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Abstract
Breast cancer is one of the three most common cancers worldwide. Early breast cancer is considered potentially curable. Therapy has progressed substantially over the past years with a reduction in therapy intensity, both for locoregional and systemic therapy; avoiding overtreatment but also undertreatment has become a major focus. Therapy concepts follow a curative intent and need to be decided in a multidisciplinary setting, taking molecular subtype and locoregional tumour load into account. Primary conventional surgery is not the optimal choice for all patients any more. In triple-negative and HER2-positive early breast cancer, neoadjuvant therapy has become a commonly used option. Depending on clinical tumour subtype, therapeutic backbones include endocrine therapy, anti-HER2 targeting, and chemotherapy. In metastatic breast cancer, therapy goals are prolongation of survival and maintaining quality of life. Advances in endocrine therapies and combinations, as well as targeting of HER2, and the promise of newer targeted therapies make the prospect of long-term disease control in metastatic breast cancer an increasing reality.
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Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center of the Ludwig-Maximilians-University, Munich, Germany.
| | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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Zambonin V, De Toma A, Carbognin L, Nortilli R, Fiorio E, Parolin V, Pilotto S, Cuppone F, Pellini F, Lombardi D, Pollini GP, Tortora G, Bria E. Clinical results of randomized trials and 'real-world' data exploring the impact of Bevacizumab for breast cancer: opportunities for clinical practice and perspectives for research. Expert Opin Biol Ther 2017; 17:497-506. [PMID: 28133971 DOI: 10.1080/14712598.2017.1289171] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Angiogenesis plays a fundamental role in breast cancer (BC) growth, progression and metastatic spread. After the promising introduction of bevacizumab for the treatment of advanced BC, the initial enthusiasm decreased when the FDA withdrew its approval in 2011. Nevertheless, several clinical studies exploring the role of bevacizumab have been subsequently published. Areas covered: The aim of this study is to review the available clinical trials exploring the potential effectiveness of bevacizumab in BC, regardless of the disease setting. Expert opinion: Even if the evidence suggests that bevacizumab must be ruled out from the HER2-positive and adjuvant setting, bevacizumab's benefit remains uncertain in the neoadjuvant setting and in the advanced treatment of HER2-negative patients. In the first setting, the addition of bevacizumab to chemotherapy increased the pathological complete response (pCR) rate in most clinical trials. However, the current absence of evidence that pCR is a trial-level surrogate for survival requires waiting for long-term results. In the advanced setting, all trials showed a benefit in progression-free survival, but not in overall survival, highlighting an increase of adverse events. The lack of predictors of response represents the main unmet need in which future clinical research will undoubtedly invest.
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Affiliation(s)
- Valentina Zambonin
- a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Alessandro De Toma
- a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Luisa Carbognin
- a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Rolando Nortilli
- a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Elena Fiorio
- a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Veronica Parolin
- a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Sara Pilotto
- a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | | | - Francesca Pellini
- b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,d Chirurgia Senologica, Azienda Ospedaliera Universitaria Integrata, A.O.U.I. Breast Surgery Verona , Verona , Italy
| | - Davide Lombardi
- b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,d Chirurgia Senologica, Azienda Ospedaliera Universitaria Integrata, A.O.U.I. Breast Surgery Verona , Verona , Italy
| | - Giovanni Paolo Pollini
- b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,d Chirurgia Senologica, Azienda Ospedaliera Universitaria Integrata, A.O.U.I. Breast Surgery Verona , Verona , Italy
| | - Giampaolo Tortora
- a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
| | - Emilio Bria
- a U.O. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata , Verona , Italy.,b Breast Unit, Azienda Ospedaliera Universitaria Integrata , Verona , Italy
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Yao H, He G, Yan S, Chen C, Song L, Rosol TJ, Deng X. Triple-negative breast cancer: is there a treatment on the horizon? Oncotarget 2017; 8:1913-1924. [PMID: 27765921 PMCID: PMC5352107 DOI: 10.18632/oncotarget.12284] [Citation(s) in RCA: 241] [Impact Index Per Article: 34.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2016] [Accepted: 09/17/2016] [Indexed: 12/28/2022] Open
Abstract
Triple-negative breast cancer (TNBC), which accounts for 15-20% of all breast cancers, does not express estrogen receptor (ER) or progesterone receptor (PR) and lacks human epidermal growth factor receptor 2 (HER2) overexpression or amplification. These tumors have a more aggressive phenotype and a poorer prognosis due to the high propensity for metastatic progression and absence of specific targeted treatments. Patients with TNBC do not benefit from hormonal or trastuzumab-based targeted therapies because of the loss of target receptors. Although these patients respond to chemotherapeutic agents such as taxanes and anthracyclines better than other subtypes of breast cancer, prognosis remains poor. A group of targeted therapies under investigation showed favorable results in TNBC, especially in cancers with BRCA mutation. The lipid-lowering statins (3-hydroxy-3-methyl-glutaryl coenzyme A reductase inhibitors), including lovastatin and simvastatin, have been shown to preferentially target TNBC compared with non-TNBC. These statins hold great promise for the management of TNBC. Only with the understanding of the molecular basis for the preference of statins for TNBC and more investigations in clinical trials can they be reformulated into a clinically approved drug against TNBC.
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Affiliation(s)
- Hui Yao
- Department of Pathology, Hunan Normal University Medical College, Changsha, Hunan, China
| | - Guangchun He
- Department of Pathology, Hunan Normal University Medical College, Changsha, Hunan, China
| | - Shichao Yan
- Department of Pathology, Hunan Normal University Medical College, Changsha, Hunan, China
| | - Chao Chen
- Department of Pathology, Hunan Normal University Medical College, Changsha, Hunan, China
| | - Liujiang Song
- Department of Pediatrics, Hunan Normal University Medical College, Changsha, Hunan, China
| | - Thomas J. Rosol
- Department of Veterinary Biosciences, The Ohio State University, Columbus, Ohio, USA
| | - Xiyun Deng
- Department of Pathology, Hunan Normal University Medical College, Changsha, Hunan, China
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Pierga JY, Bidard FC, Autret A, Petit T, Andre F, Dalenc F, Levy C, Ferrero JM, Romieu G, Bonneterre J, Lerebours F, Bachelot T, Kerbrat P, Campone M, Eymard JC, Mouret-Reynier MA, Gligorov J, Hardy-Bessard AC, Lortholary A, Soulie P, Boher JM, Proudhon C, Charafe-Jaufret E, Lemonnier J, Bertucci F, Viens P. Circulating tumour cells and pathological complete response: independent prognostic factors in inflammatory breast cancer in a pooled analysis of two multicentre phase II trials (BEVERLY-1 and -2) of neoadjuvant chemotherapy combined with bevacizumab. Ann Oncol 2017; 28:103-109. [DOI: 10.1093/annonc/mdw535] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Tolaney SM, Ziehr DR, Guo H, Ng MR, Barry WT, Higgins MJ, Isakoff SJ, Brock JE, Ivanova EV, Paweletz CP, Demeo MK, Ramaiya NH, Overmoyer BA, Jain RK, Winer EP, Duda DG. Phase II and Biomarker Study of Cabozantinib in Metastatic Triple-Negative Breast Cancer Patients. Oncologist 2017; 22:25-32. [PMID: 27789775 PMCID: PMC5313267 DOI: 10.1634/theoncologist.2016-0229] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Accepted: 07/21/2016] [Indexed: 11/17/2022] Open
Abstract
Currently, no targeted therapies are available for metastatic triplenegative breast cancer (mTNBC). We evaluated the safety, efficacy, and biomarkers of response to cabozantinib, a multikinase inhibitor, in patients with mTNBC. We conducted a single arm phase II and biomarker study that enrolled patients with measurable mTNBC. Patients received cabozantinib (60 mg daily) on a 3-week cycle and were restaged after 6 weeks and then every 9 weeks. The primary endpoint was objective response rate. Predefined secondary endpoints included progression-free survival (PFS), toxicity, and tissue and blood circulating cell and protein biomarkers. Of 35 patients who initiated protocol therapy, 3 (9% [95% confidence interval (CI): 2, 26]) achieved a partial response (PR). Nine patients achieved stable disease (SD) for at least 15 weeks, and thus the clinical benefit rate (PR+SD) was 34% [95% CI: 19, 52]. Median PFS was 2.0 months [95% CI: 1.3, 3.3]. The most common toxicities were fatigue, diarrhea, mucositis, and palmar-plantar erythrodysesthesia. There were no grade 4 toxicities, but 12 patients (34%) required dose reduction. Two patients had TNBCs with MET amplification. During cabozantinib therapy, there were significant and durable increases in plasma placental growth factor, vascular endothelial growth factor (VEGF), VEGF-D, stromal cell-derived factor 1a, and carbonic anhydrase IX, and circulating CD3 + cells and CD8 + T lymphocytes, and decreases in plasma soluble VEGF receptor 2 and CD14+ monocytes (all p < .05). Higher baseline concentrations of soluble MET (sMET) associated with longer PFS (p = .03). In conclusion, cabozantinib showed encouraging safety and efficacy signals but did not meet the primary endpoint in pretreated mTNBC. Exploratory analyses of circulating biomarkers showed that cabozantinib induces systemic changes consistent with activation of the immune system and antiangiogenic activity, and that sMET should be further evaluated a potential biomarker of response. IMPLICATIONS FOR PRACTICE Triple-negative breast cancer (TNBC)-a disease with a dearth of effective therapies-often overexpress MET, which is associated with poor clinical outcomes. However, clinical studies of agents targeting MET and VEGF pathways-alone or in combination-have shown disappointing results. This study of cabozantinib (a dual VEGFR2/MET) in metastatic TNBC, while not meeting its prespecified endpoint, showed that treatment is associated with circulating biomarker changes, and is active in a subset of patients. Furthermore, this study demonstrates that cabozantinib therapy induces a systemic increase in cytotoxic lymphocyte populations and a decrease in immunosuppressive myeloid populations. This supports the testing of combinations of cabozantinib with immunotherapy in future studies in breast cancer patients.
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Affiliation(s)
| | - David R. Ziehr
- Department of MedicineMassachusetts General Hospital Cancer CenterBostonMassachusettsUSA
| | - Hao Guo
- Dana‐Farber Cancer InstituteBostonMassachusettsUSA
| | - Mei R. Ng
- Steele Laboratories, Department of Radiation OncologyMassachusetts General Hospital Research InstituteBostonMassachusettsUSA
| | | | - Michaela J. Higgins
- Department of MedicineMassachusetts General Hospital Cancer CenterBostonMassachusettsUSA
| | - Steven J. Isakoff
- Department of MedicineMassachusetts General Hospital Cancer CenterBostonMassachusettsUSA
| | | | | | | | | | | | | | - Rakesh K. Jain
- Steele Laboratories, Department of Radiation OncologyMassachusetts General Hospital Research InstituteBostonMassachusettsUSA
| | | | - Dan G. Duda
- Steele Laboratories, Department of Radiation OncologyMassachusetts General Hospital Research InstituteBostonMassachusettsUSA
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Bevacizumab plus paclitaxel versus placebo plus paclitaxel as first-line therapy for HER2-negative metastatic breast cancer (MERiDiAN): A double-blind placebo-controlled randomised phase III trial with prospective biomarker evaluation. Eur J Cancer 2016; 70:146-155. [PMID: 27817944 DOI: 10.1016/j.ejca.2016.09.024] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Revised: 09/26/2016] [Accepted: 09/28/2016] [Indexed: 11/24/2022]
Abstract
AIM MERiDiAN evaluated plasma vascular endothelial growth factor-A (pVEGF-A) prospectively as a predictive biomarker for bevacizumab efficacy in metastatic breast cancer (mBC). METHODS In this double-blind placebo-controlled randomised phase III trial, eligible patients had HER2-negative mBC previously untreated with chemotherapy. pVEGF-A was measured before randomisation to paclitaxel 90 mg/m2 on days 1, 8 and 15 with either placebo or bevacizumab 10 mg/kg on days 1 and 15, repeated every 4 weeks until disease progression, unacceptable toxicity or consent withdrawal. Stratification factors were baseline pVEGF-A, prior adjuvant chemotherapy, hormone receptor status and geographic region. Co-primary end-points were investigator-assessed progression-free survival (PFS) in the intent-to-treat and pVEGF-Ahigh populations. RESULTS Of 481 patients randomised (242 placebo-paclitaxel; 239 bevacizumab-paclitaxel), 471 received study treatment. The stratified PFS hazard ratio was 0.68 (99% confidence interval, 0.51-0.91; log-rank p = 0.0007) in the intent-to-treat population (median 8.8 months with placebo-paclitaxel versus 11.0 months with bevacizumab-paclitaxel) and 0.64 (96% confidence interval, 0.47-0.88; log-rank p = 0.0038) in the pVEGF-Ahigh subgroup. The PFS treatment-by-VEGF-A interaction p value (secondary end-point) was 0.4619. Bevacizumab was associated with increased incidences of bleeding (all grades: 45% versus 27% with placebo), neutropenia (all grades: 39% versus 29%; grade ≥3: 25% versus 13%) and hypertension (all grades: 31% versus 13%; grade ≥3: 11% versus 4%). CONCLUSION The significant PFS improvement with bevacizumab is consistent with previous placebo-controlled first-line trials in mBC. Results do not support using baseline pVEGF-A to identify patients benefitting most from bevacizumab. CLINICAL TRIALS REGISTRATION ClinicalTrials.gov NCT01663727.
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107
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Rochlitz C, Bigler M, von Moos R, Bernhard J, Matter-Walstra K, Wicki A, Zaman K, Anchisi S, Küng M, Na KJ, Bärtschi D, Borner M, Rordorf T, Rauch D, Müller A, Ruhstaller T, Vetter M, Trojan A, Hasler-Strub U, Cathomas R, Winterhalder R. SAKK 24/09: safety and tolerability of bevacizumab plus paclitaxel vs. bevacizumab plus metronomic cyclophosphamide and capecitabine as first-line therapy in patients with HER2-negative advanced stage breast cancer - a multicenter, randomized phase III trial. BMC Cancer 2016; 16:780. [PMID: 27724870 PMCID: PMC5057418 DOI: 10.1186/s12885-016-2823-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 09/29/2016] [Indexed: 01/08/2023] Open
Abstract
Background Adding bevacizumab to chemotherapy improves response rates and progression-free survival (PFS) in metastatic breast cancer (mBC). We aimed to demonstrate decreased toxicity with metronomic chemotherapy/bevacizumab compared with paclitaxel/bevacizumab. Methods This multicenter, randomized phase III trial compared bevacizumab with either paclitaxel (arm A) or daily oral capecitabine-cyclophosphamide (arm B) as first-line treatment in patients with HER2-negative advanced breast cancer. The primary endpoint was the incidence of selected grade 3–5 adverse events (AE) including: febrile neutropenia, infection, sensory/motor neuropathy, and mucositis. Secondary endpoints included objective response rate, disease control rate, PFS, overall survival (OS), quality of life (QoL), and pharmacoeconomics. The study was registered prospectively with ClinicalTrials.gov, number NCT01131195 on May 25, 2010. Results Between September 2010 and December 2012, 147 patients were included at 22 centers. The incidence of primary endpoint-defining AEs was similar in arm A (25 % [18/71]; 95 % CI 15–35 %) and arm B (24 % [16/68]; 95 % CI 13–34 %; P = 0.96). Objective response rates were 58 % (42/73; 95 % CI 0.46–0.69) and 50 % (37/74; 95 % CI 0.39–0.61) in arms A and B, respectively (P = 0.45). Median PFS was 10.3 months (95 % CI 8.7–11.3) in arm A and 8.5 months (95 % CI 6.5–11.9) in arm B (P = 0.90). Other secondary efficacy endpoints were not significantly different between study arms. The only statistically significant differences in QoL were less hair loss and less numbness in arm B. Treatment costs between the two arms were equivalent. Conclusion This trial failed to meet its primary endpoint of a reduced rate of prespecified grade 3–5 AEs with metronomic bevacizumab, cyclophosphamide and capecitabine. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2823-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Christoph Rochlitz
- Department of Oncology, University Hospital Basel, Petersgraben 4, Basel, CH-4031, Switzerland.
| | | | - Roger von Moos
- Department of Oncology, Kantonsspital Graubünden, Chur, Switzerland
| | - Jürg Bernhard
- International Breast Cancer Study (IBCSG) and Inselspital, Bern University Hospital, Bern, Switzerland
| | - Klazien Matter-Walstra
- SAKK Coordinating Center, Bern, Switzerland and European Center for Pharmaceutical Medicine, University Basel, Basel, Switzerland
| | - Andreas Wicki
- Department of Oncology, University Hospital Basel, Petersgraben 4, Basel, CH-4031, Switzerland
| | - Khalil Zaman
- Department of Oncology, University Hospital Lausanne, Lausanne, Switzerland
| | - Sandro Anchisi
- Department of Oncology, Hospital of Valais, Sion, Switzerland
| | - Marc Küng
- Department of Oncology, Kantonsspital Fribourg, Fribourg, Switzerland
| | - Kyung-Jae Na
- SAKK Coordinating Center, Bern, Switzerland.,Present Address: Novartis Pharma, Stein, Switzerland
| | | | - Markus Borner
- Department of Oncology, Spitalzentrum Biel, Biel, Switzerland
| | - Tamara Rordorf
- Department of Oncology, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Rauch
- Department of Oncology, Spital STS, Thun, Switzerland
| | - Andreas Müller
- Department of Oncology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Thomas Ruhstaller
- Department of Oncology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Marcus Vetter
- Department of Oncology, University Hospital Basel, Petersgraben 4, Basel, CH-4031, Switzerland
| | - Andreas Trojan
- Department of Oncology, OnkoZentrum Zürich, Zürich, Switzerland
| | | | - Richard Cathomas
- Department of Oncology, Kantonsspital Graubünden, Chur, Switzerland
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Sonnenblick A, Pondé N, Piccart M. Metastatic breast cancer: The Odyssey of personalization. Mol Oncol 2016; 10:1147-59. [PMID: 27430154 PMCID: PMC5423195 DOI: 10.1016/j.molonc.2016.07.002] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 06/27/2016] [Accepted: 07/05/2016] [Indexed: 12/31/2022] Open
Abstract
Metastatic breast cancer is the most frequent cause of cancer death for women worldwide. In the last 15 years, a large number of new agents have entered clinical use, a result of the dramatic increase in our understanding of the molecular underpinnings of metastatic breast cancer. However, while these agents have led to better outcomes, they are also at the root cause of increasing financial pressure on healthcare systems. Moreover, decision making in an era where every year new agents are added to the therapeutic armamentarium has also become a significant challenge for medical oncologists. In the present article, we will provide an ample review on the most recent developments in the field of treatment of the different subtypes of metastatic breast cancer with a critical discussion on the slow progress made in identifying response biomarkers. New hopes in the form of ctDNA monitoring and functional imaging will be presented.
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Affiliation(s)
- A Sonnenblick
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 125, B 1000 Brussels, Belgium; Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - N Pondé
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 125, B 1000 Brussels, Belgium
| | - M Piccart
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 125, B 1000 Brussels, Belgium.
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Targeted Therapies for Brain Metastases from Breast Cancer. Int J Mol Sci 2016; 17:ijms17091543. [PMID: 27649142 PMCID: PMC5037817 DOI: 10.3390/ijms17091543] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Revised: 09/01/2016] [Accepted: 09/08/2016] [Indexed: 02/06/2023] Open
Abstract
The discovery of various driver pathways and targeted small molecule agents/antibodies have revolutionized the management of metastatic breast cancer. Currently, the major targets of clinical utility in breast cancer include the human epidermal growth factor receptor 2 (HER2) and epidermal growth factor receptor (EGFR), vascular endothelial growth factor (VEGF) receptor, mechanistic target of rapamycin (mTOR) pathway, and the cyclin-dependent kinase 4/6 (CDK-4/6) pathway. Brain metastasis, however, remains a thorn in the flesh, leading to morbidity, neuro-cognitive decline, and interruptions in the management of systemic disease. Approximately 20%–30% of patients with metastatic breast cancer develop brain metastases. Surgery, whole brain radiation therapy, and stereotactic radiosurgery are the traditional treatment options for patients with brain metastases. The therapeutic paradigm is changing due to better understanding of the blood brain barrier and the advent of tyrosine kinase inhibitors and monoclonal antibodies. Several of these agents are in clinical practice and several others are in early stage clinical trials. In this article, we will review the common targetable pathways in the management of breast cancer patients with brain metastases, and the current state of the clinical development of drugs against these pathways.
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Bevacizumab as first-line treatment in HER2-negative advanced breast cancer: pros and cons. TUMORI JOURNAL 2016; 102:472-480. [PMID: 27647231 DOI: 10.5301/tj.5000555] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/02/2016] [Indexed: 12/23/2022]
Abstract
PURPOSE Bevacizumab, a humanized, anti-vascular endothelial growth factor-A monoclonal antibody, has shown efficacy in a number of cancers. However, its use in metastatic breast cancer (MBC) remains controversial. METHODS A literature review using the PubMed database was performed to update the currently available clinical trials evidence on bevacizumab in the first-line treatment of breast cancer. In addition, the proceedings of selected oncology annual meetings were searched for relevant presentations. RESULTS This article reviews the available evidence for bevacizumab as first-line therapy for MBC and discusses its current and future applicability in the management of MBC. Three phase III trials (ECOG-2100, AVADO, RIBBON-1) demonstrated that the addition of bevacizumab to chemotherapy is well-tolerated and improves progression-free survival and objective response rates in the first-line setting. These findings were supported by a large clinical practice-based study (ATHENA) and a recent clinical trial in which bevacizumab added to paclitaxel showed notable activity in triple-negative MBC. However, bevacizumab has thus far not demonstrated a significant benefit in overall survival. CONCLUSIONS The addition of bevacizumab to chemotherapy is well-tolerated and produces substantial improvements in overall response rate and progression-free survival, compared with chemotherapy alone, in advanced HER2-negative breast cancer. Nevertheless, it has thus far not demonstrated a significant benefit in overall survival. Whether prolongation of progression-free survival is enough to consider bevacizumab efficacious is unclear. Based on the available clinical trials results, bevacizumab is a part of the complex therapeutic strategy of advanced HER2-negative breast cancer.
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A Phase I, Dose-Escalation Trial of Pazopanib in Combination with Cisplatin in Patients with Advanced Solid Tumors: A UNICANCER Study. Oncol Ther 2016; 4:211-223. [PMID: 28261651 PMCID: PMC5315079 DOI: 10.1007/s40487-016-0027-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Indexed: 02/02/2023] Open
Abstract
Introduction To determine the feasibility, maximum-tolerated dose (MTD), and dose-limiting toxicities (DLT) of pazopanib in combination with cisplatin. Methods Patients with advanced malignancies were included in a 3 + 3 dose-escalation phase I study. Pazopanib administration started 8 days before the first infusion of cisplatin; some patients were treated according to a reverse sequence (cisplatin first). Five dose levels (DLs) were planned. MTD was based on DLT observed during cycles 1 and 2. Results Thirty-five patients were enrolled. The MTD was reached at the first DL, (pazopanib 400 mg daily + cisplatin 75 mg/m2 every 21 days). Main DLTs were pulmonary embolism, neutropenia, thrombocytopenia, and elevation of liver enzymes. Overall, most common adverse events were anemia (83%), fatigue (80%), thrombocytopenia (80%), neutropenia (73%), hypertension (59%), neurotoxicity (56%), and anorexia (53%). Sixteen patients (46%) discontinued the study due to toxicity. One patient (sarcoma) had a complete response, and three patients (one with breast cancer and two with ovarian cancers) had a partial response. Pharmacokinetic (PK) analyses showed interactions with aprepitant, resulting in increased exposure to pazopanib, which might explain partly the poor tolerance of the combination. Conclusion Cisplatin and pazopanib could not be administered at their single agent full doses, partly due to a PK interaction between pazopanib and aprepitant. Funding This work was funded by GlaxoSmithKline and by the charity Ligue Nationale de Lutte Contre le Cancer. Trial registered ClinicalTrials.gov identifier, NCT01165385.
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Abstract
NEOADJUVANT CHEMOTHERAPY IN HER2-POSITIVE AND TRIPLE-NEGATIVE BREAST CANCER: Neoadjuvant chemotherapy is a standard option in the management of operable breast cancer, as effective as adjuvant chemotherapy in term of survival and with the potential to increase the rate of breast conservation. In HER2+ and triple-negative breast cancers, neoadjuvant chemotherapy is associated with a high probability of pathological complete response, which strongly predicts survival outcome. In HER2+ breast cancer, trastuzumab, in combination with neoadjuvant chemotherapy, mostly anthracyclines and taxane-based, demonstrated a significant increase in pathological complete response rate. Recently, dual HER2 blockade strategies (lapatinib-trastuzumab or pertuzumab-trastuzumab) demonstrated a significant improvement in terms of pathological complete response over trastuzumab. In triple-negative breast cancer, recent data indicate that incorporating platinum compounds to neoadjuvant chemotherapy also significantly improves this parameter. Yet, in both subtypes, whether these substantial improvements may lead to significant benefits in terms of survival and breast conserving surgery remains to be demonstrated.
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Affiliation(s)
- Anthony Gonçalves
- Département d'oncologie médicale, Institut Paoli-Calmettes, Marseille, 13009; Centre de recherche en cancérologie de Marseille (Institut Paoli-Calmettes, Inserm 1068, Cnrs 7258, Aix-Marseille Université), Marseille, 13009; Aix-Marseille Université, Marseille, 13006.
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Giordano G, Spagnuolo A, Olivieri N, Corbo C, Campagna A, Spagnoletti I, Pennacchio RM, Campidoglio S, Pancione M, Palladino L, Villari B, Febbraro A. Cancer drug related cardiotoxicity during breast cancer treatment. Expert Opin Drug Saf 2016; 15:1063-74. [PMID: 27120499 DOI: 10.1080/14740338.2016.1182493] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Breast cancer (BC) is the most common cancer in women. Although therapeutic armamentarium like chemotherapy, endocrine and target agents have increased survival, cardiovascular side effects have been observed. A comprehensive risk assessment, early detection and management of cardiac adverse events is therefore needed. AREAS COVERED In this review we focus on cardiotoxicity data deriving from Phase III randomized trials, systematic reviews and meta-analysis in BC patients. We provide insight into advances that have been made in the molecular mechanisms, clinical presentation and management of such adverse event. EXPERT OPINION Despite the large number of data from Phase III trials about cardiac events incidence, there are poor evidences for detection, monitoring and management of cardiotoxicity during BC treatment. Future cardiotoxicity-oriented clinical cancer research can help to predict the risk of cardiac adverse events and improve patients' outcome. Multidisciplinary approach as well as integration of blood biomarkers with imaging will be desirable.
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Affiliation(s)
- Guido Giordano
- a Medical Oncology Unit , Ospedale Sacro Cuore di Gesù, Fatebenefratelli , Benevento , Italy
| | - Alessia Spagnuolo
- a Medical Oncology Unit , Ospedale Sacro Cuore di Gesù, Fatebenefratelli , Benevento , Italy
| | - Nunzio Olivieri
- b Department of Biology , University of Naples, Federico II , Napoli , Italy
| | - Claudia Corbo
- a Medical Oncology Unit , Ospedale Sacro Cuore di Gesù, Fatebenefratelli , Benevento , Italy
| | - Angelo Campagna
- a Medical Oncology Unit , Ospedale Sacro Cuore di Gesù, Fatebenefratelli , Benevento , Italy
| | - Ilaria Spagnoletti
- a Medical Oncology Unit , Ospedale Sacro Cuore di Gesù, Fatebenefratelli , Benevento , Italy
| | | | - Serena Campidoglio
- a Medical Oncology Unit , Ospedale Sacro Cuore di Gesù, Fatebenefratelli , Benevento , Italy
| | - Massimo Pancione
- c Duepartment of Science and Technology , University of Sannio , Benevento , Italy
| | - Luciano Palladino
- d Department of Surgery , Ospedale Sacro Cuore di Gesù, Fatebenefratelli , Benevento , Italy
| | - Bruno Villari
- e Department of Cardiology , Ospedale Sacro Cuore di Gesù, Fatebenefratelli , Benevento , Italy
| | - Antonio Febbraro
- a Medical Oncology Unit , Ospedale Sacro Cuore di Gesù, Fatebenefratelli , Benevento , Italy
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114
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Liu M, Li Z, Yang J, Jiang Y, Chen Z, Ali Z, He N, Wang Z. Cell-specific biomarkers and targeted biopharmaceuticals for breast cancer treatment. Cell Prolif 2016; 49:409-20. [PMID: 27312135 PMCID: PMC6496337 DOI: 10.1111/cpr.12266] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 05/04/2016] [Indexed: 12/13/2022] Open
Abstract
Breast cancer is the second leading cause of cancer death among women, and its related treatment has been attracting significant attention over the past decades. Among the various treatments, targeted therapy has shown great promise as a precision treatment, by binding to cancer cell-specific biomarkers. So far, great achievements have been made in targeted therapy of breast cancer. In this review, we first discuss cell-specific biomarkers, which are not only useful for classification of breast cancer subtyping but also can be utilized as goals for targeted therapy. Then, the innovative and generic-targeted biopharmaceuticals for breast cancer, including monoclonal antibodies, non-antibody proteins and small molecule drugs, are reviewed. Finally, we provide our outlook on future developments of biopharmaceuticals, and provide solutions to problems in this field.
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Affiliation(s)
- Mei Liu
- School of Biological Science and Medical EngineeringSoutheast UniversityNanjingChina
| | - Zhiyang Li
- School of Biological Science and Medical EngineeringSoutheast UniversityNanjingChina
- Department of Laboratory MedicineNanjing Drum Tower Hospital Clinical CollegeNanjing UniversityNanjingChina
| | - Jingjing Yang
- School of Chemistry and Chemical EngineeringSoutheast UniversityNanjingChina
| | - Yanyun Jiang
- School of Chemistry and Chemical EngineeringSoutheast UniversityNanjingChina
| | - Zhongsi Chen
- School of Biological Science and Medical EngineeringSoutheast UniversityNanjingChina
| | - Zeeshan Ali
- School of Chemistry and Chemical EngineeringSoutheast UniversityNanjingChina
| | - Nongyue He
- School of Biological Science and Medical EngineeringSoutheast UniversityNanjingChina
| | - Zhifei Wang
- School of Chemistry and Chemical EngineeringSoutheast UniversityNanjingChina
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115
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Portha H, Jankowski C, Cortet M, Desmoulins I, Martin E, Lorgis V, Arnould L, Coutant C. [Non-metastatic triple-negative breast cancer in 2016: Definitions and management]. ACTA ACUST UNITED AC 2016; 44:492-504. [PMID: 27451066 DOI: 10.1016/j.gyobfe.2016.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2016] [Accepted: 06/15/2016] [Indexed: 12/24/2022]
Abstract
Triple-negative breast cancer (TN), as defined by the triple negativity in immunohistochemistry: the absence of estrogen receptor, progesterone receptor and the absence of overexpression or amplification of HER2, corresponds to 15 % of invasive breast cancers. This is a very heterogeneous group of tumors both at the genomic and transcriptomic level and at morphological, clinical and prognostic level. Although there are some good prognosis forms, the majority of TN tumors is characterized by a poor prognosis with a greater frequency of visceral metastases and a maximum risk of relapse in the first two years after diagnosis. Systemic adjuvant treatment with chemotherapy is almost always indicated. The surgical treatment and radiotherapy treatment should be comparable to the other subtypes and obey the same rules of oncologic surgery. TN tumors are not associated with a higher risk of locoregional relapse after conservative treatment and adjuvant radiotherapy. Optimization of systemic therapies is currently and for the last decade a challenge. A number of targeted therapies and efficiency biomarkers identification of these targeted therapies is essential to allow significant progress in optimizing systemic therapy for these tumors.
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Affiliation(s)
- H Portha
- Département de chirurgie oncologique, centre de lutte contre le cancer Georges-François-Leclerc (CGFL), Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - C Jankowski
- Département de chirurgie oncologique, centre de lutte contre le cancer Georges-François-Leclerc (CGFL), Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France; UFR des sciences de santé, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France
| | - M Cortet
- Département de chirurgie oncologique, centre de lutte contre le cancer Georges-François-Leclerc (CGFL), Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - I Desmoulins
- Département d'oncologie médicale, CGFL, Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - E Martin
- Département de radiothérapie, CGFL, Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - V Lorgis
- Département d'oncologie médicale, CGFL, Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - L Arnould
- Département de biologie et de pathologie des tumeurs, CGFL, Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France
| | - C Coutant
- Département de chirurgie oncologique, centre de lutte contre le cancer Georges-François-Leclerc (CGFL), Unicancer, 1, rue du Professeur-Marion, 21000 Dijon, France; UFR des sciences de santé, université de Bourgogne, 7, boulevard Jeanne-d'Arc, 21000 Dijon, France.
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116
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Puglisi F, Bisagni G, Ciccarese M, Fontanella C, Gamucci T, Leo L, Molino A, Silva RR, Marchetti P. A Delphi consensus and open debate on the role of first-line bevacizumab for HER2-negative metastatic breast cancer. Future Oncol 2016; 12:2589-2602. [PMID: 27443691 DOI: 10.2217/fon-2016-0295] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
To gain consensus on the role of bevacizumab plus paclitaxel as first-line treatment for HER2-negative metastatic breast cancer, a panel of expert oncologists experienced in treating patients with metastatic breast cancer in Italy participated in a Delphi consensus study. The panel reached a full consensus on the efficacy of bevacizumab plus paclitaxel and the clinical meaningfulness of the progression-free survival benefit compared with paclitaxel alone, despite the lack of an overall survival effect in clinical trials. The participants agreed that real-world data support the effectiveness and well-defined safety profile of the regimen. Views on the use of bevacizumab plus paclitaxel in specific patient populations were not unanimous and clinical judgment remains important. Nevertheless, a high level of agreement was reached.
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Affiliation(s)
- Fabio Puglisi
- Department of Medical & Biological Sciences, University of Udine, Udine, Italy
| | - Giancarlo Bisagni
- Oncology Unit, Department of Oncology, Azienda Ospedaliera ASMN, Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | | | - Caterina Fontanella
- Department of Medical & Biological Sciences, University of Udine, Udine, Italy
| | | | - Luigi Leo
- Oncology Unit, Azienda Ospedaliera dei Colli, Naples, Italy
| | | | - Rosa Rita Silva
- Medical Oncology Unit, ASUR Marche AV2 Fabriano, Fabriano, Italy
| | - Paolo Marchetti
- Medical Oncology, Sant'Andrea Hospital, Sapienza University of Rome & IDI-IRCCS, Rome, Italy
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117
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Over-treatment in metastatic breast cancer. Breast 2016; 31:309-317. [PMID: 27453572 DOI: 10.1016/j.breast.2016.06.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2016] [Revised: 06/25/2016] [Accepted: 06/30/2016] [Indexed: 12/31/2022] Open
Abstract
Metastatic breast cancer is an incurable disease and the main goals of treatment are prolongation of survival and preservation/improvement of quality of life. Thus the main philosophy of treatment should be to use the least toxic methods, as long as they provide sufficient disease control. In ER-positive tumours this can be in many cases achieved by endocrine therapy; in HER2-positive cancers efficacy of backbone therapy can be enhanced by an anti-HER2 agent. In patients requiring chemotherapy, consecutive single agent regimen provide disease control of a duration at least comparable to multidrug regimen, at a cost of significantly lower toxicity and are a preferred strategy in the majority of cases. Available data demonstrate, however, that aggressive chemotherapy is still overused in many metastatic breast cancer patients. The objective of this manuscript is to critically review available data on treatment choices and sequence in metastatic breast cancer across all breast cancer subtypes in relation to possible overtreatment, including therapies which are not recommended by current guidelines or not even approved. Our aim is to provide guidance on applying these data to clinical practice, but also to describe various, often non-scientific factors influencing therapeutic decisions in an aim to identify areas requiring educational and possibly political actions.
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118
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Cannita K, Paradisi S, Cocciolone V, Bafile A, Rinaldi L, Irelli A, Lanfiuti Baldi P, Zugaro L, Manetta R, Alesse E, Ricevuto E, Ficorella C. New schedule of bevacizumab/paclitaxel as first-line therapy for metastatic HER2-negative breast cancer in a real-life setting. Cancer Med 2016; 5:2232-9. [PMID: 27416882 PMCID: PMC5055157 DOI: 10.1002/cam4.803] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/16/2016] [Accepted: 05/20/2016] [Indexed: 12/12/2022] Open
Abstract
Angiogenesis plays an essential role in the growth and progression of breast cancer. This observational single center study evaluated the efficacy and safety of a new weekly schedule of bevacizumab/paclitaxel combination in the first-line treatment of unselected, HER2-negative, metastatic breast cancer (MBC) patients, in a real-life setting. Thirty-five patients (median age 56 years, range 40-81) with HER2-negative MBC were treated with paclitaxel (70 mg/m(2) ) dd 1,8,15 q21 (60 mg/m(2) if ≥65 years or secondary Cumulative Illness Rating Scale) plus bevacizumab (10 mg/kg) every 2 weeks. Twenty-two patients (63%) had ≥2 metastatic sites and 15 (43%) visceral disease. Eleven patients (31%) had a triple-negative breast cancer (TNBC). A clinical complete response (cCR) was observed in 6 (17%) cases after a median of seven cycles, a partial response (PR) in 22 (63%), and a stable disease (SD) in 6 (17%) cases; the overall clinical benefit rate was 97%. In TNBC subgroup, cCR occurred in 1 (9%) case, PR in 8 (73%), and SD in 2 (18%). At a median follow-up of 13 months (range 1-79 months), the median progression-free survival was 11 months and the median overall survival was 36 months. No grade 4 adverse events occurred. The main grade 3 toxicities observed were neutropenia (11.4%), hypertension (5.7%), stomatitis (2.8%), diarrhea (2.8%), and vomiting (2.8%). The administration of weekly paclitaxel plus bevacizumab in this real-life experience shows similar efficacy than previously reported schedules, with a comparable dose intensity and a good toxicity profile.
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Affiliation(s)
- Katia Cannita
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.
| | - Stefania Paradisi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Valentina Cocciolone
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Departement of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | | | - Lucia Rinaldi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Azzurra Irelli
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Paola Lanfiuti Baldi
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Luigi Zugaro
- Division of Radiology, S. Salvatore Hospital, L'Aquila, Italy
| | - Rosa Manetta
- Division of Radiology, S. Salvatore Hospital, L'Aquila, Italy
| | - Edoardo Alesse
- Departement of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Enrico Ricevuto
- Departement of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.,Oncology Network ASL1 Abruzzo, UOSD Oncology Territorial Care, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy
| | - Corrado Ficorella
- Medical Oncology, S. Salvatore Hospital, University of L'Aquila, L'Aquila, Italy.,Departement of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
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119
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Ferrero JM, Hardy-Bessard AC, Capitain O, Lortholary A, Salles B, Follana P, Herve R, Deblock M, Dauba J, Atlassi M, Largillier R. Weekly paclitaxel, capecitabine, and bevacizumab with maintenance capecitabine and bevacizumab as first-line therapy for triple-negative, metastatic, or locally advanced breast cancer: Results from the GINECO A-TaXel phase 2 study. Cancer 2016; 122:3119-3126. [DOI: 10.1002/cncr.30170] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 05/02/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Jean-Marc Ferrero
- Department of Medical Oncology, Antoine-Lacassagne Centre; Nice France
| | | | - Olivier Capitain
- Department of Medical Oncology, Paul Papin Western Oncology Institute; Angers France
| | | | - Bruno Salles
- Department of Medical Oncology, William Morey Hospital; Chalon-sur-Saone France
| | - Philippe Follana
- Department of Medical Oncology, Antoine-Lacassagne Centre; Nice France
| | | | - Mathilde Deblock
- Department of Medical Oncology, Lorraine Cancer Institute; Vandoeuvre-les-Nancy France
| | - Jérôme Dauba
- Department of Medical Oncology, Mont de Marsan Hospital; Mont de Marsan France
| | - Mustapha Atlassi
- Department of Medical Oncology, Le Mans Hospital; Le Mans France
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120
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Trédan O, Follana P, Moullet I, Cropet C, Trager-Maury S, Dauba J, Lavau-Denes S, Diéras V, Béal-Ardisson D, Gouttebel M, Orfeuvre H, Stefani L, Jouannaud C, Bürki F, Petit T, Guardiola E, Becuwe C, Blot E, Pujade-Lauraine E, Bachelot T. A phase III trial of exemestane plus bevacizumab maintenance therapy in patients with metastatic breast cancer after first-line taxane and bevacizumab: a GINECO group study. Ann Oncol 2016; 27:1020-1029. [DOI: 10.1093/annonc/mdw077] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 02/15/2016] [Indexed: 11/12/2022] Open
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121
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Endothelin-1 genetic polymorphism as predictive marker for bevacizumab in metastatic breast cancer. THE PHARMACOGENOMICS JOURNAL 2016; 17:344-350. [DOI: 10.1038/tpj.2016.25] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 02/03/2016] [Accepted: 02/26/2016] [Indexed: 11/08/2022]
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122
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Marín-Pozo JF, Duarte-Pérez JM, Sánchez-Rovira P. Safety, Effectiveness, and Costs of Bevacizumab-Based Therapy in Southern Spain: A Real World Experience. Medicine (Baltimore) 2016; 95:e3623. [PMID: 27175672 PMCID: PMC4902514 DOI: 10.1097/md.0000000000003623] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
To evaluate the safety and efficacy of bevacizumab in a broader patient population with solid tumors in the context of general clinical practice. Moreover, we quantified the economic impact and characterized the off-label use (OLU) of this agent in real-life prescribing practices.This is an open, retrospective, observational, real world study carried out at a regional Spanish hospital attending a population of 665,000 inhabitants. All of the patients receiving bevacizumab-containing therapy between January 2006 and February 2012 at the study hospital were included: no exclusion criteria were specified. All study variables were collected from available hospital records.The analysis comprised 240 episodes from 226 patients (male 41%; median age 57 years, 25% ≥65 years). Eighty cases (33%) of bevacizumab treatment were administered as first-line therapy. The median duration of bevacizumab treatment was 5.8 months (95% CI 5.1-6.6), without difference by age, line of treatment, or type of tumor. Typically bevacizumab-related toxicities included bleeding (25%), hypertension (5%), wound-healing complications (4%), gastrointestinal perforation (2%), and arterial thromboembolism (1%). Median progression-free survival was 7.5 months (95% CI 6.3-8.7) and median OS reached 13.1 months (95% CI 11.4-14.9). Bevacizumab increased the chemotherapy cost to 207% (from &OV0556;3,115,615 to &OV0556;9,552,405). Bevacizumab was prescribed off-label in 43% of episodes, amounting to &OV0556;3,586,420 (56% of bevacizumab total cost).The efficacy and safety profile of bevacizumab in routine clinical practice is consistent with results observed in prospective randomized clinical trials. OLU of this drug should be closely monitored.
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Affiliation(s)
- Juan F Marín-Pozo
- From the Complejo Hospitalario de Jaén, Jaén (JFM-P, PS-R), Spain; and University of Granada (JMD-P), Granada, Spain
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123
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Zeichner SB, Terawaki H, Gogineni K. A Review of Systemic Treatment in Metastatic Triple-Negative Breast Cancer. BREAST CANCER-BASIC AND CLINICAL RESEARCH 2016; 10:25-36. [PMID: 27042088 PMCID: PMC4807882 DOI: 10.4137/bcbcr.s32783] [Citation(s) in RCA: 103] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 02/08/2016] [Accepted: 02/09/2016] [Indexed: 12/19/2022]
Abstract
Patients with breast cancer along with metastatic estrogen and progesterone receptor (ER/PR)- and human epidermal growth factor receptor 2 (HER2)-negative tumors are referred to as having metastatic triple-negative breast cancer (mTNBC) disease. Although there have been many new treatment options approved by the Food and Drug Administration for ER/PR-positive and Her2/neu-amplified metastatic breast cancer, relatively few new agents have been approved for patients with mTNBC. There have been several head-to-head chemotherapy trials performed within the metastatic setting, and much of what is applied in clinical practice is extrapolated from chemotherapy trials in the adjuvant setting, with taxanes and anthracyclines incorporated early on in the patient's treatment course. Select synergistic combinations can produce faster and more significant response rates compared with monotherapy and are typically used in the setting of visceral threat or symptomatic disease. Preclinical studies have implicated other possible targets and mechanisms in mTNBC. Ongoing clinical trials are underway assessing new chemotherapeutic strategies and agents, including targeted therapy and immunotherapy. In this review, we evaluate the standard systemic and future treatment options in mTNBC.
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Affiliation(s)
- Simon B Zeichner
- Department of Hematology & Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Hiromi Terawaki
- Department of Hematology & Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
| | - Keerthi Gogineni
- Department of Hematology & Oncology, Winship Cancer Institute of Emory University, Atlanta, GA, USA
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124
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Michiels S, Pugliano L, Marguet S, Grun D, Barinoff J, Cameron D, Cobleigh M, Di Leo A, Johnston S, Gasparini G, Kaufman B, Marty M, Nekljudova V, Paluch-Shimon S, Penault-Llorca F, Slamon D, Vogel C, von Minckwitz G, Buyse M, Piccart M. Progression-free survival as surrogate end point for overall survival in clinical trials of HER2-targeted agents in HER2-positive metastatic breast cancer. Ann Oncol 2016; 27:1029-1034. [PMID: 26961151 DOI: 10.1093/annonc/mdw132] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 03/03/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The gold standard end point in randomized clinical trials in metastatic breast cancer (MBC) is overall survival (OS). Although therapeutics have been approved based on progression-free survival (PFS), its use as a primary end point is controversial. We aimed to assess to what extent PFS may be used as a surrogate for OS in randomized trials of anti-HER2 agents in HER2+ MBC. METHODS Eligible trials accrued HER2+ MBC patients in 1992-2008. A correlation approach was used: at the individual level, to estimate the association between investigator-assessed PFS and OS using a bivariate model and at the trial level, to estimate the association between treatment effects on PFS and OS. Correlation values close to 1.0 would indicate strong surrogacy. RESULTS We identified 2545 eligible patients in 13 randomized trials testing trastuzumab or lapatinib. We collected individual patient data from 1963 patients and retained 1839 patients from 9 trials for analysis (7 first-line trials). During follow-up, 1072 deaths and 1462 progression or deaths occurred. The median survival time was 22 months [95% confidence interval (CI) 21-23 months] and the median PFS was 5.7 months (95% CI 5.5-6.1 months). At the individual level, the Spearman correlation was equal to ρ = 0.67 (95% CI 0.66-0.67) corresponding to a squared correlation value of 0.45. At the trial level, the squared correlation between treatment effects (log hazard ratios) on PFS and OS was provided by R(2) = 0.51 (95% CI 0.22-0.81). CONCLUSIONS In trials of HER2-targeted agents in HER2+ MBC, PFS moderately correlates with OS at the individual level and treatment effects on PFS correlate moderately with those on overall mortality, providing only modest support for considering PFS as a surrogate. PFS does not completely substitute for OS in this setting.
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Affiliation(s)
- S Michiels
- Unit of Biostatistics and Epidemiology, Gustave Roussy, Villejuif; University Paris-Sud, University Paris-Saclay, UVSQ, CESP, INSERM, Villejuif; Plateform Ligue nationale contre le cancer for meta-analyses in oncology, Gustave Roussy, Villejuif, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels.
| | - L Pugliano
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels; Breast International Group (BIG), Brussels, Belgium
| | - S Marguet
- Unit of Biostatistics and Epidemiology, Gustave Roussy, Villejuif
| | - D Grun
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - J Barinoff
- Agaplesion Markus Krankenhaus, Frankfurt am Main, Germany
| | - D Cameron
- Department of Oncology, University of Edinburgh, Edinburgh, UK
| | - M Cobleigh
- Rush University Medical Center, Chicago, USA
| | - A Di Leo
- Medical Oncology Unit, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - S Johnston
- Breast Unit, Royal Marsden Hospital, London, UK
| | - G Gasparini
- Scientific Direction, IRCCS National Cancer Research Centre "Giovanni Paolo II,"Bari, Italy
| | - B Kaufman
- The Institute of Breast Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - M Marty
- Breast Cancer Diseases Unit and Department of Medical Oncology, Saint Louis Hospital, APHP, Paris, France
| | - V Nekljudova
- German Breast Group, GBG ForschungsGmbH, Neu-Isenburg, Germany
| | - S Paluch-Shimon
- The Institute of Breast Oncology, Sheba Medical Center, Tel Hashomer, Israel
| | - F Penault-Llorca
- Department of Pathology, Centre Jean Perrin, EA 4233, University of Auvergne, Clermont-Ferrand, France
| | - D Slamon
- Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles
| | - C Vogel
- University of Miami School of Medicine, Comprehensive Cancer Research Group Inc, Columbia Cancer Research Network of Florida, Miami, USA
| | - G von Minckwitz
- German Breast Group, GBG ForschungsGmbH, Neu-Isenburg, Germany
| | - M Buyse
- IDDI, Louvain-la-Neuve, Hasselt University, Hasselt, Belgium
| | - M Piccart
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels; Breast International Group (BIG), Brussels, Belgium
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125
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Evidence for Oncolytic Virotherapy: Where Have We Got to and Where Are We Going? Viruses 2015; 7:6291-312. [PMID: 26633468 PMCID: PMC4690862 DOI: 10.3390/v7122938] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/20/2015] [Accepted: 11/25/2015] [Indexed: 12/13/2022] Open
Abstract
The last few years have seen an increased interest in immunotherapy in the treatment of malignant disease. In particular, there has been significant enthusiasm for oncolytic virotherapy, with a large amount of pre-clinical data showing promise in animal models in a wide range of tumour types. How do we move forward into the clinical setting and translate something which has such potential into meaningful clinical outcomes? Here, we review how the field of oncolytic virotherapy has developed thus far and what the future may hold.
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Li Y, Liang XY, Yue YQ, Sheng L, Liu JK, Wang ZY, Chen G. Does the addition of drugs targeting the vascular endothelial growth factor pathway to first-line chemotherapy increase complete response? A meta-analysis of randomized clinical trials. Tumour Biol 2015; 37:6297-306. [PMID: 26619847 DOI: 10.1007/s13277-015-4493-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2015] [Accepted: 11/23/2015] [Indexed: 10/22/2022] Open
Abstract
Drugs targeting the vascular endothelial growth factor (VEGF) and its receptor (VEGFR) signaling (anti-VEGF/VEGFR drugs) are the most validated anti-angiogenic strategies for cancer treatment. Complete response (CR) is a rare event in cancer patients receiving chemotherapy. A meta-analysis was conducted to determine whether adding anti-VEGF/VEGFR drugs to chemotherapy can further increase the chance of CR in the first-line therapy. Relevant databases were systematically searched for the period 2000-2015. Eligible studies were selected according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The incidence, relative risk (RR), and 95 % confidence intervals (CIs) were calculated using random-effects or fixed-effects models based on the heterogeneity of selected studies. A total of 12,453 patients from 28 randomized controlled trials were included. The overall incidence of CR in patients treated with anti-VEGF/VEGFR drugs plus chemotherapy was 1.5 % (95 % CI, 1.0-2.0 %) compared to 1.1 % (95 % CI, 0.7-1.4 %) in the chemotherapy-alone arm. Adding anti-VEGF/VEGFR drugs was associated with significant improvement of CR (RR, 1.52, 95 % CI, 1.18-1.95, P = 0.001). When stratified by drug type, adding VEGFR tyrosin kinase inhibitors (TKIs) did not increase the chance of CR (RR, 0.87, 95 % CI, 0.51-1.49; P = 0.614). The addition of bevacizumab with 7.5 mg/kg every 3 weeks, but not 15 mg/kg every 3 weeks, significantly improves the CR (7.5 mg, RR, 2.43, 95 % CI, 1.64-3.60, P = 0.000; 15 mg, RR, 1.07, 95 % CI, 0.63-1.81, P = 0.799). In subgroup analysis, a significant improvement of CR by the addition of anti-VEGF/VEGFR drugs was observed in patients with colorectal cancer (RR, 2.10, 95 % CI 1.21-3.63, P = 0.008), ovarian cancer (RR, 3.07; 95 % CI, 1.68-5.62, P = 0.000), and patients who are treated with platinum-based regimens (RR, 1.78, 95 % CI, 1.23-2.59, P = 0.002). Low-dose bevacizumab, rather than VEGFR TKIs or high-dose bevacizumab, can increase the chance of CR in patients receiving chemotherapy.
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Affiliation(s)
- Yan Li
- Department of Urology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201500, China
| | - Xin-Yue Liang
- Institute of Clinical Pharmacology, Qilu Hospital, Shandong University, Shandong, China
| | - Yi-Qi Yue
- Department of Gynecology, Xuhui District Central Hospital, Shanghai, China
| | - Lei Sheng
- Centre for Personalised Cancer Medicine, School of Medicine, The University of Adelaide, Adelaide, Australia
| | - Ji-Kai Liu
- Department of Urology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201500, China
| | - Zhan-Yu Wang
- Department of Urology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201500, China
| | - Gang Chen
- Department of Urology, Jinshan Hospital, Fudan University, 1508 Longhang Road, Shanghai, 201500, China.
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Liedtke C, Kolberg HC. Current Medical Treatment of Patients with Non-Colorectal Liver Metastases: Primary Tumor Breast Cancer. VISZERALMEDIZIN 2015; 31:424-32. [PMID: 26889146 PMCID: PMC4748775 DOI: 10.1159/000441961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND (Metastatic) breast cancer is a heterogeneous entity in which every disease subtype requires an individualized systemic treatment approach. METHODS We reviewed the currently available data regarding systemic therapy of breast cancer and present a review of historical and current treatment approaches, with the publications cited covering a time span from 1896 to the last ASCO 2015. RESULTS Systemic therapy of metastatic breast cancer may include chemotherapy, endocrine therapy, and targeted therapies (e.g. antibody-based approaches). Based on the patient's breast cancer subtype, these agents may be employed alone or in combination. Therefore, characterization of the phenotype of the disease is necessary and may include biopsy of the metastatic site. Novel therapeutic approaches include immunologic therapies as well as PARP, PI3K and CDK 4/6 inhibitors, which are currently under investigation in clinical trials. CONCLUSION Systemic therapy of metastatic breast cancer requires complex and individualized treatment approaches that are best offered in an interdisciplinary setting.
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Affiliation(s)
- Cornelia Liedtke
- Department of Gynecology and Obstetrics, University Hospital Schleswig-Holstein – Campus Lübeck, Lübeck, Germany
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128
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Ogata H, Kikuchi Y, Natori K, Shiraga N, Kobayashi M, Magoshi S, Saito F, Osaku T, Kanazawa S, Kubota Y, Murakami Y, Kaneko H. Liver Metastasis of a Triple-Negative Breast Cancer and Complete Remission for 5 Years After Treatment With Combined Bevacizumab/Paclitaxel/Carboplatin: Case Report and Review of the Literature. Medicine (Baltimore) 2015; 94:e1756. [PMID: 26496295 PMCID: PMC4620831 DOI: 10.1097/md.0000000000001756] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is aggressive, with high risk of visceral metastasis and death. A substantial proportion of patients with TNBC is associated with BRCA mutations, implying that these tumors are sensitive to DNA-damaging agents. We report successful treatment of a metastatic TNBC in a woman with a BRCA2 germline mutation using combined bevacizumab/paclitaxel/carboplatin (BPC) therapy. The patient was pregnant and had liver metastases, and a complete clinical response was sustained for approximately 5 years. Mastectomy was performed during the 29th week of pregnancy, and the baby was later delivered by caesarean section. Subsequently, multiple metastases in both liver lobes were detected using computed tomography and magnetic resonance imaging and the patient was treated with a BPC regimen, which led to complete disappearance of metastatic lesions in the liver. No additional treatment was provided, and after 5 years the patient consented to direct sequencing of BRCA2 and a 6781delG mutation was identified. At the most recent (5-year) follow-up, the patient was alive with good quality of life and no evidence of metastases.This finding suggests that BPC therapy might be considered a good therapeutic option for the treatment of metastatic TNBC in a woman with a BRCA2 germline mutation.
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Affiliation(s)
- Hideaki Ogata
- From the Division of Breast and Endocrine Surgery (Omori), Department of Surgery, Toho University School of Medicine, Tokyo, Japan (HO, SM, FS, TO, SK, YK, HK); Ohki Memorial Kikuchi Cancer Clinic for Women, Saitama, Japan (YK); Division of Hematology and Oncology, Toho University Medical Center, Tokyo, Japan (KN); Department of Radiology, Toho University School of Medicine, Tokyo, Japan (NS, MK); and Faculty of Nursing, Toho University, Tokyo, Japan (YM)
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Kimbung S, Loman N, Hedenfalk I. Clinical and molecular complexity of breast cancer metastases. Semin Cancer Biol 2015; 35:85-95. [PMID: 26319607 DOI: 10.1016/j.semcancer.2015.08.009] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 08/17/2015] [Accepted: 08/21/2015] [Indexed: 12/24/2022]
Abstract
Clinical oncology is advancing toward a more personalized treatment orientation, making the need to understand the biology of metastasis increasingly acute. Dissecting the complex molecular, genetic and clinical phenotypes underlying the processes involved in the development of metastatic disease, which remains the principal cause of cancer-related deaths, could lead to the identification of more effective prognostication and targeted approaches to prevent and treat metastases. The past decade has witnessed significant progress in the field of cancer metastasis research. Clinical and technological milestones have been reached which have tremendously enriched our understanding of the complex pathways undertaken by primary tumors to progress into lethal metastases and how some of these processes might be amenable to therapy. The aim of this review article is to highlight the recent advances toward unraveling the clinical and molecular complexity of breast cancer metastases. We focus on genes mediating breast cancer metastases and organ-specific tropism, and discuss gene signatures for prediction of metastatic disease. The challenges of translating this information into clinically applicable tools for improving the prognostication of the metastatic potential of a primary breast tumor, as well as for therapeutic interventions against latent and active metastatic disease are addressed.
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Affiliation(s)
- Siker Kimbung
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Niklas Loman
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Oncology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden.
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Diéras V, Campone M, Yardley DA, Romieu G, Valero V, Isakoff SJ, Koeppen H, Wilson TR, Xiao Y, Shames DS, Mocci S, Chen M, Schmid P. Randomized, phase II, placebo-controlled trial of onartuzumab and/or bevacizumab in combination with weekly paclitaxel in patients with metastatic triple-negative breast cancer. Ann Oncol 2015. [PMID: 26202594 DOI: 10.1093/annonc/mdv263] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Increased hepatocyte growth factor/MET signaling is associated with an aggressive phenotype and poor prognosis in triple-negative breast cancer (TNBC). We evaluated the benefit of adding onartuzumab, a monoclonal anti-MET antibody, to paclitaxel with/without bevacizumab in patients with TNBC. PATIENTS AND METHODS Women with metastatic TNBC were randomized to receive onartuzumab plus placebo plus weekly paclitaxel (OP; n = 60) or onartuzumab plus bevacizumab plus paclitaxel (OBP; n = 63) or placebo plus bevacizumab plus paclitaxel (BP; n = 62). The primary end point was progression-free survival (PFS); additional end points included overall survival (OS), objective response rate (ORR), and safety. This trial was hypothesis generating and did not have power to detect minimum clinically meaningful differences between treatment arms. RESULTS There was no improvement in PFS with the addition of onartuzumab to BP [hazard ratio (HR), 1.08; 95% confidence interval (CI) 0.69-1.70]; the risk of a PFS event was higher with OP than with BP (HR, 1.74; 95% CI 1.13-2.68). Most patients had MET-negative tumors (88%); PAM50 subtype analysis showed basal-like tumors in 68% of samples. ORR was higher in the bevacizumab arms (OBP: 42.2%; 95% CI 28.6-57.1; BP: 54.7%; 95% CI 41.0-68.4) compared with OP (27.5%; 95% CI 15.9-40.6). Median OS was shorter with OBP (HR, 1.36; 95% CI 0.75-2.46) and OP (HR, 1.92; 95% CI 1.03-3.59), than with BP. Peripheral edema was more frequent in the onartuzumab arms (OBP, 51.8%; OP, 58.6%) versus BP (17.7%). CONCLUSION This study did not show a clinical benefit of the addition of onartuzumab to paclitaxel with/without bevacizumab in patients with predominantly MET-negative TNBC. CLINICALTRIALSGOV NCT01186991.
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Affiliation(s)
- V Diéras
- Department of Clinical Research, Institut Curie Paris & Saint Cloud, Paris.
| | - M Campone
- Centre René Gauducheau, Centre Régional de Lutte Contre le Cancer (CRLC) Nantes, Atlantique, France
| | - D A Yardley
- Sarah Cannon Research Institute and Tennessee Oncology, PLLC, Nashville, USA
| | - G Romieu
- Institut du Cancer de Montpellier (ICM), Montpellier, France
| | - V Valero
- The University of Texas MD Anderson Cancer Center, Houston
| | | | - H Koeppen
- Genentech, Inc., South San Francisco, USA
| | - T R Wilson
- Genentech, Inc., South San Francisco, USA
| | - Y Xiao
- Genentech, Inc., South San Francisco, USA
| | - D S Shames
- Genentech, Inc., South San Francisco, USA
| | - S Mocci
- Genentech, Inc., South San Francisco, USA
| | - M Chen
- Roche Product Development, Shanghai, China
| | - P Schmid
- Barts Cancer Institute, Queen Mary University of London, London, UK
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Calvetti L, Pilotto S, Carbognin L, Ferrara R, Caccese M, Tortora G, Bria E. The coming of ramucirumab in the landscape of anti-angiogenic drugs: potential clinical and translational perspectives. Expert Opin Biol Ther 2015; 15:1359-70. [PMID: 26190526 DOI: 10.1517/14712598.2015.1071350] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Angiogenesis plays a pivotal role in the development and progression of tumors and it represents a crucial target for therapeutic strategies. Until now, regulatory agencies approved antiangiogenic agents targeting the VEGF and multi-target agents carrying antiangiogenic and anti-proliferative effects. They often provide only a modest survival benefit and their role in clinical practice is debated. The limited efficacy may be partially explained by the complexity of the molecular background of angiogenic processes, composed of several pathways interacting with both tumor cells and the microenvironment. AREAS COVERED Ramucirumab is a fully human monoclonal antibody selectively binding and inhibiting the VEGF receptor 2 (VEGFR-2), a crucial molecule involved in angiogenesis. A series of Phase I-II trials conducted in a wide spectrum of malignancies reported promising antitumor activity. In 2014, data from large Phase III clinical trials in gastrointestinal, lung and breast malignancies were released. EXPERT OPINION Considering the evidences of efficacy emerging from the available Phase III trials, the antiangiogenic approach emerged as a promising strategy particularly for the treatment of gastric cancer. Nevertheless, the identification and validation of potentially predictive biomarkers are necessary to improve the selection of patients and the globally awaited clinical benefit.
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Affiliation(s)
- Lorenzo Calvetti
- University of Verona, Azienda Ospedaliera Universitaria Integrata, Medical Oncology , P.le L.A. Scuro 10, 37124 Verona , Italy
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Di Salvatore M, Lo Giudice L, Rossi E, Santonocito C, Nazzicone G, Rodriquenz MG, Cappuccio S, Inno A, Fuso P, Orlandi A, Strippoli A, Capoluongo E, Astone A, Cassano A, Barone C. Association of IL-8 and eNOS polymorphisms with clinical outcomes in bevacizumab-treated breast cancer patients: an exploratory analysis. Clin Transl Oncol 2015; 18:40-6. [PMID: 26141413 DOI: 10.1007/s12094-015-1334-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2015] [Accepted: 06/20/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND The role of bevacizumab in metastatic breast cancer is controversial. Identification of predictive biomarkers could help to select patients who really benefit from it. We evaluated the association of angiogenesis-related gene polymorphisms with the treatment outcome of bevacizumab in metastatic breast cancer patients. PATIENTS AND METHODS eNOS-786T/C and -894G/T, IL-8-251T/A genomic polymorphisms were assessed in 31 metastatic breast cancer patients treated with bevacizumab plus chemotherapy in the first-line setting. Testing for association between each polymorphism and treatment outcome was performed. RESULTS Patients with IL-8 251 AA genotype showed a significantly lower progression-free survival in each combination comparison: "TT" vs "AA" (13 vs 8 months; p = 0.008); TT vs TA vs AA (13 vs 11 vs 8 months; p = 0.02); TT vs TA +AA (13 vs 11 months; p = 0.01); TT + TA vs AA (12 vs 8 months; p = 0.01) and a lower overall survival when compared with TT +TA genotype (26 vs 51 months, p = 0.04). Patients carrying eNOS 894 TT genotype showed a statistically significant lower progression-free survival than patients with GG genotype (11.5 vs 26.5 months; p = 0.04) with no differences in the overall survival. No association with response rate was found with any of the polymorphisms analyzed. CONCLUSION These findings suggest that IL-8 251T/A and eNOS-894 G/T polymorphisms might have a role in predicting treatment outcome of bevacizumab in metastatic breast cancer. Our results are hypothesis generating and need to be confirmed in larger clinical trials.
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Affiliation(s)
- M Di Salvatore
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy.
| | - L Lo Giudice
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - E Rossi
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - C Santonocito
- Laboratory of Clinical Molecular Biology, Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - G Nazzicone
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - M G Rodriquenz
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - S Cappuccio
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Inno
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy.,Medical Oncology, Sacro Cuore Don Calabria Hospital, Via Don A. Sempreboni 5, 37024, Negrar, VR, Italy
| | - P Fuso
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Orlandi
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Strippoli
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - E Capoluongo
- Laboratory of Clinical Molecular Biology, Institute of Biochemistry and Clinical Biochemistry, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Astone
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - A Cassano
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
| | - C Barone
- Unit of Clinical Oncology, Catholic University of the Sacred Heart, L.go F. Vito 1, 00168, Rome, Italy
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Marmé F, Schneeweiss A. Targeted Therapies in Triple-Negative Breast Cancer. Breast Care (Basel) 2015; 10:159-66. [PMID: 26557820 DOI: 10.1159/000433622] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Triple-negative breast cancer (TNBC) is a heterogeneous disease comprised of several biologically distinct subtypes. However, treatment is currently mainly relying on chemotherapy as there are no targeted therapies specifically approved for TNBC. Despite initial responses to chemotherapy, resistance frequently and rapidly develops and metastatic TNBC has a poor prognosis. New targeted approaches are, therefore, urgently needed. Currently, bevacizumab, a monoclonal anti-vascular endothelial growth factor (VEGF)-A antibody, is the only targeted agent with an approval for the therapy of metastatic breast cancer, but does not provide a specific benefit in the TNBC subtype. This review discusses the current clinical developments in targeted approaches for TNBC, including anti-angiogenic therapies, epidermal growth factor receptor (EGFR)-targeted therapies, poly(ADP-ribose) polymerase (PARP) inhibitors and platinum salts, as well as novel strategies using immune-checkpoint inhibitors, which have recently demonstrated first promising results. Strategies focusing on specific subtypes of TNBC like anti-androgenic therapies for the luminal androgen receptor subtype (LAR) and others are also discussed.
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Affiliation(s)
- Frederik Marmé
- Universitäts-Frauenklinik, University of Heidelberg, Germany ; National Centre for Tumour Diseases, University of Heidelberg, Germany
| | - Andreas Schneeweiss
- Universitäts-Frauenklinik, University of Heidelberg, Germany ; National Centre for Tumour Diseases, University of Heidelberg, Germany
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134
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Earl HM, Hiller L, Dunn JA, Blenkinsop C, Grybowicz L, Vallier AL, Abraham J, Thomas J, Provenzano E, Hughes-Davies L, Gounaris I, McAdam K, Chan S, Ahmad R, Hickish T, Houston S, Rea D, Bartlett J, Caldas C, Cameron DA, Hayward L. Efficacy of neoadjuvant bevacizumab added to docetaxel followed by fluorouracil, epirubicin, and cyclophosphamide, for women with HER2-negative early breast cancer (ARTemis): an open-label, randomised, phase 3 trial. Lancet Oncol 2015; 16:656-66. [PMID: 25975632 DOI: 10.1016/s1470-2045(15)70137-3] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND The ARTemis trial was developed to assess the efficacy and safety of adding bevacizumab to standard neoadjuvant chemotherapy in HER2-negative early breast cancer. METHODS In this randomised, open-label, phase 3 trial, we enrolled women (≥18 years) with newly diagnosed HER2-negative early invasive breast cancer (radiological tumour size >20 mm, with or without axillary involvement), at 66 centres in the UK. Patients were randomly assigned via a central computerised minimisation procedure to three cycles of docetaxel (100 mg/m(2) once every 21 days) followed by three cycles of fluorouracil (500 mg/m(2)), epirubicin (100 mg/m(2)), and cyclophosphamide (500 mg/m(2)) once every 21 days (D-FEC), without or with four cycles of bevacizumab (15 mg/kg) (Bev+D-FEC). The primary endpoint was pathological complete response, defined as the absence of invasive disease in the breast and axillary lymph nodes, analysed by intention to treat. The trial has completed and follow-up is ongoing. This trial is registered with EudraCT (2008-002322-11), ISRCTN (68502941), and ClinicalTrials.gov (NCT01093235). FINDINGS Between May 7, 2009, and Jan 9, 2013, we randomly allocated 800 participants to D-FEC (n=401) and Bev+D-FEC (n=399). 781 patients were available for the primary endpoint analysis. Significantly more patients in the bevacizumab group achieved a pathological complete response compared with those treated with chemotherapy alone: 87 (22%, 95% CI 18-27) of 388 patients in the Bev+D-FEC group compared with 66 (17%, 13-21) of 393 patients in the D-FEC group (p=0·03). Grade 3 and 4 toxicities were reported at expected levels in both groups, although more patients had grade 4 neutropenia in the Bev+D-FEC group than in the D-FEC group (85 [22%] vs 68 [17%]). INTERPRETATION Addition of four cycles of bevacizumab to D-FEC in HER2-negative early breast cancer significantly improved pathological complete response. However, whether the improvement in pathological complete response will lead to improved disease-free and overall survival outcomes is unknown and will be reported after longer follow-up. Meta-analysis of available neoadjuvant trials is likely to be the only way to define subgroups of early breast cancer that would have clinically significant long-term benefit from bevacizumab treatment. FUNDING Cancer Research UK, Roche, Sanofi-Aventis.
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Affiliation(s)
- Helena M Earl
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, and Cambridge Breast Cancer Research Unit Cambridge, Cambridge, UK.
| | - Louise Hiller
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Janet A Dunn
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Clare Blenkinsop
- Warwick Clinical Trials Unit, University of Warwick, Coventry, UK
| | - Louise Grybowicz
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Anne-Laure Vallier
- Cambridge Clinical Trials Unit-Cancer Theme, Cambridge University Hospitals NHS Foundation Trust, UK
| | - Jean Abraham
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, and Cambridge Breast Cancer Research Unit Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Elena Provenzano
- NIHR Cambridge Biomedical Research Centre, and Cambridge Breast Cancer Research Unit Cambridge, Cambridge, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - Ioannis Gounaris
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK; Cancer Research UK Cambridge Institute, Cambridge, UK
| | - Karen McAdam
- Peterborough City Hospital, Edith Cavell Campus, Peterborough, UK
| | - Stephen Chan
- Nottingham University Hospital (City Campus), Nottingham, UK
| | | | - Tamas Hickish
- Royal Bournemouth Hospital, Bournemouth University, Bournemouth, UK
| | - Stephen Houston
- The Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Daniel Rea
- City Hospital, Dudley Road, Birmingham, UK
| | - John Bartlett
- Ontario Institute for Cancer Research, MaRS Centre, Toronto, Ontario, Canada; Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
| | - Carlos Caldas
- University of Cambridge, Department of Oncology, Addenbrooke's Hospital, Cambridge, UK; NIHR Cambridge Biomedical Research Centre, and Cambridge Breast Cancer Research Unit Cambridge, Cambridge, UK; Cancer Research UK Cambridge Institute, Cambridge, UK
| | - David A Cameron
- Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, UK
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Luengo-Gil G, González-Billalabeitia E, Chaves-Benito A, García Martínez E, García Garre E, Vicente V, Ayala de la Peña F. Effects of conventional neoadjuvant chemotherapy for breast cancer on tumor angiogenesis. Breast Cancer Res Treat 2015; 151:577-87. [PMID: 25967462 DOI: 10.1007/s10549-015-3421-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2015] [Accepted: 05/07/2015] [Indexed: 01/01/2023]
Abstract
The effects of breast cancer conventional chemotherapy on tumor angiogenesis need to be further characterized. Neoadjuvant chemotherapy is an ideal model to evaluate the results of chemotherapy, allowing intra-patient direct comparison of antitumor and antiangiogenic effects. We sought to analyze the effect of neoadjuvant chemotherapy on tumor angiogenesis and its clinical significance in breast cancer. Breast cancer patients (n = 108) treated with neoadjuvant sequential anthracyclines and taxanes were studied. Pre- and post-chemotherapy microvessel density (MVD) and mean vessel size (MVS) were analyzed after CD34 immunohistochemistry and correlated with tumor expression of pro- and antiangiogenic factors (VEGFA, THBS1, HIF1A, CTGF, and PDGFA) by qRT-PCR. Angiogenic measures at diagnosis varied among breast cancer subtypes. Pre-treatment higher MVS was associated with triple-negative subtype and more advanced disease. Higher MVS was correlated with higher VEGFA (p = 0.003), while higher MVD was correlated with lower antiangiogenic factors expression (THBS1, p < 0.0001; CTGF, p = 0.001). Increased angiogenesis at diagnosis (high MVS and glomeruloid microvascular proliferation) and higher VEGFA expression were associated with tumor recurrence (p = 0.048 and 0.009, respectively). Chemotherapy-induced angiogenic response (defined as decreased MVD) was present in 35.2 % of patients. This response correlated with an increase in antiangiogenic factors (THBS1) without changes in VEGFA expression, and it was associated with tumor downstaging, but not with clinical response, pathologic complete response, or prognosis. Global effects of chemotherapy mainly consisted in an increased expression of antiangiogenic factors (THBS1, CTGF), with significant changes neither of tumor VEGFA nor of MVS. Conventionally scheduled neoadjuvant chemotherapy exerts antiangiogenic effects, through an increase in antiangiogenic factors, THBS1 and CTGF, but the expression of VEGFA is maintained after treatment. Better markers of angiogenic response and a better understanding of the cooperation of chemotherapy and antiangiogenic therapy in the neoadjuvant clinical scenario are needed.
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Affiliation(s)
- Ginés Luengo-Gil
- Department of Hematology and Medical Oncology, University Hospital Morales Meseguer, Avda. Marqués de los Vélez, s/n, 30008, Murcia, Spain
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Andre F, Deluche E, Bonnefoi H. Bevacizumab: the phoenix of breast oncology? Lancet Oncol 2015; 16:600-1. [PMID: 25975636 DOI: 10.1016/s1470-2045(15)70201-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Fabrice Andre
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; INSERM Unit U981 and Université Paris Sud, Faculté de Medecine Kremlin Bicetre, Kremlin Bicetre, France.
| | - Elise Deluche
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Herve Bonnefoi
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
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Abstract
INTRODUCTION Triple negative breast cancer (TNBC) is a heterogeneous disease associated with a high risk of recurrence, and therapeutic options are currently limited to cytotoxic therapy. Germ-line mutations may occur in up to 20% of unselected patients with TNBC, which may serve as a biomarker identifying which patients may have tumors that are particularly sensitive to platinums and/or inhibitors of poly(ADP-ribose)polymerase. A substantial proportion of patients with TNBCs not associated with germ-line BRCA mutations may have tumors that are ‘BRCA-like’, rendering those individuals potential candidates for similar strategies. AREAS COVERED The purpose of this review is to highlight the current standard and experimental treatment strategies. EXPERT OPINION Recent research that has illuminated the molecular heterogeneity of the disease rationalizes its diverse biological behavior and differential response to chemotherapy. Modern technology platforms provide molecular signatures that can be mined for therapeatic interventions. Target pathways that are commonly dysregulated in cancer cells control cellular processes such as apoptosis, proliferation, angiogenesis, DNA repair, cell cycle progression, immune modulation and invasion, and metastasis. Novel trial design and re-defined endpoints as surrogates to clinical outcome have been introduced to expedite the development of breakthrough therapies to treat high-risk early-stage breast cancer.
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Affiliation(s)
- Eleni Andreopoulou
- Associate Professor of Medicine, Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medical Oncology, 1695 Eastchester Rd Bronx, NY 10461 USA
| | - Sarah J Schweber
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medical Oncology, Bronx, NY, USA
| | - Joseph A Sparano
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medical Oncology, Bronx, NY, USA
| | - Hayley M McDaid
- Montefiore Medical Center/Albert Einstein College of Medicine, Department of Medical Oncology, Bronx, NY, USA
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Hu XC, Zhang J, Xu BH, Cai L, Ragaz J, Wang ZH, Wang BY, Teng YE, Tong ZS, Pan YY, Yin YM, Wu CP, Jiang ZF, Wang XJ, Lou GY, Liu DG, Feng JF, Luo JF, Sun K, Gu YJ, Wu J, Shao ZM. Cisplatin plus gemcitabine versus paclitaxel plus gemcitabine as first-line therapy for metastatic triple-negative breast cancer (CBCSG006): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol 2015; 16:436-46. [PMID: 25795409 DOI: 10.1016/s1470-2045(15)70064-1] [Citation(s) in RCA: 191] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Platinum chemotherapy has a role in the treatment of metastatic triple-negative breast cancer but its full potential has probably not yet been reached. We assessed whether a cisplatin plus gemcitabine regimen was non-inferior to or superior to paclitaxel plus gemcitabine as first-line therapy for patients with metastatic triple-negative breast cancer. METHODS For this open-label, randomised, phase 3, hybrid-designed trial undertaken at 12 institutions or hospitals in China, we included Chinese patients aged 18-70 years with previously untreated, histologically confirmed metastatic triple-negative breast cancer, and an ECOG performance status of 0-1. These patients were randomly assigned (1:1) to receive either cisplatin plus gemcitabine (cisplatin 75 mg/m(2) on day 1 and gemcitabine 1250 mg/m(2) on days 1 and 8) or paclitaxel plus gemcitabine (paclitaxel 175 mg/m(2) on day 1 and gemcitabine 1250 mg/m(2) on days 1 and 8) given intravenously every 3 weeks for a maximum of eight cycles. Randomisation was done centrally via an interactive web response system using block randomisation with a size of eight, with no stratification factors. Patients and investigator were aware of group assignments. The primary endpoint was progression-free survival and analyses were based on all patients who received at least one dose of assigned treatment. The margin used to establish non-inferiority was 1·2. If non-inferiority of cisplatin plus gemcitabine compared with paclitaxel plus gemcitabine was achieved, we would then test for superiority. The trial is registered with ClinicalTrials.gov, number NCT01287624. FINDINGS From Jan 14, 2011, to Nov 14, 2013, 240 patients were assessed for eligibility and randomly assigned to treatment (120 in the cisplatin plus gemcitabine group and 120 in the paclitaxel plus gemcitabine group). 236 patients received at least one dose of assigned chemotherapy and were included in the modified intention-to-treat analysis (118 per group). After a median follow-up of 16·3 months (IQR 14·4-26·8) in the cisplatin plus gemcitabine group and 15·9 months (10·7-25·4) in the paclitaxel plus gemcitabine group, the hazard ratio for progression-free survival was 0·692 (95% CI 0·523-0·915; pnon-inferiority<0·0001, psuperiority=0·009, thus cisplatin plus gemcitabine was both non-inferior to and superior to paclitaxel plus gemcitabine. Median progression-free survival was 7·73 months (95% CI 6·16-9·30) in the cisplatin plus gemcitabine group and 6·47 months (5·76-7·18) in the paclitaxel plus gemcitabine group. Grade 3 or 4 adverse events that differed significantly between the two groups included nausea (eight [7%] vs one [<1%]), vomiting (13 [11%] vs one [<1%]), musculoskeletal pain (none vs ten [8%]), anaemia (39 [33%] vs six [5%]), and thrombocytopenia (38 [32%] vs three [3%]), for the cisplatin plus gemcitabine compared with the paclitaxel plus gemcitabine groups, respectively. In addition, patients in the cisplatin plus gemcitabine group had significantly fewer events of grade 1-4 alopecia (12 [10%] vs 42 [36%]) and peripheral neuropathy (27 [23%] vs 60 [51%]), but more grade 1-4 anorexia (33 [28%] vs 10 [8%]), constipation (29 [25%] vs 11 [9%]), hypomagnesaemia (27 [23%] vs five [4%]), and hypokalaemia (10 [8%] vs two [2%]). Serious drug-related adverse events were seen in three patients in the paclitaxel plus gemcitabine group (interstitial pneumonia, anaphylaxis, and severe neutropenia) and four in the cisplatin plus gemcitabine group (pathological bone fracture, thrombocytopenia with subcutaneous haemorrhage, severe anaemia, and cardiogenic syncope). There were no treatment-related deaths. INTERPRETATION Cisplatin plus gemcitabine could be an alternative or even the preferred first-line chemotherapy strategy for patients with metastatic triple-negative breast cancer. FUNDING Shanghai Natural Science Foundation.
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Affiliation(s)
- Xi-Chun Hu
- Department of Medical Oncology, Fudan University Shanghai Cancer Centre, Collaborative Innovation Centre for Cancer Medicine, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China.
| | - Jian Zhang
- Department of Medical Oncology, Fudan University Shanghai Cancer Centre, Collaborative Innovation Centre for Cancer Medicine, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Bing-He Xu
- Cancer Institute and Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Li Cai
- Department of Medical Oncology, Harbin Medical University Cancer Hospital, Harbin, China
| | - Joseph Ragaz
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Zhong-Hua Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Centre, Collaborative Innovation Centre for Cancer Medicine, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Bi-Yun Wang
- Department of Medical Oncology, Fudan University Shanghai Cancer Centre, Collaborative Innovation Centre for Cancer Medicine, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Yue-E Teng
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Zhong-Sheng Tong
- Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
| | - Yue-Yin Pan
- Department of Medical Oncology, The First Hospital, Anhui Medical University, Hefei, China
| | - Yong-Mei Yin
- Department of Oncology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chang-Ping Wu
- Department of Oncology, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | | | - Xiao-Jia Wang
- Department of Medical Oncology, Zhejiang Cancer Hospital, Hangzhou, China
| | - Gu-Yin Lou
- Breast Cancer Centre, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dong-Geng Liu
- Cancer Centre, Sun Yat-sen University, Guangzhou, China
| | | | - Jian-Feng Luo
- Department of Biostatistics, School of Public Health, Fudan University, Shanghai, China
| | - Kang Sun
- Biostatistics, Incyte Corporation, Wilmington DE, USA
| | - Ya-Jia Gu
- Department of Radiology, Fudan University Shanghai Cancer Centre, Collaborative Innovation Centre for Cancer Medicine, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Jiong Wu
- Department of Breast Surgery, Fudan University Shanghai Cancer Centre, Collaborative Innovation Centre for Cancer Medicine, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
| | - Zhi-Min Shao
- Department of Breast Surgery, Fudan University Shanghai Cancer Centre, Collaborative Innovation Centre for Cancer Medicine, Shanghai, China; Department of Oncology, Shanghai Medical College, Shanghai, China
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Martín M, Loibl S, von Minckwitz G, Morales S, Martinez N, Guerrero A, Anton A, Aktas B, Schoenegg W, Muñoz M, Garcia-Saenz JÁ, Gil M, Ramos M, Margeli M, Carrasco E, Liedtke C, Wachsmann G, Mehta K, De la Haba-Rodriguez JR. Phase III trial evaluating the addition of bevacizumab to endocrine therapy as first-line treatment for advanced breast cancer: the letrozole/fulvestrant and avastin (LEA) study. J Clin Oncol 2015; 33:1045-52. [PMID: 25691671 DOI: 10.1200/jco.2014.57.2388] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE To test whether combining bevacizumab, an anti-vascular endothelial growth factor treatment, with endocrine therapy (ET) could potentially delay the emergence of resistance to ET. PATIENTS AND METHODS A multicenter, randomized, open-label, phase III, binational (Spain and Germany) study added bevacizumab (15 mg/kg every 3 weeks) to ET (ET-B; letrozole or fulvestrant) as first-line therapy in postmenopausal patients with human epidermal growth factor receptor 2 (HER2) -negative and hormone receptor-positive advanced breast cancer. We compared progression-free survival (PFS), overall survival (OS), overall response rate (ORR), response duration (RD), time to treatment failure (TTF), clinical benefit rate (CBR), and safety. RESULTS From 380 patients recruited (2007 to 2011), 374 were analyzed by intent to-treat (184 patients on ET and 190 patients on ET-B). Median age was 65 years, 270 patients (72%) had Eastern Cooperative Oncology Group performance status of 0, 178 patients (48%) had visceral metastases, and 171 patients (46%) and 195 patients (52%) had received prior chemotherapy or ET, respectively. Median PFS was 14.4 months in the ET arm and 19.3 months in the ET-B arm (hazard ratio, 0.83; 95% CI, 0.65 to 1.06; P = .126). ORR, CBR, and RD with ET versus ET-B were 22% versus 41% (P < .001), 67% versus 77% (P = .041), and 13.3 months versus 17.6 months (P = .434), respectively. TTF and OS were comparable in both arms. Grade 3 to 4 hypertension, aminotransferase elevation, and proteinuria were significantly higher in the ET-B arm. Eight patients (4.2%) receiving ET-B died during study or within 30 days of end of treatment. CONCLUSION The addition of bevacizumab to ET in first-line treatment failed to produce a statistically significant increase in PFS or OS in women with HER2-negative/hormone receptor-positive advanced breast cancer.
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Affiliation(s)
- Miguel Martín
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany.
| | - Sibylle Loibl
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Gunter von Minckwitz
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Serafín Morales
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Noelia Martinez
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Angel Guerrero
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Antonio Anton
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Bahriye Aktas
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Winfried Schoenegg
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Montserrat Muñoz
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - José Ángel Garcia-Saenz
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Miguel Gil
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Manuel Ramos
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Mireia Margeli
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Eva Carrasco
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Cornelia Liedtke
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Grischa Wachsmann
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Keyur Mehta
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
| | - Juan R De la Haba-Rodriguez
- Miguel Martín, Instituto de Investigación Sanitaria Gregorio Marañón, Universidad Complutense; Noelia Martinez, University Hospital Ramón y Cajal; José Ángel Garcia-Saenz, University Hospital Clínico San Carlos; Eva Carrasco, Grupo Español de Investigación en Cáncer de Mama, Madrid; Serafín Morales, Hospital Arnau de Vilanova de Lérida, Lérida; Angel Guerrero, Valencian Institute of Oncology, Valencia; Antonio Anton, University Hospital Miguel Servet, Zaragoza; Montserrat Muñoz, University Hospital Clinic i Provincial; Mireia Margeli, Hospital Universitario Germans Trias i Pujol, Barcelona; Miguel Gil, Catalan Institute of Oncology, Hospitalet; Manuel Ramos, Centro Oncológico de Galicia, La Coruña; Juan R. De la Haba-Rodriguez, Instituto Maimonides de Investigación Biomédica de Córdoba (IMIBIC) -Hospital Universitario Reina Sofía, Universidad de Córdoba, Córdoba, Spain; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, German Breast Group, Neu-Isenburg; Sibylle Loibl, Gunter von Minckwitz, and Keyur Mehta, Sana Klinikum Offenbach, Offenbach; Bahriye Aktas, University Women's Hospital Essen, Essen; Winfried Schoenegg, Medical Practice Berlin, Berlin; Cornelia Liedtke, University Women's Hospital Münster, Münster; Cornelia Liedtke, University Hospital Lübeck, Lübeck; and Grischa Wachsmann, Klinikum Böblingen, Böblingen, Germany
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Paclitaxel and bevacizumab with or without capecitabine as first-line treatment for HER2-negative locally recurrent or metastatic breast cancer: a multicentre, open-label, randomised phase 2 trial. Eur J Cancer 2015; 50:3077-88. [PMID: 25459393 DOI: 10.1016/j.ejca.2014.10.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 08/15/2014] [Accepted: 10/06/2014] [Indexed: 11/20/2022]
Abstract
BACKGROUND The addition of bevacizumab to paclitaxel or capecitabine has demonstrated improved progression-free survival (PFS) and objective response rate (ORR) as compared with chemotherapy alone in patients with HER2-negative locally recurrent or metastatic breast cancer (LR/MBC). We evaluated the efficacy and safety of first-line therapy of paclitaxel and bevacizumab with or without capecitabine in patients with HER2-negative LR/MBC. METHODS In this multicentre, open-label, randomised phase II trial, women with HER2-negative LR/MBC were randomly assigned in a 1:1 ratio to paclitaxel (90 mg/m2 intravenously [IV] on days 1, 8, and 15) and bevacizumab (10 mg/kg IV on days 1 and 15) every 4 weeks for six cycles, followed by bevacizumab (15 mg/kg IV on day 1) every 3 weeks (AT) or to paclitaxel (90 mg/m2 IV on days 1 and 8), bevacizumab (15 mg/kg IV on day 1) and capecitabine (825 mg/m2 orally twice daily on days 1–14) every 3 weeks for eight cycles, followed by bevacizumab and capecitabine at the same doses every 3 weeks (ATX). The primary end-point was investigator-assessed PFS. Secondary end-points included ORR, duration of response, overall survival (OS) and safety. Exploratory analyses were conducted to evaluate the impact of capecitabine on OS and to validate a novel prognostic model. This trial is registered with EudraCT, number 2006-006058-83. FINDINGS Median PFS was significantly longer in ATX as compared with AT (11.2 months versus 8.4 months; stratified hazard ratio (HR), 0.52; 95% confidence interval (CI), 0.41–0.67; p < 0.0001). The ORR in ATX patients with measurable disease (n = 268) was higher than that in AT (69% versus 51%; p = 0.01). The median duration of response was 6.8 versus 5.4 months for, respectively, ATX and AT (p < 0.0001). Median OS was 24.2 months for ATX and 23.1 months for AT (p = 0.53). The increased rate of grade 3–4 adverse events related to the addition of capecitabine, being hand-foot syndrome (34% versus 0% for AT) and neutropenia (20% versus 12% for AT), generally did not preclude continuation of treatment. Exploratory analyses indicated that (1) patients receiving capecitabine at some line for treatment have significantly improved OS and (2) a prognostic model can classify patients into three risk groups associated with OS. INTERPRETATION In patients with HER2-negative LR/MBC, addition of capecitabine to paclitaxel and bevacizumab significantly improved PFS, ORR and response duration. This combination was reasonably well tolerated and may be considered of use as first-line treatment in rapidly progressive disease. FUNDING F. Hoffmann-La Roche Ltd, the Netherlands.
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Bozza C, Fontanella C, Buoro V, Mansutti M, Aprile G. Novel antiangiogenic drugs for the management of breast cancer: new approaches for an old issue? Expert Rev Clin Pharmacol 2015; 8:251-65. [PMID: 25597501 DOI: 10.1586/17512433.2015.1001837] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Since angiogenesis plays an important role in cancer growth, infiltration and metastasis, many agents targeting this pathway have been developed over the last decade. Antiangiogenic drugs interfere with this process and may inhibit neoplastic growth or induce tumor dormancy by blocking the expanding network of newly formed capillaries. Despite the initial promise, targeting angiogenesis in breast cancer has not reached major breakthroughs. Nevertheless, the immunologic role of VEGF deserves to be further explored. We aim to describe the biological mechanisms which underlie the role of angiogenesis in breast cancer carcinogenesis, to depict its contribution to the metastatic process and to review the most important clinical trials testing angiogenic inhibitors in breast cancer, including monoclonal antibodies and novel small molecules.
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Affiliation(s)
- Claudia Bozza
- Department of Medical Oncology, University Hospital of Udine, 33100 Udine, Italy
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Guarneri V, Dieci MV, Bisagni G, Boni C, Cagossi K, Puglisi F, Pecchi A, Piacentini F, Conte P. Preoperative carboplatin-paclitaxel-bevacizumab in triple-negative breast cancer: final results of the phase II Ca.Pa.Be study. Ann Surg Oncol 2015; 22:2881-7. [PMID: 25572687 DOI: 10.1245/s10434-015-4371-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Indexed: 01/25/2023]
Abstract
PURPOSE The phase II Ca.Pa.Be trial evaluated preoperative carboplatin-paclitaxel in combination with bevacizumab in triple-negative breast cancer patients with previously untreated stage II-III disease. The primary aim was the assessment of the rate of pathologic complete response (pCR). Secondary aims included safety, breast-conserving surgery rate, and early response assessment with dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). METHODS Patients with hormone receptor-negative, HER-2-negative stage II-III breast cancer were eligible. Treatment included paclitaxel 80 mg/mq + carboplatin area under the curve (AUC) 2 on days 1, 8, and 15, combined with bevacizumab 10 mg/kg on days 1 and 15 each 28 days, for 5 courses. At baseline, patients underwent breast DCE-MRI, followed by a single dose of bevacizumab 5 mg/kg (day -6). DCE-MRI was repeated before the initiation of chemotherapy. RESULTS Forty-four patients were enrolled. Forty-three patients underwent surgery, and 22 (50 %) received breast-conserving surgery (conversion rate from mastectomy indication at baseline, 34.4 %). A pCR in breast and axillary lymph nodes occurred in 22 patients (50 %). Bevacizumab-associated adverse events (AEs) were mild: G1-2 hypertension and bleeding occurred in 6 (13.6 %) and 12 (27 %) patients, respectively. No G4 nonhematologic AEs were recorded. More frequent G3 AEs were liver function test abnormalities (6.8 %), and diarrhea and fatigue (4.5 % each). The only G3-4 hematologic toxicity was neutropenia (G3, 25 %; G4, 9 %). Early assessed DCE-MRI response parameters failed to predict pCR. CONCLUSIONS The neoadjuvant anthracycline-free combination of weekly paclitaxel and carboplatin plus bevacizumab is active and safe in triple-negative breast cancer, and the rate of pCR is comparable to that observed with more intensive carboplatin- and bevacizumab-containing regimens. Further investigation is warranted.
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Affiliation(s)
- Valentina Guarneri
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padua, Italy,
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Lehmann BD, Pietenpol JA, Tan AR. Triple-negative breast cancer: molecular subtypes and new targets for therapy. Am Soc Clin Oncol Educ Book 2015:e31-e39. [PMID: 25993190 DOI: 10.14694/edbook_am.2015.35.e31] [Citation(s) in RCA: 88] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Triple-negative breast cancer (TNBC) is a molecularly diverse disease. This heterogeneity has limited the success of targeted therapy in unselected patients to date. Recent transcriptional analysis has divided TNBC into transcriptionally similar subtypes that may have different sensitivity to neoadjuvant chemotherapy and targeted therapy. At present, chemotherapy is the mainstay of treatment for early-stage and advanced TNBC; however, several actionable targets show promise in preclinical studies. Novel therapeutic strategies are currently being tested in phase II and phase III trials and will likely require patient stratification before therapy. Examples of these tailored approaches include poly(ADP-ribose) polymerase inhibitors for BRCA-mutated TNBC, antiandrogens for androgen receptor (AR)-positive TNBC, fibroblast growth factor receptor (FGFR) inhibitors for TNBC harboring FGFR amplifications, and gamma-secretase inhibitors for TNBC with mutations in the PEST domain of NOTCH proteins. Treatment of TNBC based on molecular subsets represents a potential algorithm for the future. Well-designed clinical trials with incorporation of integrated biomarkers are necessary to advance the development of molecularly targeted therapy for different subgroups of TNBC.
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Affiliation(s)
- Brian D Lehmann
- From the Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN; Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC
| | - Jennifer A Pietenpol
- From the Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN; Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC
| | - Antoinette R Tan
- From the Vanderbilt-Ingram Cancer Center, Vanderbilt University School of Medicine, Nashville, TN; Levine Cancer Institute, Carolinas Healthcare System, Charlotte, NC
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Wilson MK, Collyar D, Chingos DT, Friedlander M, Ho TW, Karakasis K, Kaye S, Parmar MKB, Sydes MR, Tannock IF, Oza AM. Outcomes and endpoints in cancer trials: bridging the divide. Lancet Oncol 2015; 16:e43-52. [PMID: 25638556 DOI: 10.1016/s1470-2045(14)70380-8] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Cancer is not one disease. Outcomes and endpoints in trials should incorporate the therapeutic modality and cancer type because these factors affect clinician and patient expectations. In this Review, we discuss how to: define the importance of endpoints; make endpoints understandable to patients; improve the use of patient-reported outcomes; advance endpoints to parallel changes in trial design and therapeutic interventions; and integrate these improvements into trials and practice. Endpoints need to reflect benefit to patients, and show that changes in tumour size either in absolute terms (response and progression) or relative to control (progression) are clinically relevant. Improvements in trial design should be accompanied by improvements in available endpoints. Stakeholders need to come together to determine the best approach for research that ensures accountability and optimises the use of available resources.
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Affiliation(s)
- Michelle K Wilson
- University of Toronto Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | | | - Michael Friedlander
- Prince of Wales Clinical School, University of New South Wales, Sydney, Australia
| | - Tony W Ho
- AstraZeneca, Wilmington DE 19850-5437, USA
| | | | - Stan Kaye
- Drug Development Unit and Gynaecology Unit, Royal Marsden Hospital and Institute of Cancer Research, London, UK
| | | | - Matthew R Sydes
- MRC Clinical Trials Unit, University College London, London, UK
| | - Ian F Tannock
- University of Toronto Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Amit M Oza
- University of Toronto Princess Margaret Cancer Centre, Toronto, ON, Canada.
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Lück HJ, Lübbe K, Reinisch M, Maass N, Feisel-Schwickardi G, Tomé O, Janni W, Aydogdu M, Neunhöffer T, Ober A, Aktas B, Park-Simon TW, Schumacher C, Höffkes HG, Illmer T, Wagner H, Mehta K, von Minckwitz G, Nekljudova V, Loibl S. Phase III study on efficacy of taxanes plus bevacizumab with or without capecitabine as first-line chemotherapy in metastatic breast cancer. Breast Cancer Res Treat 2014; 149:141-9. [PMID: 25519041 DOI: 10.1007/s10549-014-3217-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 11/18/2014] [Indexed: 11/25/2022]
Abstract
Taxanes (T) plus bevacizumab (B) and taxanes plus capecitabine (X) showed better progression-free survival (PFS) compared to taxanes alone. Since life-threatening or highly symptomatic situations require polychemotherapy in metastatic breast cancer (MBC), combination of taxanes, capecitabine plus bevacizumab appears reasonable. TABEA (NCT01200212), a prospectively randomized, open-label, phase III trial compares taxanes (paclitaxel 80 mg/m(2) i.v. d1,8,15 q22 or docetaxel 75 mg/m(2) i.v. d1 q22) plus bevacizumab (15 mg/kg i.v. d1 q22) with (TBX) or without capecitabine (TB, 1800 mg/m(2) daily d1-14 q22) as first-line therapy in MBC. Histologically confirmed HER2-negative, locally advanced or MBC patients with a chemotherapy indication and measurable or non-measurable target lesions (RECIST criteria) were included. Primary objective was PFS. Secondary objectives were response rate and duration, clinical benefit rate (complete response, partial response, stable disease ≥24 weeks), 3-year overall survival, PFS in patients ≥65 years, toxicity, and compliance. We assumed 10 and 13.3 months PFS for TB and TBX, respectively (HR = 0.75), requiring 432 patients and 386 events. Preplanned interim futility and safety analyses after 100 events in 202 patients showed no efficacy benefit and higher toxicity for TBX. Recruitment and therapy were stopped following advice from the IDMC. Final analysis revealed a HR 1.13 [95 %CI 0.806-1.59], P = 0.474, for PFS. Overall grade 3-4 adverse event (77.3 vs. 62.1 %, P = 0.014) and serious adverse event (40.0 vs. 30.2 %, P = 0.127) rates were higher for TBX after 26.1 months median follow-up, with six deaths for TBX versus 1 for TB. Adding capecitabine to TB cannot be recommended as first-line therapy in MBC.
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Kristensen TB, Knutsson MLT, Wehland M, Laursen BE, Grimm D, Warnke E, Magnusson NE. Anti-vascular endothelial growth factor therapy in breast cancer. Int J Mol Sci 2014; 15:23024-41. [PMID: 25514409 PMCID: PMC4284752 DOI: 10.3390/ijms151223024] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Revised: 12/05/2014] [Accepted: 12/06/2014] [Indexed: 12/31/2022] Open
Abstract
Neo-angiogenesis is a critical process for tumor growth and invasion and has become a promising target in cancer therapy. This manuscript reviews three currently relevant anti-angiogenic agents targeting the vascular endothelial growth factor system: bevacizumab, ramucirumab and sorafenib. The efficacy of anti-angiogenic drugs in adjuvant therapy or as neo-adjuvant treatment has been estimated in clinical trials of advanced breast cancer. To date, the overall observed clinical improvements are unconvincing, and further research is required to demonstrate the efficacy of anti-angiogenic drugs in breast cancer treatments. The outcomes of anti-angiogenic therapy have been highly variable in terms of tumor response. New methods are needed to identify patients who will benefit from this regimen. The development of biomarkers and molecular profiling are relevant research areas that may strengthen the ability to focus anti-angiogenic therapy towards suitable patients, thereby increase the cost-effectiveness, currently estimated to be inadequate.
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Affiliation(s)
- Tina Bøgelund Kristensen
- Department of Biomedicine, Pharmacology, Aarhus University, Wilhelm Meyers Allé 4, Aarhus C 8000, Denmark.
| | - Malin L T Knutsson
- Department of Biomedicine, Pharmacology, Aarhus University, Wilhelm Meyers Allé 4, Aarhus C 8000, Denmark.
| | - Markus Wehland
- Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg D-39120, Germany.
| | - Britt Elmedal Laursen
- Department of Oncology, Aarhus University Hospital, Nørrebrogade 44, Aarhus C 8000, Denmark.
| | - Daniela Grimm
- Department of Biomedicine, Pharmacology, Aarhus University, Wilhelm Meyers Allé 4, Aarhus C 8000, Denmark.
| | - Elisabeth Warnke
- Clinic for Plastic, Aesthetic and Hand Surgery, Otto-von-Guericke-University Magdeburg, Leipziger Str. 44, Magdeburg D-39120, Germany.
| | - Nils E Magnusson
- Medical Research Laboratory, Department of Clinical Medicine, Aarhus University, Nørrebrogade 44, Aarhus C 8000, Denmark.
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Brodowicz T, Lang I, Kahan Z, Greil R, Beslija S, Stemmer SM, Kaufman B, Petruzelka L, Eniu A, Anghel R, Koynov K, Vrbanec D, Pienkowski T, Melichar B, Spanik S, Ahlers S, Messinger D, Inbar MJ, Zielinski C. Selecting first-line bevacizumab-containing therapy for advanced breast cancer: TURANDOT risk factor analyses. Br J Cancer 2014; 111:2051-7. [PMID: 25268370 PMCID: PMC4260030 DOI: 10.1038/bjc.2014.504] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2014] [Revised: 08/04/2014] [Accepted: 08/18/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The randomised phase III TURANDOT trial compared first-line bevacizumab-paclitaxel (BEV-PAC) vs bevacizumab-capecitabine (BEV-CAP) in HER2-negative locally recurrent/metastatic breast cancer (LR/mBC). The interim analysis revealed no difference in overall survival (OS; primary end point) between treatment arms; however, progression-free survival (PFS) and objective response rate were significantly superior with BEV-PAC. We sought to identify patient populations that may be most appropriately treated with one or other regimen. METHODS Patients with HER2-negative LR/mBC who had received no prior chemotherapy for advanced disease were randomised to either BEV-PAC (bevacizumab 10 mg kg(-1) days 1 and 15 plus paclitaxel 90 mg m(-2) days 1, 8 and 15 q4w) or BEV-CAP (bevacizumab 15 mg kg(-1) day 1 plus capecitabine 1000 mg m(-2) bid days 1-14 q3w). The study population was categorised into three cohorts: triple-negative breast cancer (TNBC), high-risk hormone receptor-positive (HR+) and low-risk HR+. High- and low-risk HR+ were defined, respectively, as having ⩾2 vs ⩽1 of the following four risk factors: disease-free interval ⩽24 months; visceral metastases; prior (neo)adjuvant anthracycline and/or taxane; and metastases in ⩾3 organs. RESULTS The treatment effect on OS differed between cohorts. Non-significant OS trends favoured BEV-PAC in the TNBC cohort and BEV-CAP in the low-risk HR+ cohort. In all three cohorts, there was a non-significant PFS trend favouring BEV-PAC. Grade ⩾3 adverse events were consistently less common with BEV-CAP. CONCLUSIONS A simple risk factor index may help in selecting bevacizumab-containing regimens, balancing outcome, safety profile and patient preference. Final OS results are expected in 2015 (ClinicalTrials.gov NCT00600340).
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Affiliation(s)
- T Brodowicz
- Clinical Division of Oncology and Department of Medicine I, Medical University of Vienna and CECOG, Waehringer Guertel 18-20, A-1090 Vienna, Austria
| | - I Lang
- Ráth György u. 7-9, National Institute of Oncology, H-1122 Budapest, Hungary
| | - Z Kahan
- Department of Oncotherapy, University of Szeged, H-6720 Szeged, Korányi fasor 12, H-6720 Szeged, Hungary
| | - R Greil
- IIIrd Medical Department, Paracelsus Medical University Hospital Salzburg and AGMT, Salzburg, Austria
| | - S Beslija
- Institute of Oncology, Clinical Center, University of Sarajevo, Bolnicka 27, 71000 Sarajevo, Bosnia and Herzegovina
| | - S M Stemmer
- Davidoff Center, Rabin Medical Center, Kaplan Street, Petah Tiqwa 49100, Israel
| | - B Kaufman
- Breast Oncology Institute, Sheba Medical Center, 52621 Tel Hashomer, Ramat-Gan, Israel
| | - L Petruzelka
- Department of Oncology, First Faculty of Medicine and General Teaching Hospital, Charles University Prague, U Nemocnice 2, 128 08 Prague 2, Czech Republic
| | - A Eniu
- Department of Breast Tumors, Cancer Institute Ion Chiricuţă, Republicii 34–36, 400015 Cluj-Napoca, Romania
| | - R Anghel
- University of Medicine and Pharmacy Bucharest, Soseaua Fundeni, Nr 252, Sector 2, Bucharest 022328, Romania
| | - K Koynov
- Department of Medical Oncology, Hospital Serdika, 6 Damyan Gruev street, 1303 Sofia, Bulgaria
| | - D Vrbanec
- Department of Medical Oncology, University Hospital Zagreb-Rebro, Medical University of Zagreb, Kispaticeva 12, 10000 Zagreb, Croatia
| | - T Pienkowski
- Oncology Department, European Health Centre Otwock, ul. Borowa 14/18, 04-500 Otwock, Poland
| | - B Melichar
- Department of Oncology, Palacký University Medical School, I. P. Pavlova 6, 775 20 Olomouc, Czech Republic
| | - S Spanik
- St Elisabeth Cancer Institute, Heydukova 10, 812 50 Bratislava, Slovak Republic
| | - S Ahlers
- Biometrics, IST GmbH, Soldnerstrasse 1, 68219 Mannheim, Germany
| | - D Messinger
- Biometrics, IST GmbH, Soldnerstrasse 1, 68219 Mannheim, Germany
| | - M J Inbar
- Oncology Division, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel
| | - C Zielinski
- Clinical Division of Oncology and Department of Medicine I, Medical University of Vienna and CECOG, Waehringer Guertel 18-20, A-1090 Vienna, Austria
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The efficacy and safety of bevacizumab combined with chemotherapy in treatment of HER2-negative metastatic breast cancer: a meta-analysis based on published phase III trials. Tumour Biol 2014; 36:1933-41. [DOI: 10.1007/s13277-014-2799-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2014] [Accepted: 11/03/2014] [Indexed: 10/24/2022] Open
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Coudert B, Pierga JY, Mouret-Reynier MA, Kerrou K, Ferrero JM, Petit T, Kerbrat P, Dupré PF, Bachelot T, Gabelle P, Giard S, Coeffic D, Bougnoux P, Prevost JB, Paintaud G, Thibault G, Hernandez J, Coudert M, Arnould L, Berriolo-Riedinger A. Use of [(18)F]-FDG PET to predict response to neoadjuvant trastuzumab and docetaxel in patients with HER2-positive breast cancer, and addition of bevacizumab to neoadjuvant trastuzumab and docetaxel in [(18)F]-FDG PET-predicted non-responders (AVATAXHER): an open-label, randomised phase 2 trial. Lancet Oncol 2014; 15:1493-1502. [PMID: 25456368 DOI: 10.1016/s1470-2045(14)70475-9] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND An effective and well tolerated treatment is needed for patients with early HER2-positive breast cancer who do not achieve a pathological complete response after neoadjuvant therapy. The AVATAXHER trial aimed to predict pathological complete response early with the use of PET and to investigate whether the addition of bevacizumab could improve the proportion of patients achieving a pathological complete response in patients unlikely to respond to treatment. METHODS AVATAXHER was a randomised, open-label, non-comparative, multicentre phase 2 study that enrolled women (≥18 years of age) with early-stage HER2-positive breast cancer from 26 oncology centres in France. Patients initially received two cycles of neoadjuvant docetaxel (100 mg/m(2) intravenously every 3 weeks) plus trastuzumab (8 mg/kg intravenously every 3 weeks then 6 mg/kg intravenously every 3 weeks for the second course). Before the first and second cycles, [(18)F]-fluorodeoxyglucose (FDG) PET was done and the change in standardised uptake value was used to predict pathological complete response in each patient. Patients who were predicted to be responders on PET continued to receive standard therapy. Predicted non-responders were randomly assigned (2:1) to receive four cycles of docetaxel (100 mg/m(2) intravenously every 3 weeks) and trastuzumab (6 mg/kg intravenously every 3 weeks) plus bevacizumab (15 mg/kg intravenously every 3 weeks; group A) or continue on docetaxel plus trastuzumab alone (group B). Randomisation was open label and was done by an adaptive minimisation method. Although investigators and patients were aware of group assignment, the anatomo-pathologist in charge of centralised review of surgical samples and lymph nodes was masked to treatment assignment. The primary endpoint was centrally assessed pathological complete response according to the Chevallier classification. Efficacy analyses were done in the intention-to-treat population. Safety analyses in this Article were done on all patients who received at least one dose of treatment starting from cycle 3. Survival outcomes are not yet mature. This study is registered with ClinicalTrials.gov (NCT01142778) and EUDRACT (2009-013410-26). FINDINGS Between May 19, 2010, and Oct 1, 2012, 152 patients were recruited for the study. Ten patients were subsequently excluded, leaving 142 patients in the intention-to-treat population. Of these 142 patients, 69 were predicted by [(18)F]-FDG PET to be treatment responders after two cycles of treatment. The 73 predicted non-responders were randomly assigned to group A (n=48) and group B (n=25). Pathological complete responses were noted in 37 (53·6%, 95% CI 41·2-65·7) of the PET responders, 21 (43·8%, 29·5-58·8) of those in group A, and six (24·0%, 9·4-45·1) of those in group B. Incidences of grade 3-4 adverse events were similar in all three groups. The most common grade 3-4 adverse events were neutropenia (four in PET responders, five in group A, and three in group B), febrile neutropenia (one, three, and one, respectively), and myalgia (four, none, and one, respectively). Overall, 24 serious adverse events were reported in 15 patients (PET responders: nine events in four [6%] of 67 patients; group A: 14 events in ten [21%] of 47 patients; group B: one event in one [4%] of 25 patients). No deaths occurred during the study. INTERPRETATION In patients with HER2-positive breast cancer, early PET assessment can help to identify non-responders to neoadjuvant docetaxel plus trastuzumab therapy. In these patients, the addition of bevacizumab can increase the proportion of patients achieving a pathological complete response. This potential new role for PET and the activity of bevacizumab in this setting need to be confirmed in larger phase 3 trials. FUNDING Roche France.
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Affiliation(s)
- Bruno Coudert
- Department of Medical Oncology, Centre Georges-Francois Leclerc, Dijon, France.
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris Descartes, Paris, France
| | | | - Kaldoun Kerrou
- Department of Nuclear Medicine, Hopital Tenon, Paris, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - Pierre Kerbrat
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Pierre-François Dupré
- Department of Medical Oncology, Centre Hospitalier Universitaire Augustin-Morvan, Brest, France
| | - Thomas Bachelot
- Department of Medical Oncology et Unité INSERM U590, Centre Léon Berard, Lyon, France
| | - Philippe Gabelle
- Department of Surgery, Institut Daniel Hollard, Grenoble, France
| | - Sylvia Giard
- Department of Surgery, Centre Oscar Lambret, Lille, France
| | - David Coeffic
- Department of Medical Oncology, Clinique Hartmann, Neuilly sur Seine, France
| | | | | | - Gilles Paintaud
- Université François-Rabelais de Tours, CNRS, GICC UMR 7292, CHRU de Tours, Laboratory of Pharmacology-Toxicology, Tours, France
| | | | | | | | - Laurent Arnould
- Department of Pathology, Centre Georges-Francois Leclerc, Dijon, France
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