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Barroso-Sousa R, Krop IE, Trippa L, Tan-Wasielewski Z, Li T, Osmani W, Andrews C, Dillon D, Richardson ET, Winer EP, Mittendorf EA, Schoenfeld JD, Tolaney SM. A phase II study of pembrolizumab in combination with palliative radiotherapy (RT) for hormone receptor-positive (HR+) metastatic breast cancer (MBC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.1047] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1047 Background: RT is frequently used for palliation in MBC. In animal models its use has been reported to induce distant (abscopal) tumor responses when combined with immune checkpoint inhibitors. Here, we report the safety and efficacy of palliative RT plus pembrolizumab in a phase II single-arm study in patients (pts) with HR+/HER2- MBC. Methods: Eligible pts had HR+/HER2- MBC, ECOG PS <2, indication for palliative RT, and ≥1 measurable lesion outside of the RT field; there was no limit on prior lines of therapy. A total RT dose of 20 Gray was delivered over 5 daily fractions. Pembrolizumab was given at 200 mg IV 2-7 days before day 1 of RT, then every 3 weeks until disease progression. The primary endpoint was objective response rate (ORR) outside the field of radiation by RECIST v1.1. Using the Simons “optimal” method, if ≥ 1/8 pts responded during the first stage, 19 more would be enrolled. If ≥ 3/27 responded, the null hypothesis (ORR=3%) would be rejected in favor of a 20% ORR. Predefined secondary endpoints included progression free survival (PFS) and toxicity. Analyses associating PD-L1 expression, tumor-infiltrating lymphocytes (TIL), and neutrophil/lymphocyte ratio (NLR) with outcomes were exploratory. Results: Eight women were enrolled into the first stage of the trial; no objective responses were seen, and the study was closed to further accrual. The median age was 59y (37-68y), 6 (75%) had ECOG PS 1, all had bone and 5 (63%) had liver metastases. The median number of prior cytotoxic therapies for MBC was 2 (range 0 to 8). While one patient had a PR by RECIST criteria, this patient experienced concurrent clinical progression. Two pts had SD < 16 weeks and 5 had PD as best response. The median PFS was 1.4 months (95% CI 0.4 – 2.1). All-cause adverse events occurred in 87.5% of pts (G3-4, 12.5%). TIL were available for 6 pts: 4 had ≤10%, and 2 > 10%. Among 5 pts with PD-L1 status available, 2 were positive. Six pts had NLR > 4. Conclusions: Pembrolizumab combined with RT was well-tolerated, and no unexpected adverse events were observed; however, clinical benefit of the combination was not demonstrated in this heavily pretreated HR+ population. Clinical trial information: NCT03051672.
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Affiliation(s)
| | | | - Lorenzo Trippa
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA
| | | | - Tianyu Li
- Dana Farber Cancer Institute, Boston, MA
| | | | | | | | | | | | - Elizabeth A. Mittendorf
- Division of Breast Surgery, Department of Surgery, BWH, Breast Oncology Program, Dana-Farber/Brigham and Women’s Cancer Center, Boston, MA
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Ma C, Hodi FS, Giobbie-Hurder A, Wang X, Zhou J, Zhang A, Zhou Y, Mao F, Angell TE, Andrews CP, Hu J, Barroso-Sousa R, Kaiser UB, Tolaney SM, Min L. The Impact of High-Dose Glucocorticoids on the Outcome of Immune-Checkpoint Inhibitor-Related Thyroid Disorders. Cancer Immunol Res 2019; 7:1214-1220. [PMID: 31088848 DOI: 10.1158/2326-6066.cir-18-0613] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2018] [Revised: 12/18/2018] [Accepted: 05/09/2019] [Indexed: 02/06/2023]
Abstract
Thyroid disorders have emerged as one of the most common immune-related adverse events (irAE), yet optimum management and biomarkers to predict vulnerable individuals remain to be explored. High-dose glucocorticoid (HDG) therapy is routinely recommended for irAEs. However, systematic analysis of the impact of glucocorticoid therapy on the outcome of immune-checkpoint inhibitor (ICI)-induced thyroid disorders is lacking. We analyzed 151 patients with or without ICI-related thyroid disorders. We divided the patients with ICI-related thyroid disorders into two subgroups: those with and without HDG treatment. Our results showed no significant differences between HDG and no HDG groups in terms of the median duration of thyrotoxicosis: 28 (range, 7-85) and 42 (range, 14-273) days, the median time to conversion from thyrotoxicosis to hypothyroidism: 39 days (range, 14-169) and 42 days (range, 14-315) days, the median time to onset of hypothyroidism: 63 (range, 21-190) and 63 (range, 14-489) days, and the median maintenance dose of levothyroxine: 1.5 (range, 0.4-2.3) μg/kg/day, and 1.3 (range, 0.3-2.5) μg/kg/day. The median pretreatment TSH was 2.3 (range, 0.3-5.2) mIU/L and 1.7 (range, 0.5-4.5) mIU/L in patients with and without ICI-related thyroid disorders, respectively. Baseline TSH was significantly higher in patients who developed ICI-related thyroid disorders (P = 0.05). Subgroup analysis revealed significantly higher baseline TSH in male but not in female patients with ICI-induced thyroid dysfunction. Our results show that HDG treatment did not improve the outcome of ICI-related thyroid disorders.
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Affiliation(s)
- Chanjuan Ma
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Endocrinology, Shanxi Provincial People's Hospital, Taiyuan, People's Republic of China
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anita Giobbie-Hurder
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Xiaocheng Wang
- Department of Medical Record & Statistics, Shanxi Provincial People's Hospital, Taiyuan, People's Republic of China
| | - Jing Zhou
- Department of Endocrinology, Shanxi Provincial People's Hospital, Taiyuan, People's Republic of China
| | - Amy Zhang
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ying Zhou
- Department of Endocrinology and Metabolism, China-Japan Friendship Hospital, Beijing, People's Republic of China
| | - Fei Mao
- Department of Endocrinology and Metabolism, Huashan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Trevor E Angell
- Division of Endocrinology, Diabetes and Metabolism, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Chelsea P Andrews
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Jiani Hu
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Le Min
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts.
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Min L, Ma C, Hodi FS, Giobbie-Hurder A, Barroso-Sousa R, Tolaney S, Kaiser U. OR19-5 The Impact Of High Dose Glucocorticoids On The Outcome Of Immune Checkpoint Inhibitor-related Thyroid Disorders And The Baseline TSH As A Predictive Biomarker. J Endocr Soc 2019. [PMCID: PMC6554839 DOI: 10.1210/js.2019-or19-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Thyroid disorders have emerged as one of the most common immune-related adverse events (irAEs) associated with immune checkpoint inhibitors (ICI) therapy, yet optimum management and biomarkers to predict vulnerable individuals remain unknown. High dose glucocorticoid (HDG) therapy is routinely recommended for irAEs. However, systemic analysis of the impact of glucocorticoid therapy on the outcome of ICI-induced thyroid disorders is lacking. Our study analyzed presentation of thyroid disorders caused by different ICIs and examined the effects of systemic HDG treatment on the outcome of thyroid disorders. We analyzed 151 patients with or without ICI-related thyroid disorders. We divided the patients with ICI-related thyroid disorders into two subgroups: HDG and no HDG treatment. We evaluated the effects of HDG on the duration of thyrotoxicosis, the converting time from thyrotoxicosis to hypothyroidism, the onset time of hypothyroidism, and maintenance dose of levothyroxine. We explored the association of baseline TSH level with ICI-related thyroid disorders. Our results showed there were no significant differences between HDG and no HDG groups in terms of the median duration of thyrotoxicosis: 28 (range: 7-85) and 42 (range: 14-273) days, the median time to conversion from thyrotoxicosis to hypothyroidism: 39 days (range: 14-169) and 42 days (range: 14-315) days, the median time to onset of hypothyroidism: 63 (range: 21-190) and 63 (range: 14-489) days, and the median maintenance dose of levothyroxine: 1.5 (range: 0.4 - 2.3) μg/kg/day, and 1.3 (range: 0.3 - 2.5) μg/kg/day. The median pretreatment TSH levels were 2.3 (range: 0.3 - 5.2) mIU/L and 1.7 (range: 0.5 - 4.5) mIU/L in patients with and without ICPi-related thyroid disorders, respectively. The baseline TSH levels were significantly higher in patients who developed ICPi-related thyroid disorders (P = 0.05). Our results show that HDG treatment did not improve the outcome of ICPi-related thyroid disorders and higher baseline TSH increased the risk for the development of ICPi-related thyroid disorders.
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Affiliation(s)
- Le Min
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States
| | - Chanjuan Ma
- Brigham and Women's Hospital, Boston, MA, United States
| | - F. Stephen Hodi
- Dana–Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | | | | | - Sara Tolaney
- Dana–Farber Cancer Institute, Harvard Medical School, Boston, MA, United States
| | - Ursula Kaiser
- Division of Endocrinology, Brigham Women's Hospital/Harvard Medical School, Boston, MA, United States
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Barroso-Sousa R, Barry WT, Guo H, Dillon D, Tan YB, Fuhrman K, Osmani W, Getz A, Baltay M, Dang C, Yardley D, Moy B, Marcom PK, Mittendorf EA, Krop IE, Winer EP, Tolaney SM. The immune profile of small HER2-positive breast cancers: a secondary analysis from the APT trial. Ann Oncol 2019; 30:575-581. [PMID: 30753274 PMCID: PMC8033534 DOI: 10.1093/annonc/mdz047] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Previous data suggest that the immune microenvironment plays a critical role in human epidermal growth factor receptor 2 (HER2) -positive breast cancer; however, there is little known about the immune profiles of small HER2-positive tumors. In this study, we aimed to characterize the immune microenvironment of small HER2-positive breast cancers included in the Adjuvant paclitaxel and trastuzumab for node-negative, HER2-positive breast cancer (APT) trial and to correlate the immune markers with pathological and molecular tumor characteristics. PATIENTS AND METHODS The APT trial was a multicenter, single-arm, phase II study of paclitaxel and trastuzumab in patients with node-negative HER2-positive breast cancer. The study included 406 patients with HER2-positive, node-negative breast cancer, measuring up to 3 cm. Exploratory analysis of tumor infiltrating lymphocytes (TIL), programmed death-ligand 1 (PD-L1) expression (by immunohistochemistry), and immune gene signatures using data generated by nCounter PanCancer Pathways Panel (NanoString Technologies, Seattle, WA), and their association with pathological and molecular characteristics was carried out. RESULTS Of the 406 patients, 328 (81%) had at least one immune assay carried out: 284 cases were evaluated for TIL, 266 for PD-L1, and 213 for immune gene signatures. High TIL (≥60%) were seen with greater frequency in hormone-receptor (HR) negative, histological grades 2 and 3, as well in HER2-enriched and basal-like tumors. Lower stromal PD-L1 (≤1%) expression was seen with greater frequency in HR-positive, histological grade 1, and in luminal tumors. Both TIL and stromal PD-L1 were positively correlated with 10 immune cell signatures, including Th1 and B cell signatures. Luminal B tumors were negatively correlated with those signatures. Significant correlation was seen among these immune markers; however, the magnitude of correlation did not indicate a monotonic relationship between them. CONCLUSION Immune profiles of small HER2-positive breast cancers differ according to HR status, histological grade, and molecular subtype. Further work is needed to explore the implication of these findings on disease outcome. CLINICAL TRIAL REGISTRATION clinicaltrials.gov identifier: NCT00542451.
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Affiliation(s)
| | - W T Barry
- Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | - H Guo
- Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston
| | - D Dillon
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - Y B Tan
- Department of Pathology, Brigham and Women's Hospital, Boston
| | | | | | - A Getz
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - M Baltay
- Department of Pathology, Brigham and Women's Hospital, Boston
| | - C Dang
- Breast Cancer Medicine Service, Department of Medicine, Solid Tumor Division, Memorial Sloan Kettering Cancer Center, New York; Department of Medicine, Weill Cornell Medical Center, New York
| | | | - B Moy
- Department of Hematology-Oncology, Massachusetts General Hospital, Boston
| | - P K Marcom
- Department of Medicine, Division of Medical Oncology, Duke Cancer Institute, Durham
| | - E A Mittendorf
- Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston; Breast Oncology Program, Dana-Farber/Brigham and Women's Cancer Center, Boston, USA
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Barroso-Sousa R, Shapiro GI, Tolaney SM. Personalized chemotherapy in triple-negative breast cancer: are we ready for prime time? Stem Cell Investig 2019; 6:4. [PMID: 30976601 DOI: 10.21037/sci.2019.02.01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 01/28/2019] [Indexed: 11/06/2022]
Affiliation(s)
| | - Geoffrey I Shapiro
- Early Drug Development Center, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Sara M Tolaney
- Breast Oncology Program and Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
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Garrido-Castro AC, Hughes ME, Cherniack A, Barroso-Sousa R, Bychkovsky BL, Di Lascio S, Berger A, Mittendorf EA, Files JL, Guo H, Kumari P, Cerami E, Krop IE, Wagle N, Lindeman NI, MacConaill LE, Dillon DA, Winer EP, Lin NU. Abstract PD9-01: Genomic alterations associated with loss of HR expression in metastatic breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd9-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Discordance in hormone receptor (HR) status between primary (p) tumors and metastatic (m) recurrences has been widely described. Loss of estrogen and progesterone receptor expression occurs in ˜12% of asynchronous recurrences, leading to triple-negative (TN) status in the metastasis. Genomic mechanisms driving HR loss and its prognostic and therapeutic implications have not been fully elucidated.
Methods: Targeted NGS (Oncopanel, OP) at Dana-Farber Cancer Institute using multiplexed copy number variation and mutation (mut) detection across the full coding regions of 300 genes and selected intronic regions of 35 genes was prospectively performed on either archival primary or metastatic samples collected in patients (pts) with metastatic breast cancer (MBC). Receptor status at initial diagnosis and recurrence were reviewed using a 1% cutoff to define HR-positivity and excluding HER2+ cases. Fisher´s exact test was used to compare frequency of alterations. Tumor mut burden (TMB) was computed normalizing the sum of reported exon mut in each pt by the exonic-bait-set size of the panel.
Results: Between 8/2013-9/2016, 929 pts with MBC underwent OP testing. Of 517 pts diagnosed with primary HR+/HER2- breast cancer, at time of recurrence 388 remained HR+/HER2- (pHR+/mHR+), 39 switched to HR-/HER2- (pHR+/mTN, of which 23 (59%) had initial HR expression >10%), 10 switched to HER2+ and 80 had unknown metastatic receptor status. Comparison between primary samples in pHR+/mHR+ (n=245) and pHR+/mTN (n=24) showed that pHR+/mTN was significantly more likely to harbor mut in TP53, STK11 and MSH6, amplifications (amp) in CCNE1 and FGFR2, and less likely to have PIK3CA mut or CCND1 amp. Median TMB in primary pHR+/mHR+ was 6.05 mut/Mb (0-37.5) and 5.68 mut/Mb (1.2-10.9) in pHR+/mTN (p=0.45). Metastatic samples in pHR+/mTN (n=15) were enriched in ARID1A, CRTC2 and CDH1 mut compared to metastases (n=40) in pts who remained TN (pTN/mTN). Deletions in CDKN2A/2B and RB1, and mut in TP53, NOTCH2 and ERCC2 were more prevalent in recurrent tumors of pHR+/mTN than pHR+/mHR+. In metastases, TMB was higher in pHR+/mTN than pTN/mTN or pHR+/mHR+ (10.9 vs. 7.0 vs. 7.3 mut/Mb, respectively; p=0.002). Median OS from initial diagnosis was 9.4 yrs in pHR+/mTN, less than pHR+/mHR+ (15.9 yrs; p=0.009) and greater than pTN/mTN (4.3 yrs; p=0.008). Median OS from MBC diagnosis was 1.8 yrs in pHR+/mTN, less than pHR+/mHR+ (6.4 yrs; p=0.001) but not significantly different than pTN/mTN (1.5 yrs, p=0.3).
pHR+/mHR+ (n=245)pHR+/mTN (n=24)p value NFreq (%)NFreq (%) MutTP536325.72083.3<0.00001PIK3CA9438.4000GATA33514.3000.053STK1152.0312.50.026MSH641.6312.50.017AmpFGFR20028.30.008CCNE10028.30.008CCND14418.0000.018
Conclusion: Targeted NGS shows that alterations in DNA damage and cell-cycle regulation pathways in primary HR+ tumors are associated with HR loss in the metastatic setting. Primary tumors that lose HR appear more similar to basal-like than luminal tumors, despite >10% baseline HR expression in most pts, and once metastatic, survival is comparable to pTN/mTN. Metastases with HR loss have higher TMB than those that remain HR+ or TN throughout the course of the disease. These findings, if confirmed, may influence treatment and pt selection for clinical trials.
Citation Format: Garrido-Castro AC, Hughes ME, Cherniack A, Barroso-Sousa R, Bychkovsky BL, Di Lascio S, Berger A, Mittendorf EA, Files JL, Guo H, Kumari P, Cerami E, Krop IE, Wagle N, Lindeman NI, MacConaill LE, Dillon DA, Winer EP, Lin NU. Genomic alterations associated with loss of HR expression in metastatic breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD9-01.
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Affiliation(s)
- AC Garrido-Castro
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - ME Hughes
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - A Cherniack
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - R Barroso-Sousa
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - BL Bychkovsky
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - S Di Lascio
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - A Berger
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - EA Mittendorf
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - JL Files
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - H Guo
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - P Kumari
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - E Cerami
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - IE Krop
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - N Wagle
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - NI Lindeman
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - LE MacConaill
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - DA Dillon
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - EP Winer
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
| | - NU Lin
- Dana-Farber Cancer Institute; Harvard Medical School, Boston, MA; Broad Institute of MIT and Harvard, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Dana-Farber Cancer Institute, Boston, MA; Brigham and Women´s Hospital; Harvard Medical School, Boston, MA; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, MA
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Barroso-Sousa R, Tyekucheva S, Pernas-Simon S, Exman P, Jain E, Garrido-Castro AC, Hughes M, Bychkovsky B, Di Lascio S, Umeton R, Files J, Lindeman NI, MacConaill LE, Hodi FS, Krop IE, Dillon D, Winer EP, Wagle N, Lin NU, Mittendorf EA, Tolaney SM. Abstract P5-12-02: PTEN alterations and tumor mutational burden (TMB) as potential predictors of resistance or response to immune checkpoint inhibitors (ICI) in metastatic triple-negative breast cancer (mTNBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-12-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: To date no biomarker has been identified that predicts response to ICI in mTNBC. This study aimed to explore if tumor genomic alterations correlate with efficacy of PD-1/PD-L1 inhibition in patients (pts) with mTNBC. Methods: Demographic, treatment response, and long-term outcome data were collected on patients with mTNBC treated at Dana-Farber Cancer Institute (DFCI) under several clinical trials incorporating PD-1/PD-L1 inhibitors, given as monotherapy or combined with chemotherapy (CT). Pts included in this analysis had available results of targeted exon sequencing performed using Oncopanel, our institutional gene sequencing panel, on archival tumor tissue. TMB was calculated by determining the number of non-synonymous somatic mutations that occur per megabase of exonic sequence data across all genes on the panel. High TMB was defined as 310 mutations/megabase. TMB and gene alterations were correlated with objective response rate (ORR) per RECIST 1.1, progression-free (PFS) and overall survival (OS). Results: A total of 50 pts with mTNBC were included in this analysis. At baseline, the median age was 55.9 years (31.8–75.9), 60% had ECOG 0 and 40% had ECOG 1, 72% had visceral metastasis, and 46% had received 31 prior lines of systemic therapy in the metastatic setting. While 26% of pts received monotherapy [pembrolizumab (n=7, NCT02447003); atezolizumab (n=6; NCT01375842)], 74% received combination with CT [pembrolizumab plus eribulin (n=31; NCT02513472); atezolizumab plus nab-paclitaxel (n=6; NCT01633970)]. PTEN alterations were present in 30% of pts (mutations = 7; one copy number loss = 7; two copy number loss = 1). Median follow-up was 14 months (1–40). Pts with tumors harboring PTEN alterations had lower ORR (7% vs 57%; P<0.001), shorter median PFS (2.3 vs 6.3 months; P=0.027), and shorter median OS (8.1 vs 20.1 months; P=0.012) compared to pts without PTEN alterations. The median TMB was 6.6 mut/Mb (1.2–50.8), and 23% of pts had a high TMB. While high TMB was not associated with higher ORR (P=0.56), it was associated with better median PFS (16.5 vs 2.4 months; P=0.017), and better median OS (not reached vs 13.5 months; P=0.026). Both PTEN status and TMB remained significantly associated with PFS in the multivariable model. Only PTEN status remained significantly associated with OS in the multivariable analysis with the same covariables. Ongoing analysis to better understand if these predictors are specific for predicting benefit to immunotherapy and/or a marker of chemotherapy resistance will be presented at the symposium. Conclusion: PTEN genomic alterations and TMB may impact benefit from PD-1/PD-L1 inhibitors largely administered with chemotherapy in mTNBC. These observations warrant prospective validation and may inform the importance of stratifying pts according to these characteristics in future randomized studies with ICI.
Table 1.Multivariable analysis for PFS Hazard ratioConfidence Intervalp-valueCombination therapy0.420.16 – 1.130.009Visceral metastasis1.310.63 – 2.770.46Previous lines of therapy1.020.09 – 0.700.85ECOG 12.11.06 – 1.280.034PTEN altered3.741.65 – 8.440.002Hypermutated tumors0.850.75 – 0.970.011
Citation Format: Barroso-Sousa R, Tyekucheva S, Pernas-Simon S, Exman P, Jain E, Garrido-Castro AC, Hughes M, Bychkovsky B, Di Lascio S, Umeton R, Files J, Lindeman NI, MacConaill LE, Hodi FS, Krop IE, Dillon D, Winer EP, Wagle N, Lin NU, Mittendorf EA, Tolaney SM. PTEN alterations and tumor mutational burden (TMB) as potential predictors of resistance or response to immune checkpoint inhibitors (ICI) in metastatic triple-negative breast cancer (mTNBC) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-12-02.
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Affiliation(s)
- R Barroso-Sousa
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - S Tyekucheva
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - S Pernas-Simon
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - P Exman
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - E Jain
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - AC Garrido-Castro
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - M Hughes
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - B Bychkovsky
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - S Di Lascio
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - R Umeton
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - J Files
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - NI Lindeman
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - LE MacConaill
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - FS Hodi
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - IE Krop
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - D Dillon
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - N Wagle
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - NU Lin
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - EA Mittendorf
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
| | - SM Tolaney
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medichal School, Boston, MA; Harvard T.H. Chan School of Public Health, Boston, MA; Broad Institute of MIT and Harvard, Cambridge, MA; Brigham and Women´s Hospital, Boston, MA; Oncology Institute of Southern Switzerland, Bellinzona, Switzerland; Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston
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Exman P, Garrido-Castro A, Hughes ME, Freedman RA, Ma C, Bose R, Cerami E, Wagle N, Barroso-Sousa R, Fitz CD, Lindeman NI, MacConaill L, Bychkovsky BL, Lloyd MR, Mackichan CR, Kumari P, Tolaney SM, Krop IE, Winer EP, Dillon DA, Lin NU. Abstract P4-04-02: Identifying ERBB-2 activating mutations (mts) in HER2 negative tumors for clinical trials – Impact of institute-wide genomic testing and trial matching on trial enrollment in clinical practice. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-04-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Tailored treatment trials with biomarker-driven hypotheses are becoming an important strategy in drug development. Umbrella, basket and enrichment trials with eligibility predicated upon results of tumor sequencing are increasingly common. Several institutional and commercial genomic assays have been developed. However, the value of broad-based testing in recruiting patients (pts) to molecular-based clinical trials designed for small subgroups has not been fully evaluated and has been challenging to assess in a real-world setting. We evaluated the likelihood of trial enrollment based upon an institute-wide genomic test.
Methods
Since 2013, all pts with metastatic breast cancer (MBC) seen at least once at Dana-Farber Cancer Institute have been offered the option of tumor sequencing using multiplexed copy number variation (CNV) and mts detection across the full coding regions of a total of 447 cancer genes and 191 regions across 60 genes for rearrangement detection (Oncopanel; OP). For our primary analysis, we selected the ongoing multi-center phase II trial (NCT01670877) activated at our site on Sep 30, 2013, evaluating neratinib in ERBB-2 mutated pts, as the study provided a clear delineation of eligible mts, and timing of slot availability was retrievable retrospectively over an extended time frame. Our primary aim was to describe the proportion of pts with a qualifying ERBB-2 mt detected by OP who enrolled on the selected trial. Secondary objectives included median time from OP result to trial registration and description of ERBB-2 mts spectrum within each subtype. Associations were calculated by Fisher's test.
Results
We identified a total of 1,046 pts with HER-2 negative MBC and who had OP results between Sep 1, 2013 and Jun 1, 2017. A total of 43 pts (4.1%) were found to have ERBB-2 mts. Of these, 20 (1.9%) had activating eligible mts. The proportion of these pts who enrolled in the trial was 30% (6/20). Of the remaining 14 pts, 5 screen-failed and 2 were enrolled with known ERBB-2 mt through other testing modalities. Seven of 20 (35%) molecularly eligible pts were not approached (3 pts lost to follow-up, 3 enrolled in other clinical trials and 1 pt chose standard treatment). The median time from OP result to trial enrollment was 85 days (34-554). A significantly higher frequency of ERBB2 activating mts was found in ER+ compared to ER- primary tumors (2.5% vs. 0.3%, p =0.036), and in lobular tumors compared with ductal (5.5% vs. 1.25%, p=0.003). Frequency of eligible mts in primary tumors were similar to metastatic site (1.9% and 1.8%, respectively p=1.0)
Discussion
In this cohort, activating ERBB-2 mts were present in 20 of 1046 (1.9%) pts tested. Although over half of pts with eligible mts on OP testing were approached for NCT01670877, only 0.5% of the total tested population were enrolled (6/1046). Our data illustrate the substantial challenges in screening and enrolling to trials of rare subsets, even within a large academic institution, and point to the need for creative and novel approaches to leverage pts and community- and academic-based providers to more effectively support the success of such studies.
Citation Format: Exman P, Garrido-Castro A, Hughes ME, Freedman RA, Ma C, Bose R, Cerami E, Wagle N, Barroso-Sousa R, Fitz CD, Lindeman NI, MacConaill L, Bychkovsky BL, Lloyd MR, Mackichan CR, Kumari P, Tolaney SM, Krop IE, Winer EP, Dillon DA, Lin NU. Identifying ERBB-2 activating mutations (mts) in HER2 negative tumors for clinical trials – Impact of institute-wide genomic testing and trial matching on trial enrollment in clinical practice [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-04-02.
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Affiliation(s)
- P Exman
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - A Garrido-Castro
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - ME Hughes
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - RA Freedman
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - C Ma
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - R Bose
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - E Cerami
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - N Wagle
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - R Barroso-Sousa
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - CD Fitz
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - NI Lindeman
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - L MacConaill
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - BL Bychkovsky
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - MR Lloyd
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - CR Mackichan
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - P Kumari
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - SM Tolaney
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - IE Krop
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - EP Winer
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - DA Dillon
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
| | - NU Lin
- Dana Farber Cancer Institute, Boston, MA; Washington University School of Medicine in St Louis, St. Louis, MO; Brigham and Women's Hospital, Boston, MA
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Chang LS, Barroso-Sousa R, Tolaney SM, Hodi FS, Kaiser UB, Min L. Endocrine Toxicity of Cancer Immunotherapy Targeting Immune Checkpoints. Endocr Rev 2019; 40:17-65. [PMID: 30184160 PMCID: PMC6270990 DOI: 10.1210/er.2018-00006] [Citation(s) in RCA: 280] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/07/2018] [Indexed: 12/13/2022]
Abstract
Immune checkpoints are small molecules expressed by immune cells that play critical roles in maintaining immune homeostasis. Targeting the immune checkpoints cytotoxic T-lymphocyte-associated protein 4 (CTLA-4) and programmed death 1 (PD-1) with inhibitory antibodies has demonstrated effective and durable antitumor activity in subgroups of patients with cancer. The US Food and Drug Administration has approved several immune checkpoint inhibitors (ICPis) for the treatment of a broad spectrum of malignancies. Endocrinopathies have emerged as one of the most common immune-related adverse events (irAEs) of ICPi therapy. Hypophysitis, thyroid dysfunction, insulin-deficient diabetes mellitus, and primary adrenal insufficiency have been reported as irAEs due to ICPi therapy. Hypophysitis is particularly associated with anti-CTLA-4 therapy, whereas thyroid dysfunction is particularly associated with anti-PD-1 therapy. Diabetes mellitus and primary adrenal insufficiency are rare endocrine toxicities associated with ICPi therapy but can be life-threatening if not promptly recognized and treated. Notably, combination anti-CTLA-4 and anti-PD-1 therapy is associated with the highest incidence of ICPi-related endocrinopathies. The precise mechanisms underlying these endocrine irAEs remain to be elucidated. Most ICPi-related endocrinopathies occur within 12 weeks after the initiation of ICPi therapy, but several have been reported to develop several months to years after ICPi initiation. Some ICPi-related endocrinopathies may resolve spontaneously, but others, such as central adrenal insufficiency and primary hypothyroidism, appear to be persistent in most cases. The mainstay of management of ICPi-related endocrinopathies is hormone replacement and symptom control. Further studies are needed to determine (i) whether high-dose corticosteroids in the treatment of ICPi-related endocrinopathies preserves endocrine function (especially in hypophysitis), and (ii) whether the development of ICPi-related endocrinopathies correlates with tumor response to ICPi therapy.
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Affiliation(s)
- Lee-Shing Chang
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Romualdo Barroso-Sousa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Le Min
- Division of Endocrinology, Diabetes, and Hypertension, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
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Barroso-Sousa R, Ott PA. Transformation of Old Concepts for a New Era of Cancer Immunotherapy: Cytokine Therapy and Cancer Vaccines as Combination Partners of PD1/PD-L1 Inhibitors. Curr Oncol Rep 2018; 21:1. [PMID: 30498900 DOI: 10.1007/s11912-018-0738-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
PURPOSE OF REVIEW Immune checkpoint inhibitors (ICI) are only effective in a subset of patients. Here, we will review the rationale and data supporting the combination of PD-1 pathway inhibition with recombinant cytokines and neoantigen-based cancer vaccines that can potentially increase the number of patients who will benefit from immunotherapy. RECENT FINDINGS The safety and tolerability of new interleukin(IL)-2 formulations, IL-15 super agonist, and PEGylated IL-10 have been evaluated in early phase clinical trials with promising efficacy data, both as monotherapy and in combination with ICI. Larger studies focusing on the efficacy of these combinations are ongoing. Personalized neoantigen-based cancer vaccines, enabled by improvements in sequencing computational capabilities, have been proven to be feasible, safe, and able to trigger a consistent vaccine-specific immune response in cancer patients. New pharmacologically modified recombinant cytokines and personalized neoantigen-based vaccines may turn these approaches into powerful tools for effective combination immunotherapy.
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Affiliation(s)
- Romualdo Barroso-Sousa
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Dana 2127, Boston, MA, 02215, USA
| | - Patrick A Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Dana 2127, Boston, MA, 02215, USA.
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Pernas S, Barroso-Sousa R, Tolaney SM. Optimal treatment of early stage HER2-positive breast cancer. Cancer 2018; 124:4455-4466. [PMID: 30291791 DOI: 10.1002/cncr.31657] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Revised: 05/16/2018] [Accepted: 07/15/2018] [Indexed: 01/20/2023]
Abstract
Significant advances have occurred in the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer that have changed its natural history. The addition of trastuzumab to standard therapy has dramatically improved the prognosis for patients with early stage, HER2-positive breast cancer to unprecedented survival outcomes. Yet, long-term follow-up data from adjuvant pivotal trials indicate that 15-24% of patients still develop recurrent disease. Most of the research has focused on the addition of novel anti-HER2 drugs to standard therapy, including studies evaluating the monoclonal antibody pertuzumab; the antibody-drug conjugate trastuzumab-emtansine (T-DM1); the selective, reversible HER2/epidermal growth factor receptor kinase inhibitor lapatinib; or the irreversible pan-HER2 inhibitor neratinib. Dual HER2 blockade has improved overall survival remarkably in metastatic breast cancer; however, in patients with early stage disease, it has led to small benefits in progression-free survival. Moreover, biologic heterogeneity within HER2-positive disease may determine response to treatment and prognosis. Different subgroups of patients with HER2-positive breast cancer may benefit from different therapeutic approaches. Thus, there is ongoing work to optimize and de-escalate treatment in patients who may do just as well with less therapy and can avoid unnecessary treatments and their related toxicities. The objective of this review is to summarize the background and latest evidence on the current management of early stage, HER2-positive breast cancer and to present novel perspectives on its management.
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Affiliation(s)
- Sonia Pernas
- Department of Medical Oncology, Institut Catala d'Oncologia-H.U.Bellvitge-IDIBELL, L´Hospitalet-Barcelona, Spain.,Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Maia MC, Pereira AAL, Lage LV, Fraile NM, Vaisberg VV, Kudo G, Barroso-Sousa R, Bastos DA, Dzik C. Efficacy and Safety of Docetaxel in Elderly Patients With Metastatic Castration-Resistant Prostate Cancer. J Glob Oncol 2018; 4:1-9. [PMID: 30241182 PMCID: PMC6180794 DOI: 10.1200/jgo.2016.007807] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose Limited data are available about the tolerability and clinical outcomes of
elderly patients with metastatic castration-resistant prostate cancer
(mCRPC) who are treated with docetaxel. We evaluated the efficacy and safety
of docetaxel as first-line chemotherapy for patients with mCRPC who were
treated in our institution. Materials and Methods We retrospectively identified patients with mCRPC and a Karnosfky performance
status of 60% or greater treated with docetaxel on any schedule as
first-line chemotherapy between 2008 and 2013. The primary end point was a
comparison of median overall survival (OS) according to age in this
population. Secondary end points were comparisons of the rates of severe
toxicities, prostate-specific antigen (PSA) decline of 50% or greater, and
time to progression (TTP). Results were stratified by three age groups:
younger than 65 years, 65 to 74 years, and 75 years or older. Results Among the 197 patients included, 68 (34%) were younger than 65 years, 85
(43%) were 65 to 74 years, and 44 (22%) were 75 years or older. The mean
number of comorbidities was not different among groups (1.19
v 1.32 v 1.43; P =
.54). Patients younger than 65 years received a higher cumulative dose of
docetaxel (450 mg/m2v 382 mg/m2v 300 mg/m2; P = .004). The
rates of PSA decline of 50% or greater (41% v 47%
v 36.4%; P = .51) and the median TTP
(5.13 v 5.13 v 4.7 months;
P = .15) were comparable among all groups. The median
OS was longer in the group of patients younger than age 65 years (19.6
v 12.4 v 12.3 months;
P = .012). Rates of any grade 3 or higher adverse event
were not different among groups (63.2% v 71.8%
v 54.5%; P = .14). Conclusion Administration of docetaxel in elderly patients who had good performance
status was well tolerated. Rates of PSA decline and TTP were similar to
those of younger patients, but median survival was lower.
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Affiliation(s)
| | | | | | | | | | - Guilherme Kudo
- All authors: Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Carlos Dzik
- All authors: Universidade de São Paulo, São Paulo, Brazil
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Barroso-Sousa R, Barry WT, Tolaney SM. Database Selection and Heterogeneity—More Details, More Credibility—Reply. JAMA Oncol 2018; 4:1295-1296. [DOI: 10.1001/jamaoncol.2018.1231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
| | - William T. Barry
- Department of Biostatistics and Computation Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sara M. Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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64
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Barroso-Sousa R, Guo H, Barry WT, Ferreira AR, Rees R, Winer EP, Wagle N, Tolaney SM. A phase I study of palbociclib (PALBO) plus everolimus (EVE) and exemestane (EXE) in hormone-receptor positive (HR+)/HER2- metastatic breast cancer (MBC) after progression on a CDK4/6 inhibitor (CDK4/6i): safety, tolerability and pharmacokinetic (PK) analysis. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Hao Guo
- Dana-Farber Cancer Institute, Boston, MA
| | | | - Arlindo R. Ferreira
- Oncology Division, Hospital de Santa Maria - Centro Hospitalar Lisboa Norte and Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal
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65
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Barroso-Sousa R, Barry WT, Kumthekar P, Guo H, Silvestri KM, Krop IE, Winer EP, Tolaney SM, Lin NU. A phase II study of atezolizumab (Atezo) combined with pertuzumab (P) and high-dose trastuzumab (H) for the treatment of central nervous system (CNS) metastases in patients with Her2-positive (HER2+) metastatic breast cancer (MBC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps1100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | - Hao Guo
- Dana-Farber Cancer Institute, Boston, MA
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66
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Barroso-Sousa R, Guo H, Barry WT, Winship G, Overmoyer B, Duda DG, Tolaney SM. A phase II study of nivolumab in combination with cabozantinib for metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps1119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Hao Guo
- Dana-Farber Cancer Institute, Boston, MA
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67
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Barroso-Sousa R, Jain E, Kim D, Partridge AH, Cohen O, Wagle N. Determinants of high tumor mutational burden (TMB) and mutational signatures in breast cancer. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.1010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Esha Jain
- Broad Institute of MIT and Harvard, Cambridge, MA
| | - Dewey Kim
- Broad Institute of MIT and Harvard, Cambridge, MA
| | | | - Ofir Cohen
- Broad Institute of MIT and Harvard, Cambridge, MA
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68
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Campesato LF, Silva APM, Cordeiro L, Correa BR, Navarro FCP, Zanin RF, Marçola M, Inoue LT, Duarte ML, Molgora M, Pasqualini F, Massara M, Galante P, Barroso-Sousa R, Polentarutti N, Riva F, Costa ET, Mantovani A, Garlanda C, Camargo AA. High IL-1R8 expression in breast tumors promotes tumor growth and contributes to impaired antitumor immunity. Oncotarget 2018; 8:49470-49483. [PMID: 28533483 PMCID: PMC5564782 DOI: 10.18632/oncotarget.17713] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 04/25/2017] [Indexed: 12/26/2022] Open
Abstract
Tumors develop numerous strategies to fine-tune inflammation and avoid detection and eradication by the immune system. The identification of mechanisms leading to local immune dysregulation is critical to improve cancer therapy. We here demonstrate that Interleukin-1 receptor 8 (IL-1R8 - previously known as SIGIRR/TIR8), a negative regulator of Toll-Like and Interleukin-1 Receptor family signaling, is up-regulated during breast epithelial cell transformation and in primary breast tumors. IL-1R8 expression in transformed breast epithelial cells reduced IL-1-dependent NF-κB activation and production of pro-inflammatory cytokines, inhibited NK cell activation and favored M2-like macrophage polarization. In a murine breast cancer model (MMTV-neu), IL-1R8-deficiency reduced tumor growth and metastasis and was associated with increased mobilization and activation of immune cells, such as NK cells and CD8+ T cells. Finally, immune-gene signature analysis in clinical specimens revealed that high IL-1R8 expression is associated with impaired innate immune sensing and T-cell exclusion from the tumor microenvironment. Our results indicate that high IL-1R8 expression acts as a novel immunomodulatory mechanism leading to dysregulated immunity with important implications for breast cancer immunotherapy.
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Affiliation(s)
- Luis Felipe Campesato
- Ludwig Institute for Cancer Research, São Paulo, São Paulo, Brazil.,Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil.,Graduate Program in Biochemistry, Institute of Chemistry, University of São Paulo, São Paulo, Brazil
| | | | - Luna Cordeiro
- Humanitas Clinical and Research Center, Rozzano, Italy
| | - Bruna R Correa
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
| | - Fabio C P Navarro
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
| | - Rafael F Zanin
- Cellular and Molecular Immunology Laboratory, Pontifícia Universidade Católica do Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
| | - Marina Marçola
- Institute of Biosciences, University of São Paulo, São Paulo, Brazil
| | - Lilian T Inoue
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
| | - Mariana L Duarte
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
| | | | | | | | - Pedro Galante
- Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
| | | | | | - Federica Riva
- Department of Veterinary Pathology, University of Milan, Milan, Italy
| | - Erico T Costa
- Ludwig Institute for Cancer Research, São Paulo, São Paulo, Brazil.,Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
| | - Alberto Mantovani
- Humanitas Clinical and Research Center, Rozzano, Italy.,Humanitas University, Rozzano, Italy
| | | | - Anamaria A Camargo
- Ludwig Institute for Cancer Research, São Paulo, São Paulo, Brazil.,Molecular Oncology Center, Hospital Sírio-Libanês, São Paulo, São Paulo, Brazil
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Abstract
The decision to offer adjuvant therapy to patients with early-stage cancer relies on factors related to the risk of disease recurrence, degree of benefit with the proposed therapy and the associated risk of toxicities. For patients with stages II and III HER2-positive breast cancer, administering 1 year of trastuzumab plus comprehensive chemotherapy is the standard of care. However, the pivotal adjuvant trials had very few older patients and patients with small HER2-positive tumors. In this review, we will discuss the clinical data regarding strategies to de-escalate adjuvant systemic therapy in patients with early stage HER2-positive disease.
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Affiliation(s)
- Romualdo Barroso-Sousa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Pedro Exman
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA 02215, USA
- Harvard Medical School, Boston, MA 02115, USA
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70
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Barroso-Sousa R, Gao H, Barry WT, Krop IE, Schoenfeld JD, Tolaney SM. Abstract OT1-02-02: A phase II study of pembrolizumab in combination with palliative radiotherapy for metastatic hormone receptor positive breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-02-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Despite recent advances in the treatment of patients with metastatic hormone receptor positive (HR+)/HER2- breast cancer (BC), it remains an incurable disease. The activity of immune checkpoint inhibitors (ICI) as monotherapy in patients with metastatic HR+/HER2- BC has been limited. Therefore, the addition of other strategies that elicit an immunogenic tumor microenvironment may be needed. We hypothesize that radiation therapy (RT) will potentiate the efficacy of the PD-1 inhibitor pembrolizumab in patients with metastatic HR+/HER2- BC. METHODS: Trial Design: This is a phase II single arm study assessing objective response rate (ORR) according to RECIST 1.1 in patients with metastatic HR+/HER2- BC who will receive pembrolizumab in combination with palliative RT. Pembrolizumab 200 mg intravenously will be administered 2-7 days before day 1 of RT, and will be given every 21 days until disease progression. Biopsies will be performed in the same lesion at baseline (mandatory if tumor tissue is accessible outside the field of RT) and during cycle 2 within 7-14 days before the day 1 of cycle 3 of pembrolizumab. Key Eligibility Criteria: Patients with metastatic HR+/HER2- BC, with measurable disease outside the field of radiation, for whom palliative RT to at least one bone, lymph node, or soft tissue lesion is indicated. Radiation of visceral lesions (such as lung or hepatic lesions) is not permitted. Although prior RT is allowed, patients must be at least 3 months free from RT; Re-irradiation of the same field is not allowed. There is no limit to the number of previous treatments, and systemic treatment naive patients for metastatic disease are also eligible. Specific Aims: The primary aim is to evaluate the efficacy of the combination, as defined by objective response rate (ORR) outside the field of RT according to RECIST 1.1. Secondary objectives include to determine the ORR according to immune-related criteria, the progression-free survival, the abscopal response rate, the clinical benefit rate, the safety and the tolerability of the combination. In addition, correlative studies will be performed to explore the correlation of immunosuppressive and/or immune-stimulating immune marker profiles at baseline and after cycle 2 to disease response to therapy. Statistical Methods: Using the Simons “optimal” method, in the first stage, 8 patients will be enrolled. If there is at least 1 response, accrual will continue to the second stage where up to 19 additional patients will be enrolled. If at least 3 of these 27 patients have an objective response (≥10%), the regimen will be considered worthy of further study. With this design, the probability of stopping the trial early is 78% if the true response rate is 3%. If the true response rate is 20% the chance that the regimen is declared worthy of further study is 80%. Patient accrual and target accrual: The trial opened in April/2017, and so far, has accrued 2 patients with a target accrual of 27 patients. Accrual should be complete in 14-25 months. Clinical trial information: NCT03051672.
Citation Format: Barroso-Sousa R, Gao H, Barry WT, Krop IE, Schoenfeld JD, Tolaney SM. A phase II study of pembrolizumab in combination with palliative radiotherapy for metastatic hormone receptor positive breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-02-02.
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Affiliation(s)
| | - H Gao
- Dana-Farber Cancer Institute, Boston, MA
| | - WT Barry
- Dana-Farber Cancer Institute, Boston, MA
| | - IE Krop
- Dana-Farber Cancer Institute, Boston, MA
| | | | - SM Tolaney
- Dana-Farber Cancer Institute, Boston, MA
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71
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Barroso-Sousa R, Ott PA, Hodi FS, Kaiser UB, Tolaney SM, Min L. Endocrine dysfunction induced by immune checkpoint inhibitors: Practical recommendations for diagnosis and clinical management. Cancer 2018; 124:1111-1121. [PMID: 29313945 DOI: 10.1002/cncr.31200] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 11/21/2017] [Accepted: 11/28/2017] [Indexed: 11/11/2022]
Abstract
Immune checkpoint inhibitors (ICIs) have revolutionized cancer therapy. However, because ICIs block coinhibitory molecules on T cells and other immune cells, unleashing them to mediate tumor cell killing, they also can disrupt the maintenance of immunological tolerance to self-antigens. Compared with chemotherapy, ICIs have a different toxicity profile, especially the occurrence of autoimmune-like manifestations against multiple organ systems, including endocrine glands, commonly referred to as immune-related adverse events. The aim of this review was to provide practical recommendations regarding the proper assessment and clinical management related to the new onset of endocrinopathies after the use of ICIs in patients with cancer. Cancer 2018;124:1111-21. © 2018 American Cancer Society.
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Affiliation(s)
| | - Patrick A Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Le Min
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
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72
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Lee H, Hodi FS, Giobbie-Hurder A, Ott PA, Buchbinder EI, Haq R, Tolaney S, Barroso-Sousa R, Zhang K, Donahue H, Davis M, Gargano ME, Kelley KM, Carroll RS, Kaiser UB, Min L. Characterization of Thyroid Disorders in Patients Receiving Immune Checkpoint Inhibition Therapy. Cancer Immunol Res 2017; 5:1133-1140. [PMID: 29079654 DOI: 10.1158/2326-6066.cir-17-0208] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Revised: 08/12/2017] [Accepted: 10/19/2017] [Indexed: 01/14/2023]
Abstract
Thyroid disorders have emerged as one of the most common immune-related adverse events associated with anti-PD-1 monotherapy or combination anti-PD-1 and anti-CTLA-4 therapy. This study characterizes and compares the evolution of monotherapy and combination therapy-related thyroid disorders. We analyzed the dynamic evolution of thyroid disorders in 45 patients who developed thyroid disorders following treatment with either anti-PD-1 monotherapy or anti-PD-1 and anti-CTLA-4 combination therapy. The patients presented with thyrotoxicosis or hypothyroidism as the initial presentation of their thyroid disorder. Thyrotoxicosis as the initial presentation occurred in the majority of patients (93% and 56% of the patients receiving combination therapy and monotherapy, respectively). The onset pattern of the thyroid disorder was significantly different between the two groups (P = 0.01). Subsequently, 76% and 90% of the patients with thyrotoxicosis evolved to develop hypothyroidism in the combination and monotherapy groups, respectively. In the combination therapy and monotherapy groups, the median times to onset of thyrotoxicosis and hypothyroidism after first treatment were 21 and 63 days, and 31 and 68 days, respectively. The median time for transition from thyrotoxicosis to hypothyroidism was 42 days in both groups. Our study demonstrates that most thyroid disorders induced by either anti-PD-1 or combination anti-PD-1 and anti-CTLA-4 therapy are thyroiditis. The time to onset of thyrotoxicosis after treatment initiation and evolution of thyrotoxicosis to hypothyroidism was short, emphasizing the importance of close monitoring of thyroid function in these patients. Cancer Immunol Res; 5(12); 1133-40. ©2017 AACR.
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Affiliation(s)
- Hyunju Lee
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts.,MetroWest Medical Center, Framingham, Massachusetts
| | - F Stephen Hodi
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Anita Giobbie-Hurder
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Patrick A Ott
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Rizwan Haq
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Sara Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | | | - Kevin Zhang
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Hilary Donahue
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Meredith Davis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Maria E Gargano
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Kristina M Kelley
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Rona S Carroll
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Ursula B Kaiser
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts
| | - Le Min
- Division of Endocrinology, Diabetes and Hypertension, Brigham and Women's Hospital, Boston, Massachusetts.
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Pai SG, Carneiro BA, Mota JM, Costa R, Leite CA, Barroso-Sousa R, Kaplan JB, Chae YK, Giles FJ. Wnt/beta-catenin pathway: modulating anticancer immune response. J Hematol Oncol 2017; 10:101. [PMID: 28476164 PMCID: PMC5420131 DOI: 10.1186/s13045-017-0471-6] [Citation(s) in RCA: 396] [Impact Index Per Article: 56.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 04/25/2017] [Indexed: 02/08/2023] Open
Abstract
Wnt/β-catenin signaling, a highly conserved pathway through evolution, regulates key cellular functions including proliferation, differentiation, migration, genetic stability, apoptosis, and stem cell renewal. The Wnt pathway mediates biological processes by a canonical or noncanonical pathway, depending on the involvement of β-catenin in signal transduction. β-catenin is a core component of the cadherin protein complex, whose stabilization is essential for the activation of Wnt/β-catenin signaling. As multiple aberrations in this pathway occur in numerous cancers, WNT-directed therapy represents an area of significant developmental therapeutics focus. The recently described role of Wnt/β-catenin pathway in regulating immune cell infiltration of the tumor microenvironment renewed the interest, given its potential impact on responses to immunotherapy treatments. This article summarizes the role of Wnt/β-catenin pathway in cancer and ongoing therapeutic strategies involving this pathway.
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Affiliation(s)
- Sachin Gopalkrishna Pai
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, IL, USA. .,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA. .,Current Address: Department of Interdisciplinary Clinical Oncology, Mitchell Cancer Institute, University of South Alabama, 1660 Springhill Avenue, Mobile, AL, USA.
| | - Benedito A Carneiro
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Jose Mauricio Mota
- Instituto do Câncer do Estado de São Paulo, University of São Paulo, São Paulo, Brazil
| | - Ricardo Costa
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | | | | | - Jason Benjamin Kaplan
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Young Kwang Chae
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
| | - Francis Joseph Giles
- Developmental Therapeutics Program, Division of Hematology/Oncology, Feinberg School of Medicine, Chicago, IL, USA.,Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, USA
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74
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Barroso-Sousa R, Vaz-Luis I, Guo H, Barry WT, Brackett AM, Brock VA, Roche KA, Kasparian E, Winer EP, Lin NU. Abstract OT1-01-09: Feasibility and safety of avoiding granulocyte colony-stimulating factor prophylaxis during the paclitaxel portion of dose dense doxorubicin-cyclophosphamide and paclitaxel regimen. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot1-01-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The need for granulocyte-colony stimulating factor (G-CSF) support during dose-dense (DD) paclitaxel (T) after doxorubicin and cyclophosphamide (AC) is unclear. Given that G-CSF is not devoid of adverse effects, and adds significant costs to treatment, we are examining the feasibility and safety of avoiding G-CSF during dose dense T. Methods: This is a single center, single-arm, phase II, two stage study. The primary aim is to evaluate the rate of T treatment completion within 7 weeks (from D1 of cycle 1 to D1 of cycle 4 of T) omitting Pegfilgrastim using pre-specified safety rules. Secondary aims include: characterization of the utilization of Pegfilgrastim using pre-specified safety rules in patients receiving dose dense T; evaluation of the safety of omitting routine Pegfilgrastim support in patients receiving dose dense T; evaluation of total cost ($ United States) of omitting routine Pegfilgrastim use during dose dense T. As a secondary aim we will evaluate the safety of simplifying the pre-medication regimen used for the T portion of the regimen (withholding corticosteroids in cycle 3 and 4 if no evidence of allergic reactions in cycle 1 and 2). A Simon Optimal design was selected with an overall one-side type I error of 10% and 90% power to detect the difference between unacceptable T completion rate (75%) and desirable completion rate (85%). In the first stage, 51 evaluable patients will be enrolled. If during the first stage, at any point, a total of 12 or more patients do not complete treatment within 7 weeks the trial will be closed permanently. Among the 51 patients enrolled after the first stage, if at least 40 patients complete treatment without dose delay, accrual will continue to the second stage where an additional 74 evaluable patients will be enrolled. If there are at least 100 among the 125 evaluable patients completing treatment without dose delay, the regimen will be considered worthy of further study. If during the second stage, at any point, a total of 26 patients do not complete treatment within 7 weeks the trial will be closed permanently and the study intervention will not be of clinical interest. If the true treatment completion rate is 75%, the chance the regimen is declared ineffective is 91% (exact alpha = 0.094) and if the true treatment completion rate is 85% the chance that the regimen is falsely declared ineffective is 10% (exact power = 0.899). The estimated accrual rate is 6-8 patients/month. Accrual started in April 2016. Clinical trial information: NCT02698891.
Citation Format: Barroso-Sousa R, Vaz-Luis I, Guo H, Barry WT, Brackett AM, Brock VA, Roche KA, Kasparian E, Winer EP, Lin NU. Feasibility and safety of avoiding granulocyte colony-stimulating factor prophylaxis during the paclitaxel portion of dose dense doxorubicin-cyclophosphamide and paclitaxel regimen [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 OT1-01-09.
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Affiliation(s)
| | - I Vaz-Luis
- Dana-Farber Cancer Institute, Boston, MA
| | - H Guo
- Dana-Farber Cancer Institute, Boston, MA
| | - WT Barry
- Dana-Farber Cancer Institute, Boston, MA
| | | | - VA Brock
- Dana-Farber Cancer Institute, Boston, MA
| | - KA Roche
- Dana-Farber Cancer Institute, Boston, MA
| | | | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA
| | - NU Lin
- Dana-Farber Cancer Institute, Boston, MA
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75
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76
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Barroso-Sousa R, Paes FR, Vaz-Luis I, Batista RB, Costa RB, Losk K, Camuso K, Metzger-Filho O, Hughes ME, Bunnell CA, Golshan M, Winer EP, Lin NU. Variation in the use of granulocyte-colony stimulating factor for dose dense paclitaxel: A single institution retrospective study. Breast 2016; 30:136-140. [DOI: 10.1016/j.breast.2016.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/14/2016] [Accepted: 09/17/2016] [Indexed: 11/30/2022] Open
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77
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Campesato LF, Barroso-Sousa R, Jimenez L, Correa BR, Sabbaga J, Hoff PM, Reis LFL, Galante PAF, Camargo AA. Comprehensive cancer-gene panels can be used to estimate mutational load and predict clinical benefit to PD-1 blockade in clinical practice. Oncotarget 2016; 6:34221-7. [PMID: 26439694 PMCID: PMC4741447 DOI: 10.18632/oncotarget.5950] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 09/04/2015] [Indexed: 12/17/2022] Open
Abstract
Cancer gene panels (CGPs) are already used in clinical practice to match tumor's genetic profile with available targeted therapies. We aimed to determine if CGPs could also be applied to estimate tumor mutational load and predict clinical benefit to PD-1 and CTLA-4 checkpoint blockade therapy. Whole-exome sequencing (WES) mutation data obtained from melanoma and non-small cell lung cancer (NSCLC) patients published by Snyder et al. 2014 and Rizvi et al. 2015, respectively, were used to select nonsynonymous somatic mutations occurring in genes included in the Foundation Medicine Panel (FM-CGP) and in our own Institutional Panel (HSL-CGP). CGP-mutational load was calculated for each patient using both panels and was associated with clinical outcomes as defined and reported in the original articles. Higher CGP-mutational load was observed in NSCLC patients presenting durable clinical benefit (DCB) to PD-1 blockade (FM-CGP P=0.03, HSL-CGP P=0.01). We also observed that 69% of patients with high CGP-mutational load experienced DCB to PD-1 blockade, as compared to 20% of patients with low CGP-mutational load (FM-CGP and HSL-CGP P=0.01). Noteworthy, predictive accuracy of CGP-mutational load for DCB was not statistically different from that estimated by WES sequencing (P=0.73). Moreover, a high CGP-mutational load was significantly associated with progression-free survival (PFS) in patients treated with PD-1 blockade (FM-CGP P=0.005, HR 0.27, 95% IC 0.105 to 0.669; HSL-CGP P=0.008, HR 0.29, 95% IC 0.116 to 0.719). Similar associations between CGP-mutational load and clinical benefit to CTLA-4 blockade were not observed. In summary, our data reveals that CGPs can be used to estimate mutational load and to predict clinical benefit to PD-1 blockade, with similar accuracy to that reported using WES.
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Affiliation(s)
- Luís Felipe Campesato
- Instituto Ludwig de Pesquisa Sobre o Câncer, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil.,Departmento de Bioquímica, Instituto de Química, Universidade de São Paulo, São Paulo, Brazil
| | | | - Leandro Jimenez
- Instituto Ludwig de Pesquisa Sobre o Câncer, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
| | | | | | | | | | | | - Anamaria A Camargo
- Instituto Ludwig de Pesquisa Sobre o Câncer, São Paulo, Brazil.,Hospital Sírio-Libanês, São Paulo, Brazil
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Barroso-Sousa R, Shapiro GI, Tolaney SM. Clinical Development of the CDK4/6 Inhibitors Ribociclib and Abemaciclib in Breast Cancer. Breast Care (Basel) 2016; 11:167-73. [PMID: 27493615 PMCID: PMC4960359 DOI: 10.1159/000447284] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Clinical and preclinical data support a significant role for inhibitors of the cyclin-dependent kinases (CDKs) 4 and 6 in the treatment of patients with breast cancer. Recently, based on data showing improvement in progression-free survival, the use of palbociclib (Ibrance; Pfizer, Inc.) in combination with endocrine agents was approved to treat patients with hormone receptor-positive advanced disease. Importantly, 2 other CDK4/6 inhibitors, abemaciclib (LY2835219; Lilly) and ribociclib (LEE011; Novartis), are in the late stage of clinical development. In this review, we will focus on clinical data on these 2 new drugs, highlighting their differences compared to palbociclib in terms of single-agent activity, central nervous system penetration, and common adverse events. In addition, we will present the ongoing clinical trials and discuss future directions in the field.
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Affiliation(s)
- Romualdo Barroso-Sousa
- Breast Oncology Program, Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA, MA, USA
| | - Geoffrey I. Shapiro
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Sara M. Tolaney
- Breast Oncology Program, Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA, MA, USA
- Early Drug Development Center, Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
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79
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Barroso-Sousa R, Metzger-Filho O. Differences between invasive lobular and invasive ductal carcinoma of the breast: results and therapeutic implications. Ther Adv Med Oncol 2016; 8:261-6. [PMID: 27482285 DOI: 10.1177/1758834016644156] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Invasive lobular carcinoma (ILC) is the second most common histologic subtype of breast cancer (BC): ILC differs from invasive ductal carcinoma (IDC) in its clinicopathological characteristics and responsiveness to systemic therapy. From the clinical standpoint, data suggest that ILC derives a distinct benefit from systemic therapy compared to IDC. In addition, comprehensive molecular analyses have been reported for ILCs, confirming that these tumors have specific genomic profiles compared to IDC. Despite these differences, clinical trials and practical clinical guidelines tend to treat BC as a single entity. Here we discuss these clinical and molecular data and their therapeutic implications.
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Affiliation(s)
- Romualdo Barroso-Sousa
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Otto Metzger-Filho
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Yawkey 1238, Boston, MA 02215, USA
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Czaikoski PG, Mota JMSC, Nascimento DC, Sônego F, Castanheira FVES, Melo PH, Scortegagna GT, Silva RL, Barroso-Sousa R, Souto FO, Pazin-Filho A, Figueiredo F, Alves-Filho JC, Cunha FQ. Neutrophil Extracellular Traps Induce Organ Damage during Experimental and Clinical Sepsis. PLoS One 2016; 11:e0148142. [PMID: 26849138 PMCID: PMC4743982 DOI: 10.1371/journal.pone.0148142] [Citation(s) in RCA: 239] [Impact Index Per Article: 29.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 01/13/2016] [Indexed: 02/06/2023] Open
Abstract
Organ dysfunction is a major concern in sepsis pathophysiology and contributes to its high mortality rate. Neutrophil extracellular traps (NETs) have been implicated in endothelial damage and take part in the pathogenesis of organ dysfunction in several conditions. NETs also have an important role in counteracting invading microorganisms during infection. The aim of this study was to evaluate systemic NETs formation, their participation in host bacterial clearance and their contribution to organ dysfunction in sepsis. C57Bl/6 mice were subjected to endotoxic shock or a polymicrobial sepsis model induced by cecal ligation and puncture (CLP). The involvement of cf-DNA/NETs in the physiopathology of sepsis was evaluated through NETs degradation by rhDNase. This treatment was also associated with a broad-spectrum antibiotic treatment (ertapenem) in mice after CLP. CLP or endotoxin administration induced a significant increase in the serum concentrations of NETs. The increase in CLP-induced NETs was sustained over a period of 3 to 24 h after surgery in mice and was not inhibited by the antibiotic treatment. Systemic rhDNase treatment reduced serum NETs and increased the bacterial load in non-antibiotic-treated septic mice. rhDNase plus antibiotics attenuated sepsis-induced organ damage and improved the survival rate. The correlation between the presence of NETs in peripheral blood and organ dysfunction was evaluated in 31 septic patients. Higher cf-DNA concentrations were detected in septic patients in comparison with healthy controls, and levels were correlated with sepsis severity and organ dysfunction. In conclusion, cf-DNA/NETs are formed during sepsis and are associated with sepsis severity. In the experimental setting, the degradation of NETs by rhDNase attenuates organ damage only when combined with antibiotics, confirming that NETs take part in sepsis pathogenesis. Altogether, our results suggest that NETs are important for host bacterial control and are relevant actors in the pathogenesis of sepsis.
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Affiliation(s)
- Paula Giselle Czaikoski
- Department of Pharmacology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Daniele Carvalho Nascimento
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Fabiane Sônego
- Department of Pharmacology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | | | - Paulo Henrique Melo
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Gabriela Trentin Scortegagna
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Rangel Leal Silva
- Department of Pharmacology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Romualdo Barroso-Sousa
- Department of Clinics, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Fabrício Oliveira Souto
- Department of Biochemistry and Immunology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Antonio Pazin-Filho
- Department of Clinics, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Florencio Figueiredo
- Department of Pathology, School of Medicine, University of Brasilia, Brasilia, Brazil
| | - José Carlos Alves-Filho
- Department of Pharmacology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
| | - Fernando Queiróz Cunha
- Department of Pharmacology, Ribeirão Preto Medical School, University of Sao Paulo, Ribeirao Preto, Brazil
- * E-mail:
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81
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Barroso-Sousa R, Silva DDAFR, Alessi JVM, Mano MS. Neoadjuvant endocrine therapy in breast cancer: current role and future perspectives. Ecancermedicalscience 2016; 10:609. [PMID: 26823678 PMCID: PMC4720494 DOI: 10.3332/ecancer.2016.609] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Indexed: 12/18/2022] Open
Abstract
Luminal breast cancer, as defined by oestrogen and/or progesterone expression by immunohistochemistry, accounts for up to 75% of all breast cancers. In this population, endocrine therapy is likely to account for most of the gains obtained with the administration of adjuvant systemic treatment. The role of adjuvant chemotherapy in these patients remains debatable since it is known that only a small fraction of patients will derive meaningful benefit from this treatment whilst the majority will be exposed to significant and unnecessary chemotherapy-related toxicities, in particular the elderly and frail. Therefore, neoadjuvant endocrine therapy (NET) becomes an attractive option for selected patients with hormonal-receptor positive locally advanced breast cancer. In this review, we discuss the current role of NET and future perspectives in the field.
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Affiliation(s)
- Romualdo Barroso-Sousa
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 251, 5o andar, 01246-000 São Paulo, SP, Brazil
| | - Danilo D A Fonseca Reis Silva
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 251, 5o andar, 01246-000 São Paulo, SP, Brazil
| | - Joao Victor Machado Alessi
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 251, 5o andar, 01246-000 São Paulo, SP, Brazil
| | - Max Senna Mano
- Instituto do Câncer do Estado de São Paulo (ICESP), Faculdade de Medicina, Universidade de São Paulo, Av Dr Arnaldo, 251, 5o andar, 01246-000 São Paulo, SP, Brazil
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Silva Lima J, Matutino A, Brito Silva S, Silva-Junior A, Vilas Boas M, Oliveira Stephan B, Van Vairsberg V, Lima Pereira A, Barroso-Sousa R, Senna Mano M. 1958 Correlation between body mass index and pathologic complete response after neoadjuvant chemotherapy for locally advanced breast cancer. Eur J Cancer 2015. [DOI: 10.1016/s0959-8049(16)30906-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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83
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Caires IQDS, Souza KT, Negrão MV, de Oliveira JA, Barroso-Sousa R, de Lima RCA, Hoff PMG, Diz MDPE. Definitive chemoradiotherapy for advanced cervical cancer: should it be different in the elderly? Eur J Obstet Gynecol Reprod Biol 2015; 192:86-9. [PMID: 26182837 DOI: 10.1016/j.ejogrb.2015.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 04/16/2015] [Accepted: 05/19/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Cervical cancer (CC) is the second most common cancer in Brazilian women, and approximately 10% of cases occur in elderly patients (pts). In this age group, disease is usually diagnosed in more advanced stages and oncological therapies are usually less intensive, due to comorbidities and impaired performance status. METHODS Retrospective analysis of pts ≥65 years old with CC admitted at a Brazilian University Cancer Center from August 2008 to February 2012. We performed a descriptive analysis of baseline performance status (PS), disease stage (FIGO), histology, body mass index (BMI), treatment received and overall survival, using the Kaplan-Meier method. RESULTS 900 medical records were analyzed and 75 pts (8%) fulfilled the inclusion criteria. Median age was 73.4 years old (±5.5 years). Squamous cell carcinoma (SCC) was the most common histology (71 pts, 94.7%). 67 (89.3%) had PS 0 or 1 and 52 pts (69.3%) were eutrophic (BMI 18.5-25 kg/m(2)). At presentation, disease staging consisted of 18 pts (24%) stage I, 35 pts (46.7%) stage II, 8 pts (10.7%) stage III, 12 pts (16%) stage IVa and 2 pts (2.7%) stage IVb. 24 pts (32%) underwent surgery (hysterectomy, adnexectomy, pelvic and paraaortic lymphadenectomy). Adjuvant treatment with radiotherapy (RT) was performed in 13 pts (total dose of external RT in pelvis ranged from 39.6 to 45 Gy, parametrial boost ranged from 14 to 20 Gy and 4 inserts from 7 to 7.5 Gy of brachytherapy); 8 of them received concomitant platinum-based chemotherapy (CT). 30 pts underwent definitive CRT, 17 definitive RT, 1 palliative CT and 3 best supportive care. In the CRT group, 18 pts received cisplatin (CDDP 40 mg/m(2)/w/6w) and 12 carboplatin (AUC 2/w/6w). During definitive CRT, treatment was discontinued in 39% of pts who received CDDP and 25% of pts who received carboplatin, all due to treatment toxicities. CDDP was associated with more nefrotoxicity (5 pts, 28%) than carboplatin (1 pt, 8.3%). The CDDP group also presented more radiodermatitis and stroke. However, myelosuppression and diarrhea were similar in both groups. After a 26.1-month follow-up, median OS was not reached. CONCLUSIONS Despite advanced age, more than 60% of pts underwent complete CRT treatment. Thus, age should not be the only factor to guide therapeutic decisions in CC. Carboplatin was better tolerated than CDDP in CRT group, but prospective trials are necessary to evaluate the best treatment option in this population.
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Affiliation(s)
- Inacelli Queiroz de Souza Caires
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil.
| | - Karla Teixeira Souza
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Marcelo Vailati Negrão
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Julia Andrade de Oliveira
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Romualdo Barroso-Sousa
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Rafael Caires Alvino de Lima
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Paulo Marcelo Gehm Hoff
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
| | - Maria del Pilar Estevez Diz
- Department of Clinical Oncology, Instituto do Câncer do Estado de São Paulo - ICESP/Faculdade de Medicina do Estado de São Paulo - HC/FMUSP, Av. Dr. Arnaldo, 251, Cerqueira César, São Paulo, CEP: 01246-000, Brazil
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DA Fonseca LG, Barroso-Sousa R, Bento ADASA, Blanco BP, Valente GL, Pfiffer TEF, Hoff PM, Sabbaga J. Safety and efficacy of sorafenib in patients with Child-Pugh B advanced hepatocellular carcinoma. Mol Clin Oncol 2015; 3:793-796. [PMID: 26171182 DOI: 10.3892/mco.2015.536] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Accepted: 03/27/2015] [Indexed: 01/17/2023] Open
Abstract
Sorafenib demonstrated a survival benefit in the treatment of advanced hepatocellular carcinoma (HCC) in phase III trials. However, almost all the patients included in those trials exhibited well-preserved liver function (Child-Pugh A). The aim of this study was to describe our experience with sorafenib in Child-Pugh B HCC patients. A database of patients with advanced HCC treated with sorafenib was retrospectively evaluated. The median overall survival of Child-Pugh B patients (n=20) was 2.53 months [95% confidence interval (CI): 0.33-5.92 months] and of Child-Pugh A patients (n=100) 9.71 months (95% CI: 6.22-13.04). Child-Pugh B patients had a significantly poorer survival compared to Child-Pugh A patients (P=0.002). The toxicities were similar between the two groups. Metastasis, vascular invasion and α-fetoprotein level >1,030 ng/ml were not associated with survival among Child-Pugh B patients (P=0.281, 0.189 and 0.996, respectively). Although the survival outcomes were worse in Child-Pugh B patients treated with sorafenib, the toxicity profile was manageable. Therefore, there remains the question of whether to treat this subgroup of patients and more data are required to define the role of sorafenib in the context of liver dysfunction.
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Affiliation(s)
- Leonardo Gomes DA Fonseca
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | - Romualdo Barroso-Sousa
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | | | - Bruna Paccola Blanco
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | - Gabriel Luis Valente
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | | | - Paulo Marcelo Hoff
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
| | - Jorge Sabbaga
- Cancer Institute of the State of Sao Paulo, University of Sao Paulo, Sao Paulo, SP 01255-000, Brazil
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Petry V, Gagliato DM, Leal AIC, Arai RJ, Longo E, Andrade F, Ricci MD, Piato JR, Barroso-Sousa R, Hoff PM, Mano MS. Metronomic chemotherapy in the neoadjuvant setting: results of two parallel feasibility trials (TraQme and TAME) in patients with HER2+ and HER2- locally advanced breast cancer. ACTA ACUST UNITED AC 2015; 48:479-85. [PMID: 25760024 PMCID: PMC4445673 DOI: 10.1590/1414-431x20144354] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2014] [Accepted: 12/05/2014] [Indexed: 11/23/2022]
Abstract
Neoadjuvant chemotherapy has practical and theoretical advantages over adjuvant
chemotherapy strategy in breast cancer (BC) management. Moreover, metronomic delivery
has a more favorable toxicity profile. The present study examined the feasibility of
neoadjuvant metronomic chemotherapy in two cohorts [HER2+ (TraQme) and HER2− (TAME)]
of locally advanced BC. Twenty patients were prospectively enrolled (TraQme, n=9;
TAME, n=11). Both cohorts received weekly paclitaxel at 100 mg/m2 during 8
weeks followed by weekly doxorubicin at 24 mg/m2 for 9 weeks in
combination with oral cyclophosphamide at 100 mg/day (fixed dose). The HER2+ cohort
received weekly trastuzumab. The study was interrupted because of safety issues.
Thirty-six percent of patients in the TAME cohort and all patients from the TraQme
cohort had stage III BC. Of note, 33% from the TraQme cohort and 66% from the TAME
cohort displayed hormone receptor positivity in tumor tissue. The pathological
complete response rates were 55% and 18% among patients enrolled in the TraQme and
TAME cohorts, respectively. Patients in the TraQme cohort had more advanced BC stages
at diagnosis, higher-grade pathological classification, and more tumors lacking
hormone receptor expression, compared to the TAME cohort. The toxicity profile was
also different. Two patients in the TraQme cohort developed pneumonitis, and in the
TAME cohort we observed more hematological toxicity and hand-foot syndrome. The
neoadjuvant metronomic chemotherapy regimen evaluated in this trial was highly
effective in achieving a tumor response, especially in the HER2+ cohort. Pneumonitis
was a serious, unexpected adverse event observed in this group. Further larger and
randomized trials are warranted to evaluate the association between metronomic
chemotherapy and trastuzumab treatment.
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Affiliation(s)
- V Petry
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - D M Gagliato
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - A I C Leal
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R J Arai
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - E Longo
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - F Andrade
- Núcleo de Mastologia, Hospital Sírio Libanês, São Paulo, SP, Brasil
| | - M D Ricci
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - J R Piato
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - R Barroso-Sousa
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - P M Hoff
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
| | - M S Mano
- Divisão de Oncologia Médica, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
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Barroso-Sousa R, Munhoz RR, Mak MP, Fonseca LG, Fede ABS, Linck RDM, Coelho CR, Moniz CMV, Souza CE, Dzik C. Activity and safety of sunitinib in poor risk metastatic renal cell carcinoma patients. Int Braz J Urol 2014; 40:835-41. [DOI: 10.1590/s1677-5538.ibju.2014.06.16] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 05/03/2014] [Indexed: 01/14/2023] Open
Affiliation(s)
| | | | | | | | | | | | | | | | - Ciro E. Souza
- Universidade de São Paulo, Brazil; Hospital Sírio-Libanês, Brazil
| | - Carlos Dzik
- Universidade de São Paulo, Brazil; Hospital Sírio-Libanês, Brazil
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da Fonseca LG, de Melo Gagliato D, Takahashi TK, Mak MP, Barroso-Sousa R, Testa L, Helena VP, de Paula Costa R, Hoff PM, Mano MS. Cardiac safety of (neo)adjuvant trastuzumab in the community setting: a single-center experience. ACTA ACUST UNITED AC 2014; 9:255-60. [PMID: 25404884 DOI: 10.1159/000365950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Trastuzumab improves the survival of patients with human epidermal growth factor receptor 2 (HER2)-positive breast cancer (BC). The incidence and long-term impact of trastuzumab-related cardiotoxicity in the community setting is of great clinical importance. MATERIAL AND METHODS Patients with HER2-positive BC treated with (neo)adjuvant trastuzumab were retrospectively evaluated. Cardiotoxicity was defined as cardiac death or absolute decrease in left ventricular ejection fraction of at least 10% to a value less than 50%, or symptomatic heart failure. RESULTS We evaluated 237 patients: median age 53 years (range 27-83 years). 40.5% of these patients had received neoadjuvant and 59.5% adjuvant chemotherapy. The majority (83.9%) were treated with an anthracycline-based regimen. Median exposure to trastuzumab was 8 months (range 2-12 months). Cardiotoxicity was diagnosed in 20.2%, but symptoms only occurred in 3.8%. 41.6% recovered cardiac function. None of the risk factors were associated with cardiotoxicity. CONCLUSION The incidence of trastuzumab-related cardiotoxicity found in this study was slightly higher than those reported in randomized clinical trials. Nevertheless, most patients were asymptomatic. We describe the cardiac outcomes of a non-selected population, which possibly reflects those found in the 'real world'. The risks versus benefits of trastuzumab use remain in favor of treatment, but cardiotoxicity should be monitored.
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Affiliation(s)
- Leonardo Gomes da Fonseca
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Debora de Melo Gagliato
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Tiago K Takahashi
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Milena Perez Mak
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Romualdo Barroso-Sousa
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Laura Testa
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Vanessa Petry Helena
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Romulo de Paula Costa
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Paulo M Hoff
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
| | - Max S Mano
- Division of Medical Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina, Universidade de São Paulo, São Paulo, Brazil
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Souza K, Barroso-Sousa R, Fonseca L, Dzik C. Prognostic Role of Pre-Treatment Neutrophil to Lymphocyte Ratio (Nlr) in Patients with Metastatic Renal Cell Carcinoma (Mrcc) on Sunitinib Therapy. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu337.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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89
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Barroso-Sousa R, Lerario AM, Evangelista J, Papadia C, Lourenço DM, Lin CS, Kulcsar MA, Fragoso MC, Hoff AO. Complete resolution of hypercortisolism with sorafenib in a patient with advanced medullary thyroid carcinoma and ectopic ACTH (adrenocorticotropic hormone) syndrome. Thyroid 2014; 24:1062-6. [PMID: 24499195 DOI: 10.1089/thy.2013.0571] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND The treatment of advanced medullary thyroid carcinoma (MTC) has evolved significantly over the past decade. The discovery of genetic abnormalities in MTC has led to the development of targeted therapies such as vandetanib and cabozantinib. Other kinase inhibitors (KI), such as sorafenib, have been investigated in this setting and are an alternative therapeutic option. The lack of specificity of these KIs to a single target may result in additional, unexpected effects. In this report, we describe a patient with metastatic MTC and Ectopic ACTH (adrenocorticotropic hormone) Syndrome in whom treatment with sorafenib resulted in complete resolution of hypercortisolism. SUMMARY A 45-year-old male with progressive metastatic MTC presented with clinical manifestations suspicious for Cushing's syndrome. Investigation revealed ACTH-dependent hypercortisolism suggestive of Ectopic ACTH Syndrome. Treatment with sorafenib 400 mg twice a day was initiated resulting in a rapid and significant reduction of cortisol and ACTH levels associated with dramatic clinical improvement. The rapid and effective control of hypercortisolism in the absence of a significant tumor reduction raises the question of whether sorafenib may have a direct effect on ACTH or cortisol hypersecretion. CONCLUSIONS This report suggests a previously unknown potential effect of sorafenib on the pituitary-adrenal axis. Further studies will be necessary to investigate the role of sorafenib in other cases of ACTH excess and to understand the mechanisms by which it alters steroid synthesis, action, or secretion.
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Affiliation(s)
- Romualdo Barroso-Sousa
- 1 Department of Medical Oncology, Instituto do Câncer do Estado de São Paulo (ICESP) , São Paulo, Brazil
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Barroso-Sousa R, Guindalini RSC, Negrao MV, Nakazato D, Moniz CMV, Takahashi TK, Dzik C. Role of paclitaxel and platinum-based chemotherapy in locally advanced and metastatic penile squamous cell carcinoma. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Romualdo Barroso-Sousa
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Marcelo Vailati Negrao
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Sao Paulo, Brazil
| | - Denyei Nakazato
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Tiago Kenji Takahashi
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Dzik
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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Fonseca LG, Barroso-Sousa R, Blanco BP, Valente GL, Braghiroli MIFM, Pfiffer TEF, Sabbaga J, Hoff PM. Pretreatment neutrophil to lymphocyte ratio and prognosis of patients with advanced hepatocelullar carcinoma treated with sorafenib. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e15144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Leonardo Gomes Fonseca
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Romualdo Barroso-Sousa
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Bruna Paccola Blanco
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Sao Paulo, Brazil
| | - Gabriel Luis Valente
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, Sao Paulo, Brazil
| | | | | | - Jorge Sabbaga
- Instituto do Câncer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
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da Fonseca LG, Barroso-Sousa R, Sabbaga J, Hoff PM. Acute acalculous cholecystitis in a patient with metastatic renal cell carcinoma treated with sunitinib. Clin Pract 2014; 4:635. [PMID: 24847435 PMCID: PMC4019924 DOI: 10.4081/cp.2014.635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 04/18/2014] [Accepted: 04/18/2014] [Indexed: 11/28/2022] Open
Abstract
A 55-year old man was treated with sunitinib 50 mg/day for 4 weeks on and 2 weeks off, as a first-line therapy for metastatic renal cell carcinoma. During the fourth week of the first cycle, he was admitted to the Emergency Department with abdominal pain and vomiting. Acute acalculous cholecystitis was diagnosed. Sunitnib-associated cholecystitis is a rare adverse event previously reported in few cases. The mechanism behind this complication is not fully understood, although vascular endothelial dysfunction may play a role. The use of this drug is expanding in clinical oncology, and physicians should be aware of this life-threating adverse event.
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Affiliation(s)
- Leonardo Gomes da Fonseca
- Division of Medical Oncology, Institute of Cancer of the state of São Paulo, University of São Paulo , Brazil
| | - Romualdo Barroso-Sousa
- Division of Medical Oncology, Institute of Cancer of the state of São Paulo, University of São Paulo , Brazil
| | - Jorge Sabbaga
- Division of Medical Oncology, Institute of Cancer of the state of São Paulo, University of São Paulo , Brazil
| | - Paulo Marcelo Hoff
- Division of Medical Oncology, Institute of Cancer of the state of São Paulo, University of São Paulo , Brazil
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Miranda V, Barroso-Sousa R, Glasberg J, Riechelmann R. Exploring the role of metformin in anticancer treatments: A systematic review. Drugs Today (Barc) 2014; 50:623-40. [DOI: 10.1358/dot.2014.50.9.2229920] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Barroso-Sousa R, Santana IA, Testa L, de Melo Gagliato D, Mano MS. Biological therapies in breast cancer: Common toxicities and management strategies. Breast 2013; 22:1009-18. [DOI: 10.1016/j.breast.2013.09.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2013] [Revised: 09/14/2013] [Accepted: 09/21/2013] [Indexed: 02/03/2023] Open
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Barroso-Sousa R, Munhoz RR, Fonseca LG, Fede ABDS, Linck RDM, Moniz CMV, Mak MP, Souza CE, Hoff PM, Dzik C. Outcomes of sunitinib therapy in patients (pts) with metastatic renal cell carcinoma (mRCC) with poor risk features. J Clin Oncol 2013. [DOI: 10.1200/jco.2013.31.6_suppl.476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
476 Background: Temsirolimus is perceived as the standard of care in pts with mRCC with poor risk features. However, sunitinib (Su) is commonly used in this setting. In this study, we assessed the use of Su in an unselected mRCC population. Methods: Retrospective analysis of 51 pts with mRCC and ≥ 3 poor prognosis features, as determined in the Advanced Renal Cell Carcinoma (ARCC) trial, treated with Su between January 2006 and July 2012. Primary outcome was overall survival (OS). Clinical and laboratory parameters were evaluated, as well as Su-related adverse events (AE). Median time to treatment failure (mTTF) and OS were estimated by Kaplan–Meier methods. On exploratory grounds, univariate, and multivariate analysis using Cox regression model was performed to determine possible prognostic variables. Results: Median age was 60 years (26-89). Most had clear cell histology (98%), 19% prior systemic treatment, and 51% prior nephrectomy. 64%, 15%, and 4% had 4, 5, and 6 adverse prognosis factors respectively. 88% had diagnosis to treatment intervals < 1 year and 45% had KPS scores of < 80. A median of 2 cycles (0–12) were administered. 63% received standard regimen of Su (50 mg/d 4 wk on/2 wk off). Reasons for discontinuation were disease progression (63%) and adverse events (21%). Most grade ≥ 3 AE were fatigue (14%), neutropenia (8%), and stomatitis (8%). 17%, 25%, and 14% developed hypothyroidism, hand-foot syndrome (HFS), and hypertension, respectively. Two therapy-related deaths were observed (one febrile neutropenia and one intracranial hemorrhage). Estimated mTTF and mOS of this cohort were 2.4 and 6.6 months, respectively. Multivariate analysis revealed that in a model adjusted for type of Su regimen, KPS, presence of brain metastasis, and occurrence of HFS, only Su-associated hypothyroidism was significantly associated with survival (respectively, odds ratio [OR] = 0.23; 95% CI = 0.07-0.68). Conclusions: Pts with mRCC with poor risk features treated with Su have an OS, TTF and rates of therapy discontinuation due to AE comparable to clinical trial subsets of similar pts. Our data suggest that the development of hypothyroidism in this setting might be useful as a predictor of OS, and this finding should be further investigated.
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Affiliation(s)
- Romualdo Barroso-Sousa
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | - Leonardo Gomes Fonseca
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Angelo Bezerra de Sousa Fede
- Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | | | | | - Milena Perez Mak
- Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | | | - Paulo M. Hoff
- Instituto do Cancer do Estado de São Paulo, Universidade de São Paulo, São Paulo, Brazil
| | - Carlos Dzik
- Centro de Oncologia, Hospital Sirio Libanes, e Instituto do Cancer do Estado de São Paulo, Universidade de Sao Paulo, São Paulo, Brazil
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Barroso-Sousa R, Lobo RR, Mendonça PR, Memória RR, Spiller F, Cunha FQ, Pazin-Filho A. Decreased levels of alpha-1-acid glycoprotein are related to the mortality of septic patients in the emergency department. Clinics (Sao Paulo) 2013; 68:1134-9. [PMID: 24037010 PMCID: PMC3752623 DOI: 10.6061/clinics/2013(08)12] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2013] [Accepted: 04/11/2013] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To determine the validity of alpha-1-acid glycoprotein as a novel biomarker for mortality in patients with severe sepsis. METHODS We prospectively included patients with severe sepsis or septic shock at the emergency department at a single tertiary referral teaching hospital. All of the patients were enrolled within the first 24 hours of emergency department admission, and clinical data and blood samples were obtained. As the primary outcome, we investigated the association of serum levels of alpha-1-acid glycoprotein and 96-hour mortality with logistic regression analysis and generalized estimating equations adjusted for age, sex, shock status and Acute Physiology and Chronic Health Evaluation II score. RESULTS Patients with septic shock had lower alpha-1-acid glycoprotein levels at the time of emergency department admission compared to patients without shock (respectively, 149.1 ±42.7 vs. 189.8 ±68.6; p = 0.005). Similarly, non-survivors in the first 96 hours were also characterized by lower levels of alpha-1-acid glycoprotein at the time of emergency department admission compared to survivors (respectively, 132.18 ±50.2 vs. 179.8 ±61.4; p = 0.01). In an adjusted analysis, alpha-1-acid glycoprotein levels ≤120 mg/dL were significantly associated with 96-hour mortality (odds ratio = 14.37; 95% confidence interval = 1.58 to 130.21). CONCLUSION Septic shock patients exhibited lower circulating alpha-1-acid glycoprotein levels than patients without shock. Alpha-1-acid glycoprotein levels were independently associated with 96-hour mortality in individuals with severe sepsis.
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Affiliation(s)
- Romualdo Barroso-Sousa
- Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo (FMRP), Department of Internal Medicine, Ribeirão Preto/SPSP, Brazil
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Caires I, Lima R, Barroso-Sousa R, Andrade E, Silva J, Sanchez F, Hoff P, Diz M. Prognostic Factors and Treatment of Cervical Cancer (CC) in Elderly. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33568-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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98
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Fonseca L, Takahashi T, Mak M, Barroso-Sousa R, Testa L, Helena VP, De Costa R, Hoff P, Mano M. Cardiac Safety of (NEO) Adjuvant Trastuzumab in the Brazilian Community Setting: A Single Center Experience. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(20)33946-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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