Background

Patients (pts) receiving chemotherapy for breast cancer experience toxicities impacting short and long-term quality of life (QOL). Within I-SPY 2, a trial adaptively randomizing stage II/III breast cancer pts to neoadjuvant chemotherapy +/- an investigational agent, we are collecting pt reported outcome (PRO) data to understand the impact of investigational agents on QOL. This PRO sub-study provides a unique opportunity to study QOL longitudinally and explore how pt and tumor characteristics, exposure to investigational therapies, and surgical outcome impact QOL.

Methods

Pts enrolled in this trial receive paclitaxel (T) +/- an investigational agent for 12 weeks followed by 4 cycles of doxorubicin and cyclophosphamide (AC). Surveys include the EORTC QLQ-C30 and BR-23, and PROMIS measures for QOL metrics including but not limited to physical function (PF), anxiety, and depression. Surveys are administered pre-chemotherapy to 2 years post-surgery. PF data from the EORTC and PROMIS instruments was analyzed for 238 pts at 5 sites (UCSF, UCSD, U of Pennsylvania, U of Minnesota, and Swedish Cancer Center). 48 pts completed baseline, inter-regimen (between T and AC), pre-operative and post-surgery surveys. Of the 48 pts 32 completed a 6-month follow up (FUP) and 31 completed a 1-year FUP survey. A linear mixed effect model, adjusting for HER2 status and treatment type was used to evaluate changes in PF over time. Sample size is small and statistics are descriptive rather than inferential.

Results

Median age of pts in this analysis was 50 (range 27-72).

Table 1 shows PROMIS & EORTC PF scores in this cohort.

Time Point     PROMIS EORTC 
    Mean SE Mean SE 
Pre-Treatment All 48 52.5 1.0 92.0 2.0 
  HER2+ 15 53.5 1.5 94.1 2.2 
  HER2- 33 52.1 1.3 91.1 2.8 
Inter-Regimen All 48 45.5 1.2 82.2 2.7 
  HER2+ 15 48.6 2.3 84.4 4.2 
  HER2- 33 44.1 1.3 81.2 3.4 
Pre-Surgery All 48 43.9 1.1 79.4 2.3 
  HER2+ 15 45.1 2.2 75.3 4.1 
  HER2- 33 43.4 1.3 81.3 2.8 
6-Month FUP All 32 48.1 1.4 87.4 1.9 
  HER2+ 12 47.5 2.2 85.0 3.3 
  HER2- 20 48.4 1.8 88.9 2.4 
1 Year FUP All 31 48.9 1.4 88.4 3.1 
  HER2+ 49.1 2.9 88.9 5.4 
  HER2- 22 48.8 1.7 88.3 3.8 
Time Point     PROMIS EORTC 
    Mean SE Mean SE 
Pre-Treatment All 48 52.5 1.0 92.0 2.0 
  HER2+ 15 53.5 1.5 94.1 2.2 
  HER2- 33 52.1 1.3 91.1 2.8 
Inter-Regimen All 48 45.5 1.2 82.2 2.7 
  HER2+ 15 48.6 2.3 84.4 4.2 
  HER2- 33 44.1 1.3 81.2 3.4 
Pre-Surgery All 48 43.9 1.1 79.4 2.3 
  HER2+ 15 45.1 2.2 75.3 4.1 
  HER2- 33 43.4 1.3 81.3 2.8 
6-Month FUP All 32 48.1 1.4 87.4 1.9 
  HER2+ 12 47.5 2.2 85.0 3.3 
  HER2- 20 48.4 1.8 88.9 2.4 
1 Year FUP All 31 48.9 1.4 88.4 3.1 
  HER2+ 49.1 2.9 88.9 5.4 
  HER2- 22 48.8 1.7 88.3 3.8 

At baseline, mean PROMIS PF scores were higher than the US average (mean = 50) but declined as expected throughout treatment. HER2+ patients experienced a similar degree of recovery as HER2- pts post-surgery despite adjuvant treatment with Herceptin. Analysis of post-operative PROMIS PF indicated an average score within the U.S. general population (mean =50) but did not return to higher functioning seen at baseline levels (mean 52.5, p-value < 0.05). Analysis of the EORTC PF sub-scale demonstrated a similar trend; however, the baseline and post-operative difference was not significant (p-value=0.15 for both FUP). Finding supports PROMIS PF ability to measure high functioning cancer patients.

Conclusions: Among a subset of pts who completed all surveys in the I-SPY 2 QOL substudy, PF did not return to baseline at 6-12 months post-operatively. Through transition to an electronic platform of data collection we hope to improve compliance with survey completion. We continue to analyze other QOL measures and plan to correlate QOL data with treatment arm, adverse events, comorbidities, and response to neoadjuvant treatment.

Citation Format: Shah M, Jensen R, Yau C, Straehley I, Berry DA, DeMichele A, Buxton MB, Hylton NM, Perlmutter J, Symmans WF, Tripathy D, Yee D, Wallace A, Kaplan HG, Clark A, Chien AJ, I-SPY 2 Investigators, Esserman LJ, Melisko ME. Trajectory of patient (Pt) reported physical function (PF) during and after neoadjuvant chemotherapy in the I-SPY 2 trial [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 P5-11-18.