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Urruticoechea A, Rizwanullah M, Im SA, Ruiz ACS, Láng I, Tomasello G, Douthwaite H, Badovinac Crnjevic T, Heeson S, Eng-Wong J, Muñoz M. Randomized Phase III Trial of Trastuzumab Plus Capecitabine With or Without Pertuzumab in Patients With Human Epidermal Growth Factor Receptor 2-Positive Metastatic Breast Cancer Who Experienced Disease Progression During or After Trastuzumab-Based Therapy. J Clin Oncol 2017; 35:3030-3038. [PMID: 28437161 DOI: 10.1200/jco.2016.70.6267] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To assess the efficacy and safety of trastuzumab plus capecitabine with or without pertuzumab in patients with human epidermal growth factor receptor 2-positive metastatic breast cancer who experienced disease progression during or after trastuzumab-based therapy and received a prior taxane. Patients and Methods Patients were randomly assigned to arm A: trastuzumab 8 mg/kg → 6 mg/kg once every 3 weeks plus capecitabine 1,250 mg/m2 twice a day (2 weeks on, 1 week off, every 3 weeks); or arm B: pertuzumab 840 mg → 420 mg once every 3 weeks plus trastuzumab at the same dose and schedule as arm A plus capecitabine 1,000 mg/m2 on the same schedule as arm A. The primary end point was independent review facility-assessed progression-free survival (IRF PFS). Secondary end points included overall survival (OS) and safety. Hierarchical testing procedures were used to control type I error for statistical testing of IRF PFS, OS, and objective response rate. Results Randomly assigned (intent-to-treat) populations were 224 and 228 patients in arms A and B, respectively. Median IRF PFS at 28.6 and 25.3 months' median follow-up was 9.0 v 11.1 months (hazard ratio, 0.82; 95% CI, 0.65 to 1.02; P = .0731) and interim OS was 28.1 v 36.1 months (hazard ratio, 0.68; 95% CI, 0.51 to 0.90). The most common adverse events (all grades; incidence of ≥ 10% in either arm and ≥ 5% difference between arms) were hand-foot syndrome, nausea, and neutropenia in arm A, and diarrhea, rash, and nasopharyngitis in arm B. Conclusion The addition of pertuzumab to trastuzumab and capecitabine did not significantly improve IRF PFS. An 8-month increase in median OS to 36.1 months with pertuzumab was observed. Statistical significance for OS cannot be claimed because of the hierarchical testing of OS after the primary PFS end point; however, the magnitude of OS difference is in keeping with prior experience of pertuzumab in metastatic breast cancer. No new safety signals were identified.
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Affiliation(s)
- Ander Urruticoechea
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - Mohammed Rizwanullah
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - Seock-Ah Im
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - Antonio Carlos Sánchez Ruiz
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - István Láng
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - Gianluca Tomasello
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - Hannah Douthwaite
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - Tanja Badovinac Crnjevic
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - Sarah Heeson
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - Jennifer Eng-Wong
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
| | - Montserrat Muñoz
- Ander Urruticoechea, Onkologikoa Foundation, San Sebastián; Ander Urruticoechea, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, GEICAM; Montserrat Muñoz, Translational Genomics and Targeted Therapeutics in Solid Tumors and Hospital Clínic, Barcelona, GEICAM; Antonio Carlos Sánchez Ruiz, Hospital Universitario Puerta de Hierro, Madrid, Spain; Mohammed Rizwanullah, Beatson West of Scotland Cancer Centre, Glasgow; Hannah Douthwaite and Sarah Heeson, Roche, Welwyn Garden City, United Kingdom; Seock-Ah Im, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea; István Láng, National Institute of Oncology, Budapest, Hungary; Gianluca Tomasello, ASST di Cremona - Ospedale di Cremona, Cremona, Italy; Tanja Badovinac Crnjevic, F Hoffmann-La Roche, Basel, Switzerland; and Jennifer Eng-Wong, Genentech, South San Francisco, CA
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Kaufman PA, Awada A, Twelves C, Yelle L, Perez EA, Velikova G, Olivo MS, He Y, Dutcus CE, Cortes J. Phase III open-label randomized study of eribulin mesylate versus capecitabine in patients with locally advanced or metastatic breast cancer previously treated with an anthracycline and a taxane. J Clin Oncol 2015; 33:594-601. [PMID: 25605862 PMCID: PMC4463422 DOI: 10.1200/jco.2013.52.4892] [Citation(s) in RCA: 327] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
Purpose This phase III randomized trial (ClinicalTrials.gov identifier: NCT00337103) compared eribulin with capecitabine in patients with locally advanced or metastatic breast cancer (MBC). Patients and Methods Women with MBC who had received prior anthracycline- and taxane-based therapy were randomly assigned to receive eribulin or capecitabine as their first-, second-, or third-line chemotherapy for advanced/metastatic disease. Stratification factors were human epidermal growth factor receptor-2 (HER2) status and geographic region. Coprimary end points were overall survival (OS) and progression-free survival (PFS). Results Median OS times for eribulin (n = 554) and capecitabine (n = 548) were 15.9 and 14.5 months, respectively (hazard ratio [HR], 0.88; 95% CI, 0.77 to 1.00; P = .056). Median PFS times for eribulin and capecitabine were 4.1 and 4.2 months, respectively (HR, 1.08; 95% CI, 0.93 to 1.25; P = .30). Objective response rates were 11.0% for eribulin and 11.5% for capecitabine. Global health status and overall quality-of-life scores over time were similar in the treatment arms. Both treatments had manageable safety profiles consistent with their known adverse effects; most adverse events were grade 1 or 2. Conclusion In this phase III study, eribulin was not shown to be superior to capecitabine with regard to OS or PFS.
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Affiliation(s)
- Peter A Kaufman
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain.
| | - Ahmad Awada
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Chris Twelves
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Louise Yelle
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Edith A Perez
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Galina Velikova
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Martin S Olivo
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Yi He
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Corina E Dutcus
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
| | - Javier Cortes
- Peter A. Kaufman, Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH; Edith A. Perez, Mayo Clinic, Jacksonville, FL; Martin S. Olivo, Yi He, and Corina E. Dutcus, Eisai, Woodcliff Lake, NJ; Ahmad Awada, Medical Oncology Clinic, Jules Bordet Institute, Université Libre de Bruxelles, Brussels, Belgium; Chris Twelves and Galina Velikova, Leeds Institute of Cancer and Pathology, and St James's Institute of Oncology, Leeds, United Kingdom; Louise Yelle, University of Montreal, Montreal, Quebec, Canada; and Javier Cortes, Vall D'Hebron University Institute of Oncology, Barcelona, Spain
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