Treatment Efficacy Score-continuous residual cancer burden-based metric to compare neoadjuvant chemotherapy efficacy between randomized trial arms in breast cancer trials.

BACKGROUND: Difference in pathologic complete response (pCR) rate after neoadjuvant chemotherapy does not capture the impact of treatment on downstaging of residual cancer in the experimental arm. We developed a method to compare the entire distribution of residual cancer burden (RCB) values between clinical trial arms to better quantify the differences in cytotoxic efficacy of treatments. PATIENTS AND METHODS: The Treatment Efficacy Score (TES) reflects the area between the weighted cumulative distribution functions of RCB values from two trial arms. TES is based on a modified Kolmogorov-Smirnov test with added weight function to capture the importance of high RCB values and uses the area under the difference between two distribution functions as a statistical metric. The higher the TES the greater the shift to lower RCB values in the experimental arm. We developed TES from the durvalumab + olaparib arm (n = 72) and corresponding controls (n = 282) of the I-SPY2 trial. The 11 other experimental arms and control cohorts (n = 947) were used as validation sets to assess the performance of TES. We compared TES to Kolmogorov-Smirnov, Mann-Whitney, and Fisher's exact tests to identify trial arms with higher cytotoxic efficacy and assessed associations with trial arm level survival differences. Significance was assessed with a permutation test. RESULTS: In the validation set, TES identified arms with a higher pCR rate but was more accurate to identify regimens as less effective if treatment did not reduce the frequency of high RCB values, even if the pCR rate improved. The correlation between TES and survival was higher than the correlation between the pCR rate difference and survival. CONCLUSIONS: TES quantifies the difference between the entire distribution of pathologic responses observed in trial arms and could serve as a better early surrogate to predict trial arm level survival differences than pCR rate difference alone.

An information system for improving clinical laboratory outcomes.

Laboratories performing clinical molecular diagnostic and cytogenetic testing require improved information systems to address their specialized data processing needs. We developed an application that automates result reporting, documents quality assurance information, and tracks specimens. While similar functionality was implemented in both the molecular diagnostic and cytogenetic modules, we present an outcome assessment of the cytogenetic laboratory's use of the system since it maintained a relatively constant number of personnel, test procedures, and samples over a three-year period. Upon implementation, significant reductions occurred in the time taken from receipt of sample to the release of the final report by 44% (P < 0.001) and 48% (P < 0.001) for peripheral blood and bone marrow samples, respectively. The number of cases processed per technologist increased by 26% (P = 0.017). We attribute these gains in quality improvement to the automation of clerical tasks and decision support provided by the information system.

CpG island arrays: an application toward deciphering epigenetic signatures of breast cancer.

CpG island hypermethylation is a frequent epigenetic event in cancer. We have recently developed an array-based method, called differential methylation hybridization (DMH), allowing for a genome-wide screening of CpG island hypermethylation in breast cancer cell lines (T. H-M. Huang et al., Hum. Mol. Genet., 8: 459-470, 1999). In the present study, DMH was applied to screen 28 paired primary breast tumor and normal samples and to determine whether patterns of specific epigenetic alterations correlate with pathological parameters in the patients analyzed. Amplicons, representing a pool of methylated CpG DNA derived from these samples, were used as hybridization probes in an array panel containing 1104 CpG island tags. Close to 9% of these tags exhibited extensive hypermethylation in the majority of breast tumors relative to their normal controls, whereas others had little or no detectable changes. Pattern analysis in a subset of CpG island tags revealed that CpG island hypermethylation is associated with histological grades of breast tumors. Poorly differentiated tumors appeared to exhibit more hypermethylated CpG islands than their moderately or well-differentiated counterparts (P = 0.041). This early finding lays the groundwork for a population-based DMH study and demonstrates the need to develop a database for examining large-scale methylation data and for associating specific epigenetic signatures with clinical parameters in breast cancer.

Integrating molecular diagnostic and flow cytometric reporting for improved longitudinal monitoring of HIV patients.

Studies have shown that monitoring HIV-infected patients undergoing antiretroviral therapy is best represented by combined measurement of plasma HIV-1 RNA and CD4+ T-lymphocytes [1]. This pilot study at the University of Missouri-Columbia integrates molecular diagnostic and flow cytometric data reporting to provide current and historical HIV-1 RNA levels and CD4+ T-cell counts. The development of a single database for storage and retrieval of these values facilitates composite report generation that includes longitudinal HIV-1 RNA levels and CD4+ T-cell counts for all patients. Results are displayed in tables and plotted graphically within a web browser. This method of data presentation converts individual data points to more useful medical information and could provide clinicians with decision support for improved monitoring of HIV patients undergoing antiretroviral therapy.