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PurposeGANEA2 study was designed to assess accuracy and safety of sentinel lymph node (SLN) after neo-adjuvant chemotherapy (NAC) in breast cancer patients.MethodsEarly breast cancer patients treated with NAC were included. Before NAC, patients with cytologically proven node involvement were allocated into the pN1 group, other patient were allocated into the cN0 group. After NAC, pN1 group patients underwent SLN and axillary lymph node dissection (ALND); cN0 group patients underwent SLN and ALND only in case of mapping failure or SLN involvement. The main endpoint was SLN false negative rate (FNR). Secondary endpoints were predictive factors for remaining positive ALND and survival of patients treated with SLN alone.ResultsFrom 2010 to 2014, 957 patients were included. Among the 419 patients from the cN0 group treated with SLN alone, one axillary relapse occurred during the follow-up. Among pN1 group patients, with successful mapping, 103 had a negative SLN. The FNR was 11.9% (95% CI 7.3–17.9%). Multivariate analysis showed that residual breast tumor size after NAC ≥ 5 mm and lympho-vascular invasion remained independent predictors for involved ALND. For patients with initially involved node, with negative SLN after NAC, no lympho-vascular invasion and a remaining breast tumor size 5 mm, the risk of a positive ALND is 3.7% regardless the number of SLN removed.ConclusionIn patients with no initial node involvement, negative SLN after NAC allows to safely avoid an ALND. Residual breast tumor and lympho-vascular invasion after NAC allow identifying patients with initially involved node with a low risk of ALND involvement.

Resistance to endocrine therapy is a major complication of luminal breast cancer and studies of the biological features of hormonal resistance are limited by the lack of adequate preclinical models. The aim of this study is to establish and characterize a panel of primary human luminal breast carcinoma xenografts, and to evaluate their response to endocrine therapies. Four hundred and twenty-three tumor fragments obtained directly from patients have been grafted in the interscapular fatpad of Swiss nude mice. After stable engraftment with estradiol supplementation, xenografted tumors have been validated by conventional pathology and immunohistochemistry examination, and additional molecular studies. In vivo tumor growth and response to different endocrine treatments were evaluated. We have engrafted 423 tumors including 314 ER+ tumors, and 8 new luminal breast cancer xenografts have been obtained (2.5%). Tumor take was much lower for luminal tumors than for non-luminal tumors (2.5 vs. 24.7%, P  < 0.0001), and was associated with two independent criteria, i.e., ER status ( P  < 0.0001) and a high grade tumor ( P  = 0.05). Histological and immunohistochemical analyses performed on patient’s tumors and xenografts showed striking similarities in the tumor morphology as well as in the expression level of ER, PR, and HER2. Response to hormone therapy, evaluated in 6 luminal models, showed different sensitivities, thus exhibiting heterogeneity similar to what is observed in the clinic. We have established a panel of primary human luminal breast cancer xenografts, recapitulating the biological and clinical behaviors of patient tumors, and therefore suitable for further preclinical experiments.

Introduction/BackgroundThe RAIDs consortium (http://www.raids-fp7.eu/) conducted a prospective study [BioRAIDs (NCT02428842)] with the objectives to stratify patient populations as well as to identify clinical and molecular patterns associated with poor outcome. Debate is ongoing about the benefit of surgical staging prior to chemoradiation. Here we report on the value of diagnostic pelvic and para-aortal lymphadenectomy (LA) for patients scheduled for primary chemoradiation.MethodologyBetween 2013–2017, the RAIDs Network collected a clinical dataset involving 419 participant patients from 18 centers in seven EU countries, of whom 377 patients are evaluable. Treatment decisions had been based on guidelines defined in the clinical protocol as detailed in Ngo et al, 2015 and were also based on the policy of the center. Systematic MRI imaging was mandatory. LA as well as PET imaging was recommended. From 262 patients in stage IIB-IV who were scheduled for primary chemoradiation 126underwent LA.ResultsPatients who underwent surgical LA followed by chemoradiation showed better PFS at 24 months compared to those who did not. This difference was statistically significant (p-value of univariate : p=0.008). If we adjust with the FIGO, the effect of staging LA remains.ConclusionAlthough these data were collected retrospectively and might be biased we found that staging LA improved PFS also after adjusting for stage. These data are in line with literature and advocate for a randomized trial to proof the value of staging lymphadenectomy prior to chemoradiation for patients with high stage cervical cancer.DisclosureThis project has received funding from the European Union’s Seventh Program for research, technological development and demonstration under grant agreement No 30481.Abstract EP1217 Figure 1PFS curves: red line with LA, green line withoutAbstract EP1217 Table 1LA according to FIGO stagemultivariate hr 1c95% (hr) pvalue lymphadenectomy no LA/surgery plus LA 1 staging LA 0.52 0.32;0.83 0.006 figo 2018 1b-2a 1 2b-3a 1.42 0.51;3.90 0.50 3b-4 2.7 1.08;6.75 0.03

Les 40es Journées de la SFSPM se sont tenues à Avignon du 7 au 9 novembre 2018. Le thème abordé—Cancer du sein : optimisation du parcours de soins — a réuni plus de 1 200 participants sous les voûtes du Palais des Papes. La fluidité de chaque segment du parcours a été analysée en termes de risques de rupture de continuité des soins tant au sein du segment lui-même qu’en amont et en aval. Dans un parcours par essence pluridisciplinaire et plurimétiers, la nécessité d’une réflexion globale et d’une coordination active réalisées par des professionnels formés a été rappelée à chaque session. Chacun des intervenants a esquissé de potentiels indicateurs de qualité tenant compte à la fois de son implication dans son segment d’intervention, mais tenant compte aussi d’une vision plus globale de ce que devrait être le parcours au travers de la maladie et des soins. La parole a été très largement partagée entre soignants et associations de malades, entre paramédicaux et acteurs en sciences humaines et sociales, entre responsables de la santé publique HAS, ARS, CNAM–CPAM 84 et représentants des différents modes d’hospitalisation publique/privée et ESPIC. La session grand public a été l’occasion d’échanges fructueux et instructifs sur la perception des difficultés comme des satisfactions rencontrées que nous ont fait partager les malades, leurs proches et les représentantes des associations. Au total, un congrès de réflexion partagé par de nombreux acteurs qui cherchent tous à améliorer le parcours de soins des malades atteintes de cancer du sein. La publication le 21 janvier par l’INCa de dix indicateurs de qualité du parcours de soins pour les malades atteints de cancer du sein est une étape importante qu’attendaient tous les participants d’Avignon — SFSPM 2018. The 40th SFSPM conference was held in Avignon from 7 to 9 November 2018. The topics addressed—Breast Cancer: Optimisation of the Care Process — brought together more than 1,200 participants under the vaults of the Palais des Papes. The fluidity of each process segment was analysed in terms of risks to the continuity of care within the segment itself, and both upstream and downstream. In a multidisciplinary and multi-professional process, the need for global reflection and active coordination by trained professionals was emphasised at each session. Each speaker outlined potential quality indicators, taking into account both their involvement in their intervention segment and also taking into account a more global view of what the journey through illness and care should be. The talk time was widely shared between caregivers and patient associations, between medical paraprofessionals and stakeholders in the humanities and social sciences, between public health officials HAS, ARS, CNAM−CPAM 84 and representatives from the different modes of private public hospitalisation and ESPIC. The public session was an opportunity for constructive and informative exchanges about perceptions of both the difficulties and satisfactions encountered that patients, their relatives and representatives of associations shared with us. Overall, a conference for shared reflection between many stakeholders, all seeking to improve the care process for breast cancer patients. The INCa publication on 21 January covering 10 quality indicators of the care process for breast cancer patients is an important milestone eagerly awaited by all Avignon participants — SFSPM 2018.

The coronavirus SARS-CoV-2 (COVID-19) outbreak is having a profound impact on the management of patients with cancer. In this review, we comprehensively investigate the various aspects of cancer care during the pandemic, taking advantage of data generated in Asia and Europe at the frontline of the COVID-19 pandemic spread. Cancer wards have been subjected to several modifications to protect patients and healthcare professionals from COVID-19 infection, while attempting to maintain cancer diagnosis, therapy, and research. In this setting, the management of COVID-19 infected patients with cancer is particularly challenging. We also discuss the direct and potential remote impacts of the global pandemic on the mortality of patients with cancer. As such, the indirect impact of the pandemic on the global economy and the potential consequences in terms of cancer mortality are discussed. As the infection is spreading worldwide, we are obtaining more knowledge on the COVID-19 pandemic consequences that are currently impacting and may continue to further challenge cancer care in several countries.

Breast cancer (BC) is a major health concern affecting millions of women worldwide. This study (NCT04217109) explores canine odorology as a method for identifying BC using patient sweat samples. To collect the sweat samples, the night before biopsies, a compress is applied to the affected breast and the sample is subsequently presented to two trained dogs during the training or testing sessions. A positive cancer detection is indicated if a dog halts in front of the compress. A total of 181 patients participate, 107 with breast cancer (82 invasive and 25 in situ) and 74 with benign lesions. Sensitivity (Se) is 68% and specificity (Sp) 27% for a single randomly selected dog. When at least one dog marks a sample, Se rises to 80.4% but Sp drops to 21.6%. If both dogs mark it, Se is 48.6% and Sp 45.9%. Results show limited ability to distinguish benign from malignant lesions. Dogs perform best with mixed samples but struggle when all are negative, with variable responses between dogs. Identifying BC-specific volatile compounds may improve accuracy. Dog olfaction has been reported to detect different human diseases, including cancer. Here, the authors present a trial where two trained dogs are exposed to human sweat samples to identify breast cancer.

In most cases of cervical cancers, HPV DNA is integrated into the genome of carcinoma cells. This mutational insertion constitutes a highly specific molecular marker of tumor DNA for every patient. Circulating tumor DNA (ctDNA) is an emerging marker of tumor dynamics which detection requires specific molecular motif. To determine whether the sequence of the cell-viral junction could be used in clinical practice as a specific marker of ctDNA, we analyzed a series of cervical cancer patient serums. Serum specimens of 16 patients diagnosed with HPV16/18-associated cervical cancer, and for which the viral integration locus had been previously localized, were analyzed. Sequential serum specimens, taken at different times during the course of the disease, were also available for two of these cases. ctDNA was found in 11 out of 13 patients with tumor size greater than 20 mm at diagnosis, and analysis of sequential serum specimens showed that ctDNA concentration in patients serum was related to tumor dynamics. We report that HPV mutational insertion constitutes a highly specific molecular marker of ctDNA in HPV-associated tumor patients. Using this original approach, ctDNA was detected in most cervical cancer patients over stage I and ctDNA concentration was found to reflect tumor burden. In addition to its potential prognostic and predictive value, HPV mutation insertion is likely to constitute a new molecular surrogate of minimal residual disease and of subclinical relapse in HPV-associated tumor. This is of major importance in the perspective of specific anti-HPV therapy.

Background The current retrospective study was intended to obtain up-to-date and comprehensive data on surgical practice for breast cancer throughout France, including neoadjuvant chemotherapy (NAC) and the more recent surgical techniques of oncoplastic surgery (OPS). Methods In June 2011, e-mail surveys were sent to 33 nationally renowned breast cancer surgeons from French public or private hospitals. The questionnaire focused on all the new cases of breast cancer treated in 2010. It included questions regarding surgical practices, with special emphases on NAC and OPS and other surgical characteristics. Results The overall response rate for the survey was 72.7 %. The total number of breast cancer cases from the survey was 13,762, which constitutes 26.2 % of the total incidence in 2010. Breast-conserving surgery (BCS) was performed for 71.0 % of the patients, and the results were similar throughout the types of practices. Of these patients, 13.9 % received OPS, either upfront or after NAC. Mastectomy was performed for 29.0 % of the patients, which is consistent with French official numbers. Among all patients, 16.3 % underwent surgery after NAC. Conclusion To the authors’ knowledge, there are no publications of national figures on NAC or OPS rates to date. They are convinced that this study offers real-life surgical care information on a large population and covers France’s breast cancer surgical landscape. Mastectomy rates in France remain stable and consistent with those in other European countries. However, additional large-scale retrospective studies are required to confirm these figures and further explore NAC and OPS rates as well as surgical practice characteristics.

Background: The European Society of Breast Cancer Specialists (EUSOMA) has defined quality indicators for breast cancer (BC). The aim of this study was to describe the preoperative clinical pathway of breast cancer patients and evaluate the determinants of compliance with EUSOMA quality indicators in the Optisoins01 cohort. Methods: Optisoins01 is a prospective, multicentric study. Data from operable BC patients were collected, including results from before surgery to 1 year follow-up. Seven preoperative EUSOMA quality indicators were compared with the clinical pathways Optisoins01. Results: Six hundred and four patients were included. European Society of Breast Cancer Specialists targets were reached for indicator 1 (completeness of clinical and imaging diagnostic work-up), 3 (preoperative definitive diagnosis) and 5 (waiting time). For indicator 8 (multidisciplinary discussion), the minimum standard of 90% of the patients was reached only in general hospitals and comprehensive cancer centres. Having more than 1 medical examination within the centre was associated with an increased waiting time for surgery, whereas it was reduced by having an outpatient breast biopsy. The comprehensive cancer centre type was the only parameter associated with the other quality indicators. Conclusions: European Society of Breast Cancer Specialists quality indicators are a useful tool to evaluate care organisations. This study highlights the need for a standardised and coordinated preoperative clinical pathway.