate (RR) by RECIST, quality of Life using the FACT-HEP scale and toxicity of all pts on study.
<b>Correlative</b>
Correlation of clinical outcomes with functional imaging response assessed by DCE-MRI (Ktrans, AUC 90, % necrotic tumor), sunitinib PK, soluble VEGFR2 levels and monocyte numbers.

<b>ELIGIBILITY</b>
<u>Inclusion criteria</u>
1. Patients with histologically or biochemically confirmed HCC that is inoperable and involves 50% or less of the liver parenchyma.
2. Child Pugh Class A or B cirrhosis
3. ECOG performance status 0 or 1.
4. Adequate hematologic, hepatic and renal parameters (Platelets equal to or greater than 100K, Bilirubin less than or equal to 2mg/dl)
5. Written informed consent.

<b>DESIGN</b>
<u>Design</u>: This is a single arm, multicenter phase II trial. A total of 37 eligible patients will be enrolled.
<u>Treatment</u>: Cycle 1-Sunitinib 37.5mg PO QD days 1-7 followed by TACE with doxorubicin in lipiodol on day 8, continued sunitinib 37.5mg PO QD day 15-36 followed by 2 weeks off. Cycle 2 onwards- sunitinib 4 weeks on and 2 weeks off, with dose escalation to 50 mg in pts without any grade 3 toxicities in Cycle 1.

<b>RESULTS</b>
<u>Patient Characteristics</u>
Sixteen of the planned 37 pts were accrued between April 2007 and January 2011. The study was closed when sunitinib failed to show superiority to sorafenib in a large Phase 3 trial. Patient characteristics are summarized in Table 1.

<u>Clinical endpoints</u>
Median PFS was 8 mo (95% CL 4.3-9.3) and OS was 14.9 mo (95% Cl 6.3-27.1) with a median follow up of 12.8 months, and 5 patients still alive.

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A decrease in viable tumor at same timepoints was 3% (day and 15 % (day 36)

ROSWELL PARK CANCER INSTITUTE

<b><u>Poster 236</u></b>
<b> Significance of CEACAM6 Expression in Cholangiocarcinoma</b>
F.G. Rocha, J. Torres, N. Katabi, M. Gonen, R.P. DeMatteo, Y. Fong, M.I. D’Angelica, P.J. Allen, D.S. Klimstra, W.R. Jarnagin. <i>1. Virginia Mason Medical Center, Seattle, WA: 2. Memorial Sloan-Kettering Cancer Center New York, NY.</i>

<b>ABSTRACT</b>
<u>Background</u>: The entire biliary tree is at risk for malignant change, but little is known about differences in molecular pathogenesis with respect to anatomic site. CEACAM6 is a membrane protein involved in cell adhesion and signaling that is overexpressed in pancreatic adenocarcinoma and associated with poor prognosis. This study examines CEACAM6 expression in the entire spectrum of cholangiocarcinoma and its relationship to outcome.

<b><u>Poster 237</u></b>

<b>Are We Justified in Excluding Patients with Combined Hepatocellular-Cholangiocarcinoma from Transplantation?</b>

R.T. Groeschl, S.G. Pappas, K.K. Christians, S. Tsai, E.J. Quebbeman, T.C. Gamblin, K.K. Turaga. <i>Medical College of Wisconsin, Milwaukee, WI. </i>

<b>INTRODUCTION</b>
Although transplantation has demonstrated survival benefit for patients with hepatoceullular carcinoma [HCC], there is limited data to support or refute transplantation for combined hepatocellular-cholangiocarcinoma [cHCC-CC].
We hypothesized that patients with cHCC-CC had a poorer overall survival than patients with HCC after liver transplantation [LT]. we also examined the outcomes of partial hepatectomy [PH] for patients with HCC and cHCC-CC.

<b>RESULTS</b>
We included 3378 patients with HCC of cHCC-CC from the SEER database (table 1).
Patients undergoing LT for HCC had a significantly greater survival benefit at 3 years as compared to patients transplanted for cHCC-CC (78% vs 48%, p = 0.01 Table 2).
The number of cHCC-CC diagnoses annually from the SEER and UNOS datasets are shown in Figure 1.
OS for cHCC-CC patients by treatment type is shown in Figure 2.
Clinical characteristics and OS of the control cohort of 65 cHCC-CC patients from UNOS is shown in Table3.
In a multivariable model controlling for age and gender, LT for cHCC-CC was associated with a significantly greater hazard of death when compared to LT for HCC (hazard ration: 2.5, 95% Cl: 1.2-5.1, p = 0.01).

<b>CONCLUSIONS</b>

Patients with cHCC-CC had poorer overall survival than patients with HCC after transplantation.
Both transplant and resection offered similar survival benefit for patients with cHCC-CC. In an era of organ shortage, this supports liver resection as a viable treatment option for these patients.
Further research is needed to address the comparative benefits of systemic and liver-directed therapies for patients with cHCC-CC.

• This topic was modified 6 years, 6 months ago by karend.