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Oner G, Broeckx G, Van Berckelaer C, Zwaenepoel K, Altintas S, Canturk Z, Tjalma W, Berneman Z, Peeters M, Pauwels P, van Dam PA. The immune microenvironment characterisation and dynamics in hormone receptor-positive breast cancer before and after neoadjuvant endocrine therapy. Cancer Med 2023; 12:17901-17913. [PMID: 37553911 PMCID: PMC10524081 DOI: 10.1002/cam4.6425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 07/05/2023] [Accepted: 07/27/2023] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Oestrogen receptor positive (ER+)/HER-2 negative breast cancer (BC) is considered to be an immunologically cold tumour compared to triple negative breast cancer. Therefore, the tumour microenvironment (TME) of ER+/HER-2 negative BC is understudied. The aim of this project is to investigate the TME and the immune response during neoadjuvant endocrine therapy (NET) and to correlate this with the treatment response in a real life setting. METHODS Expression of immune checkpoint receptors and immune cells was examined immunohistochemically, pre- and post-NET in a cohort of 56 ER+/HER-2 negative BC patients. They were treated with tamoxifen (n = 16), an aromatase inhibitor (n = 40) or a combination of an aromatase inhibitor with a PI3K inhibitor (n = 11) for a median duration of 6 months (range 1-32 months). Immunohistochemical staining with monoclonal antibodies for PDL-1, PD-1, TIM-3, LAG-3, CTLA-4, CD4, CD68 and FOXP3 were performed. All staining procedures were done according to validated protocols, and scoring was done by a pathologist specialized in breast cancer. Positivity was defined as staining >1% on TILs. Response to NET was evaluated according to tumour size change on imaging and Ki-67 change. RESULTS The median age was 61.02 (37-90) years. Diameter of tumour size decreased with a mean of 8.1 mm (-16 mm to 45 mm) (p < 0.001) during NET and the value of Ki-67 value decreased with a median of 9 after NET (p < 0.001). An increase in PD-L1 expression after NET showed a trend towards significant (p = 0.088) and CD-4+ T cells significantly increased after NET (p = 0.03). A good response to NET defined as a decrease in tumour size and/or decrease of Ki-67 was found to be associated with a longer duration of NET, a change of CD4+ T-cells and a higher number of CD68+ tumour-associated macrophages before the start of NET. CONCLUSION The immune microenvironment plays an important role in ER+/HER-2 negative BC. NET influences the composition and functional state of the infiltrating immune cells. Furthermore, changes in the immune microenvironment are also associated with treatment response.
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Affiliation(s)
- Gizem Oner
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
- Department of General SurgeryKocaeli UniversityKocaeliTurkey
| | - Glenn Broeckx
- Department of HistopathologyAntwerp University HospitalEdegemBelgium
| | | | - Karen Zwaenepoel
- Department of HistopathologyAntwerp University HospitalEdegemBelgium
| | - Sevilay Altintas
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
| | - Zafer Canturk
- Department of General SurgeryKocaeli UniversityKocaeliTurkey
| | - Wiebren Tjalma
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
| | - Zwi Berneman
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
- Department of HematologyAntwerp University HospitalEdegemBelgium
| | - Marc Peeters
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
| | - Patrick Pauwels
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
- Department of HistopathologyAntwerp University HospitalEdegemBelgium
| | - Peter A. van Dam
- Multidisciplinary Oncologic Centre Antwerp (MOCA)Antwerp University HospitalEdegemBelgium
- Center for Oncological Research (CORE)University of AntwerpWilrijkBelgium
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Determining the Optimal Cut-Off Values of Serum E2 and FSH for Evaluating the Menopausal Status of Breast Cancer Patients in a Southern Chinese Population. DISEASE MARKERS 2022; 2022:8716160. [PMID: 36046380 PMCID: PMC9420640 DOI: 10.1155/2022/8716160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 06/16/2022] [Accepted: 08/03/2022] [Indexed: 11/17/2022]
Abstract
Background Chemotherapy-induced amenorrhea (CIA) is one of universal phenomena in breast cancer (BC) patients, and it causes difficulties in evaluating the actual menopausal status which is important for the oncologists to choose appropriate treatment. Currently, serum estradiol (E2) and follicle-stimulating hormone (FSH) levels are the most commonly used clinical parameters for the assessment of menopausal status in BC patients. However, the optimal cut-off points of serum E2 and FSH have little been explored in southern Chinese population. Objective This study is aimed to determine the optimal cut-off values of the serum E2 and FSH levels for evaluating the menopausal status of BC patients in a southern Chinese population. Methods A retrospective analysis was done among a total of 206 patients with BC from a southern Chinese area. The data of serum E2, FSH, and luteinizing hormone (LH) levels were collected and analyzed for the comparison purpose. The receiver-operating curve (ROC) was generated to assess the specificity and sensitivity of the three biomarkers in discriminating the menopausal status of BC patients. The optimal cut-off values were determined according to the Youden index and then compared with the recommended reference values by the Chinese Anti-cancer Association (CACA) and those recommended by the manufacturers. Results The areas under the ROC curves (AUCs) of E2, FSH, and LH were 0.846 (95% CI: 0.790-0.903), 0.781 (95% CI: 0.714-0.847) and 0.608 (95% CI: 0.526-0.690), respectively. The optimal cut-off values were 130.0 pg/mL for E2, 23.325 IU/L for FSH, and 11.625 IU/L for LH with a maximum of the Youden index. When E2, FSH, and LH were used in combination for ROC analysis, the AUC increased to 0.847 (95% CI: 0.790-0.904), which was higher than that of any other biomarker alone. In this study, the sensitivity and specificity of E2 and FSH were 91.6% and 73.70% and 94.4% and 58.6%, respectively, in comparison with 85.0% and 75.80% and 76.6% and 65.7% according to the CACA-recommended cut-off points, or 92.5% and 68.7% and 96.3% and 53.5% according to the manufacturer recommended cut-off points. Conclusion Considering the sensitivity and specificity of serum E2 and FSH for assessing the menopausal status, the optimal cut-off values determined in the present study were similar to the manufacturer's recommendations, but obviously superior to the cut-off points suggested by CACA. These cut-off points calculated in this study seem to be valuable in southern Chinese population and might be used by clinicians to make a correct medical decision for BC patients who would benefit from endocrine therapy of aromatase inhibitor (AI).
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Agostinetto E, Nader-Marta G, Paesmans M, Ameye L, Veys I, Buisseret L, Neven P, Taylor D, Fontaine C, Duhoux FP, Canon JL, Denys H, Coussy F, Chakiba C, Ribeiro JM, Piccart M, Desmedt C, Ignatiadis M, Aftimos P. ROSALINE: a phase II, neoadjuvant study targeting ROS1 in combination with endocrine therapy in invasive lobular carcinoma of the breast. Future Oncol 2022; 18:2383-2392. [PMID: 35695563 DOI: 10.2217/fon-2022-0358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Invasive lobular carcinoma (ILC) is the most common histologic subtype of breast cancer after invasive ductal carcinoma (i.e., no special type [NST]). ILC differs from NST in clinical presentation, site-specific metastases and response to conventional therapies. Loss of E-cadherin protein expression, due to alterations in its encoding gene CDH1, is the most frequent oncogenic event in ILC. Synthetic lethality approaches have shown promising antitumor effects of ROS1 inhibitors in models of E-cadherin-defective breast cancer in in vivo studies and provide the rationale for testing their clinical activity in patients with ILC. Entrectinib is a tyrosine kinase inhibitor targeting TRK, ROS1 and ALK tyrosine kinases. Here, the authors present ROSALINE (NCT04551495), a phase II study testing neoadjuvant entrectinib and endocrine therapy in women with estrogen receptor-positive, HER2-negative early ILC.
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Affiliation(s)
- Elisa Agostinetto
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium.,Humanitas University, Department of Biomedical Sciences, via Rita Levi Montalcini 4, 20090 Pieve Emanuele - Milan, Italy
| | | | - Marianne Paesmans
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Lieveke Ameye
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Isabelle Veys
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Laurence Buisseret
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | | | | | | | | | | | | | - Martine Piccart
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Desmedt
- Department of Oncology, Laboratory for Translational Breast Cancer Research, KU Leuven, Leuven, Belgium
| | - Michail Ignatiadis
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
| | - Philippe Aftimos
- Institut Jules Bordet & l'Université Libre de Bruxelles, Brussels, Belgium
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Martí C, Yébenes L, Oliver JM, Moreno E, Frías L, Berjón A, Loayza A, Meléndez M, Roca MJ, Córdoba V, Hardisson D, Rodríguez MÁ, Sánchez-Méndez JI. The Clinical Impact of Neoadjuvant Endocrine Treatment on Luminal-like Breast Cancers and Its Prognostic Significance: Results from a Single-Institution Prospective Cohort Study. Curr Oncol 2022; 29:2199-2210. [PMID: 35448153 PMCID: PMC9026529 DOI: 10.3390/curroncol29040179] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/15/2022] [Accepted: 03/21/2022] [Indexed: 01/02/2023] Open
Abstract
Purpose: Neoadjuvant endocrine treatment (NET) has become a useful tool for the downstaging of luminal-like breast cancers in postmenopausal patients. It enables us to increase breast- conserving surgery (BCS) rates, provides an opportunity for us to assess in vivo NET effectiveness, and allows us to study any biological changes that may act as valid biomarkers. The purpose of this study was to evaluate the safety and effectiveness of NET, and to assess the role of Ki67 proliferation rate changes as an indicator of endocrine responsiveness. Methods: From 2016 to 2020, a single-institution cohort of patients, treated with NET and further surgery, was evaluated. In patients with Ki67 ≥ 10%, a second core biopsy was performed after four weeks. Information regarding histopathological and clinical changes was gathered. Results: A total of 115 estrogen receptor-positive (ER+)/HER2-negative patients were included. The median treatment duration was 5.0 months (IQR: 2.0−6.0). The median maximum size in the surgical sample was 40% smaller than the pretreatment size measured by ultrasound (p < 0.0001). The median pretreatment Ki67 expression was 20.0% (IQR: 12.0−30.0), and was reduced to 5.0% (IQR: 1.8−10.0) after four weeks, and to 2.0% (IQR: 1.0−8.0) in the surgical sample (p < 0.0001). BCS was performed on 98 patients (85.2%). No pathological complete responses were recorded. A larger Ki67 fold change after four weeks was significantly related to a PEPI score of zero (p < 0.002). No differences were observed between luminal A- and B-like tumors, with regard to fold change and PEPI score. Conclusions: In our cohort, NET was proven to be effective for tumor size and Ki67 downstaging. This resulted in a higher rate of conservative surgery, aided in therapeutic decision making, provided prognostic information, and constituted a safe and well-tolerated approach.
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Affiliation(s)
- Covadonga Martí
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
- Correspondence:
| | - Laura Yébenes
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Pathology, Hospital Universitario La Paz, 28046 Madrid, Spain
- IdiPaz—Instituto de Investigación La Paz, 28046 Madrid, Spain
| | - José María Oliver
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Radiology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Elisa Moreno
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Laura Frías
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Alberto Berjón
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Pathology, Hospital Universitario La Paz, 28046 Madrid, Spain
- IdiPaz—Instituto de Investigación La Paz, 28046 Madrid, Spain
| | - Adolfo Loayza
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Marcos Meléndez
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - María José Roca
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Radiology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - Vicenta Córdoba
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Radiology, Hospital Universitario La Paz, 28046 Madrid, Spain
| | - David Hardisson
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Pathology, Hospital Universitario La Paz, 28046 Madrid, Spain
- IdiPaz—Instituto de Investigación La Paz, 28046 Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
- Center for Biomedical Research in the Cancer Network (CIBERONC), 28029 Madrid, Spain
| | - María Ángeles Rodríguez
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
| | - José Ignacio Sánchez-Méndez
- Breast Cancer Unit, Hospital Universitario La Paz, 28046 Madrid, Spain; (L.Y.); (J.M.O.); (E.M.); (L.F.); (A.B.); (A.L.); (M.M.); (M.J.R.); (V.C.); (D.H.); (M.Á.R.); (J.I.S.-M.)
- Department of Gynecology, Hospital Universitario La Paz, 28046 Madrid, Spain
- IdiPaz—Instituto de Investigación La Paz, 28046 Madrid, Spain
- Faculty of Medicine, Universidad Autónoma de Madrid, 28046 Madrid, Spain
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Nam G, Singh K, Lopresti ML, Ouseph MM, Wang LJ, Wang Y. How Does Invasive Breast Cancer Oncotype Dx Recurrence Score on Core Needle Biopsies Influence Neoadjuvant Treatment Decision? A Descriptive Study. Technol Cancer Res Treat 2021; 20:15330338211035037. [PMID: 34696631 PMCID: PMC8552406 DOI: 10.1177/15330338211035037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Oncotype Dx (ODx) is a genomic assay which estimates the risk of distant recurrence and predicts adjuvant chemotherapy benefit in early stage breast cancer patients. Most ODx data is derived from excisional specimens. Aim: We assess the utility of ODx on core needle biopsies (CNB) and measure its impact on neoadjuvant treatment decisions, particularly in patients with clinically complicated situations. Methods: Consecutive ODx results on breast CNBs with invasive carcinoma from 2012-2020 at 3 tertiary care hospitals with dedicated Breast Health Centers were reviewed. Clinical indications to perform ODx on CNB were recorded through a review of patients’ electronic medical records. Clinicopathologic features, surgical or oncologic modalities and follow-up data were recorded. Results: Three distinct clinical indications for performing ODx on CNB in 85 ER+ invasive breast carcinomas were identified: 1) Excisions with insufficient tissue to perform ODx, 2) adjudicate neoadjuvant therapy versus primary surgical resection, and 3) select neoadjuvant chemotherapy (NAC) versus neoadjuvant endocrine therapy (NET). Primary surgery was selected in patients with low score RS (<18), and NET was preferred in patients with intermediate or high RS (>18). NET was preferred over NAC in patients with low RS (<18). Conclusion: This study shows that CNB ODx RS helps guide treatment decisions in a neoadjuvant setting along with other contributing factors such as the presence of pathogenic mutations, node positivity, patient age, and comorbidities. The use of ODx on CNB is furthermore valuable in the midst of the COVID-19 pandemic for early breast cancer patients to administer effective therapy in a timely manner.
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Affiliation(s)
- Gahie Nam
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Kamaljeet Singh
- Department of Pathology, Women and Infants Hospital, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Mary L Lopresti
- Department of Medical Oncology, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Madhu M Ouseph
- Department of Pathology, Weill Cornell Medicine, NY, USA
| | - Li Juan Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Warren Alpert Medical School of Brown University, Providence, RI, USA
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The Present and Future of Neoadjuvant Endocrine Therapy for Breast Cancer Treatment. Cancers (Basel) 2021; 13:cancers13112538. [PMID: 34064183 PMCID: PMC8196711 DOI: 10.3390/cancers13112538] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Revised: 05/16/2021] [Accepted: 05/19/2021] [Indexed: 12/15/2022] Open
Abstract
Simple Summary The treatment of breast cancer has evolved considerably over the last two decades, leading toward individualized disease management. Hormone-sensitive breast cancers constitute the vast majority of cases and endocrine therapy is the mainstay of their treatment. On the other hand, neoadjuvant or pre-surgical treatments provide a number of advantages for tumor management. In this review we will discuss the existing evidence on neoadjuvant endocrine therapy, as well as its possible future indications. Abstract Endocrine therapy (ET) has established itself as an efficacious treatment for estrogen receptor-positive (ER+) breast cancers, with a reduction in recurrence rates and increased survival rates. The pre-surgical approach with chemotherapy (NCT) has become a common form of management for large, locally advanced, or high-risk tumors. However, a good response to NCT is not usually expected in ER+ tumors. Good results with primary ET, mainly in elderly women, have encouraged studies in other stages of life, and nowadays neoadjuvant endocrine treatment (NET) has become a useful approach to many ER+ breast cancers. The aim of this review is to provide an update on the current state of art regarding the present and the future role of NET.
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LeVasseur N, Willemsma KA, Li H, Gondara L, Yip WC, Illmann C, Chia SK, Simmons C. Efficacy of Neoadjuvant Endocrine Therapy Versus Neoadjuvant Chemotherapy in ER-positive Breast Cancer: Results From a Prospective Institutional Database. Clin Breast Cancer 2019; 19:e683-e689. [DOI: 10.1016/j.clbc.2019.05.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 05/17/2019] [Accepted: 05/27/2019] [Indexed: 11/30/2022]
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Lee KA, Shepherd ST, Johnston SR. Abemaciclib, a potent cyclin-dependent kinase 4 and 6 inhibitor, for treatment of ER-positive metastatic breast cancer. Future Oncol 2019; 15:3309-3326. [PMID: 31464525 DOI: 10.2217/fon-2019-0169] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
CDK 4/6 inhibitors have given patients with estrogen receptor (ER)-positive/HER2-negative (ER+/HER2ࢤ) advanced metastatic breast cancer important new therapeutic options. Abemaciclib is different to the other two licensed and approved CDK 4/6 inhibitors, palbociclib and ribociclib, both in dosing schedule (continuous vs intermittent) and toxicity profile (less neutropenia, more diarrhea), yet the magnitude of clinical benefit seen in first- and second-line studies is very similar. One of the key issues for clinicians is when to use these therapies. Ultimately, the biggest impact of abemaciclib could be in the adjuvant setting if the current MONARCH-E trial in high-risk node-positive patients is positive. The emerging biomarker work in the early breast cancer setting (i.e., neoMONARCH) may determine which tumors are most sensitive to abemaciclib.
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Affiliation(s)
- Karla A Lee
- Breast Unit, The Royal Marsden NHS Foundation Trust, Chelsea, London SW3 6JJ, UK
| | - Scott Tc Shepherd
- Breast Unit, The Royal Marsden NHS Foundation Trust, Chelsea, London SW3 6JJ, UK
| | - Stephen Rd Johnston
- Breast Unit, The Royal Marsden NHS Foundation Trust, Chelsea, London SW3 6JJ, UK
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Johnston S, Martin M, Di Leo A, Im SA, Awada A, Forrester T, Frenzel M, Hardebeck MC, Cox J, Barriga S, Toi M, Iwata H, Goetz MP. MONARCH 3 final PFS: a randomized study of abemaciclib as initial therapy for advanced breast cancer. NPJ Breast Cancer 2019; 5:5. [PMID: 30675515 PMCID: PMC6336880 DOI: 10.1038/s41523-018-0097-z] [Citation(s) in RCA: 338] [Impact Index Per Article: 67.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 12/11/2018] [Indexed: 12/17/2022] Open
Abstract
At the MONARCH 3 interim analysis, abemaciclib plus a nonsteroidal aromatase inhibitor (AI) significantly improved progression-free survival (PFS) and objective response rate (ORR) with a tolerable safety profile as initial treatment for hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancer (ABC). MONARCH 3 is a randomized, phase III, double-blind study of abemaciclib/placebo (150 mg twice daily, continuous) plus nonsteroidal AI (1 mg anastrozole or 2.5 mg letrozole, daily). A total of 493 postmenopausal women with HR+, HER2- ABC with no prior systemic therapy in this setting were enrolled. The primary endpoint was investigator-assessed PFS (final analysis after 240 events); other endpoints included response and safety evaluations. Here we analyze the final PFS data and update secondary endpoints. The abemaciclib arm had a significantly longer median PFS than the placebo arm (28.18 versus 14.76 months; hazard ratio [95% confidence interval], 0.540 [0.418-0.698]; p = .000002). The ORR was 61.0% in the abemaciclib arm versus 45.5% in the placebo arm (measurable disease, p = .003). The median duration of response was longer in the abemaciclib arm (27.39 months) compared to the placebo arm (17.46 months). The safety profile was consistent with previous reports. The most frequent grade ≥ 3 adverse events in the abemaciclib versus placebo arms were neutropenia (23.9% versus 1.2%), diarrhea (9.5% versus 1.2%), and leukopenia (8.6% versus 0.6%). Abemaciclib plus a nonsteroidal AI was an effective initial treatment with an acceptable safety profile for HR+, HER2- ABC.
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Affiliation(s)
| | - Miguel Martin
- Instituto De Investigacion Sanitaria Gregorio Marañon, Ciberonc, Geicam; Universidad Complutense, Madrid, Spain
| | - Angelo Di Leo
- Department of Oncology, Hospital of Prato, Istituto Toscano Tumori, Prato, Italy
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Ahmad Awada
- Oncology Medicine department, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium
| | - Tammy Forrester
- Global Statistical Sciences, Eli Lilly and Company, Indianapolis, IN USA
| | - Martin Frenzel
- Global Statistical Sciences, Eli Lilly and Company, Indianapolis, IN USA
| | - Molly C. Hardebeck
- Oncology Clinical Development, Eli Lilly and Company, Indianapolis, IN USA
| | - Joanne Cox
- Oncology Clinical Development, Eli Lilly and Company, Windlesham, UK
| | - Susana Barriga
- Oncology Clinical Development, Eli Lilly and Company, Madrid, Spain
| | - Masakazu Toi
- Department of Breast Surgery, Kyoto University, Kyoto, Japan
| | - Hiroji Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
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10
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Magnetic resonance imaging in breast cancer management in the context of neo-adjuvant chemotherapy. Crit Rev Oncol Hematol 2018; 132:51-65. [DOI: 10.1016/j.critrevonc.2018.09.012] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 08/31/2018] [Accepted: 09/19/2018] [Indexed: 12/19/2022] Open
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11
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Bear HD, Wan W, Robidoux A, Rubin P, Limentani S, White RL, Granfortuna J, Hopkins JO, Oldham D, Rodriguez A, Sing AP. Using the 21-gene assay from core needle biopsies to choose neoadjuvant therapy for breast cancer: A multicenter trial. J Surg Oncol 2017; 115:917-923. [PMID: 28407247 DOI: 10.1002/jso.24610] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 02/19/2017] [Indexed: 12/28/2022]
Abstract
OBJECTIVE We hypothesized that the Oncotype Dx® 21-gene Recurrence Score (RS) could guide neoadjuvant systemic therapy (NST) to facilitate breast conserving surgery (BCS) for hormone receptor positive (HR+) breast cancers. METHODS This study enrolled patients with HR+, HER2-negative, invasive breast cancers not suitable for BCS (size ≥ 2 cm). Core needle biopsy blocks were tested. For tumors with RS < 11, patients received hormonal therapy (NHT); patients with RS > 25 tumors received chemotherapy (NCT); patients with RS 11-25 were randomized to NHT or NCT. Primary endpoint was whether 1/3 or more of randomized patients refused assigned treatment. RESULTS Sixty-four patients were enrolled. Of 33 patients with RS 11-25, 5 (15%) refused assignment to NCT. This was significantly lower than the 33% target (binomial test, P = 0.0292). Results for clinical outcomes (according to treatment received for 55 subjects) included successful BCS for 75% of tumors with RS < 11 receiving NHT, 72% for RS 11-25 receiving NHT, 64% for RS 11-25 receiving NCT, and 57% for RS > 25 receiving NCT. CONCLUSIONS Using the RS to guide NST is feasible. These results suggest that for patients with RS < 25 NHT is a potentially effective strategy.
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Affiliation(s)
- Harry D Bear
- Virginia Commonwealth University and Massey Cancer Center, Richmond, Virginia
| | - Wen Wan
- Virginia Commonwealth University and Massey Cancer Center, Richmond, Virginia
| | - André Robidoux
- Centre Hospitalier de l'Universite de Montreal, Montreal, Quebec, Canada
| | - Peter Rubin
- Cone Health Cancer Center, Greensboro, North Carolina
| | | | | | | | | | - Dwight Oldham
- Lynchburg Hematology Oncology Clinic, Lynchburg, Virginia
| | | | - Amy P Sing
- Genomic Health, Inc., Redwood City, California
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12
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Zhang L, Liu P, Chen H, Li Q, Chen L, Qi H, Shi X, Du Y. Characterization of a selective inverse agonist for estrogen related receptor α as a potential agent for breast cancer. Eur J Pharmacol 2016; 789:439-448. [PMID: 27498368 DOI: 10.1016/j.ejphar.2016.08.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 07/13/2016] [Accepted: 08/03/2016] [Indexed: 12/26/2022]
Abstract
The estrogen-related receptor α (ERRα) is an orphan nuclear receptor that plays a primary role in the regulation of cellular energy homeostasis and osteogenesis. It is reported that ERRα is widely expressed in a range of tissues and accumulating evidence has supported that the high expression of ERRα correlates with poor prognosis of various human malignancies, including breast, endometrium, colon, prostate and ovary cancers. Herein is described the discovery of a novel selective inverse agonist (HSP1604) of ERRα, but not of ERRβ and ERRγ, as determined using transient transfection luciferase reporter assay and a time-resolved fluorescence resonance energy transfer (TR-FRET) co-activator assay. HSP1604 potently inhibits ERRα transcriptional activity with IC50=1.47±0.17μM in cell-based luciferase reporter assay and also decreases the protein level of ERRα and the mRNA levels of its downstream target genes such as pyruvate dehydrogenase kinase 4 (PDK4), pS2 and osteopontin. HSP1604 has also suppressed the proliferation of different human cancer cell lines and the migration of breast cancer cells with high expression of ERRα. Representative in vivo results show that HSP1604 suppresses the growth of human breast cancer xenograft in nude mice as doses at 30mg/kg or 100mg/kg administered every other day during 28-day period. HSP1604 thus has the potential both as a new agent to inhibit the growth of tumors and as a chemical probe of ERRα biology.
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Affiliation(s)
- Liudi Zhang
- Clinical Pharmacy Laboratory, Huashan Hospital, Fudan University, Shanghai 200040, China
| | - Peihong Liu
- School of Chemistry and Pharmaceutical Engineering, Qilu University of Technology, Jinan 250353, China
| | - Haifei Chen
- Clinical Pharmacy Unit, Huashan Hospital North, Fudan University, Shanghai 201907, China
| | - Qunyi Li
- Clinical Pharmacy Laboratory, Huashan Hospital, Fudan University, Shanghai 200040, China; Clinical Pharmacy Unit, Huashan Hospital North, Fudan University, Shanghai 201907, China.
| | - Lu Chen
- Clinical Pharmacy Unit, Huashan Hospital North, Fudan University, Shanghai 201907, China
| | - Huijie Qi
- Clinical Pharmacy Unit, Huashan Hospital North, Fudan University, Shanghai 201907, China
| | - Xiaojin Shi
- Clinical Pharmacy Laboratory, Huashan Hospital, Fudan University, Shanghai 200040, China; Clinical Pharmacy Unit, Huashan Hospital North, Fudan University, Shanghai 201907, China
| | - Yongli Du
- School of Chemistry and Pharmaceutical Engineering, Qilu University of Technology, Jinan 250353, China.
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