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Balch SM, Vaz-Luis I, Li T, Tayob N, Jain E, Helvie K, Buendia-Buendia JE, Shannon E, Isakoff SJ, Tung NM, Krop IE, Lin NU, Wagle N, Freedman RA. A phase II study of efficacy, toxicity, and the potential impact of genomic alterations on response to eribulin mesylate in combination with trastuzumab and pertuzumab in women with human epidermal growth factor receptor 2 (HER2)+ metastatic breast cancer. Breast Cancer Res Treat 2021; 189:411-423. [PMID: 34302589 DOI: 10.1007/s10549-021-06329-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Accepted: 07/07/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE There are limited data on trastuzumab-pertuzumab (HP)-based treatments beyond the first-line, HER2+ metastatic breast cancer (MBC) setting. We conducted a phase II study of eribulin mesylate, which extends survival in MBC, with HP in patients with previously treated HER2+ MBC to evaluate efficacy, toxicity, and genomic alterations driving therapeutic response. METHODS After a run-in phase for eribulin dosing, two cohorts were enrolled (Cohort A-no prior pertuzumab; Cohort B-prior pertuzumab). All patients received eribulin 1.4 mg/m2 on days 1, 8 with standard-dose HP on day 1 (21-day cycles). The primary endpoint was objective response rate (ORR). Genomic characterization via whole exome sequencing (WES) was completed on tumor DNA and matched germline DNA from 19 patients. RESULTS The six-patient run-in established a dose of eribulin 1.4 mg/m2 with HP. Cohorts A and B enrolled 17 and 7 patients, respectively. Accrual stopped early due to an evolving treatment landscape and slow enrollment. The ORR was 26.3% (95% Confidence Interval [CI] 9.2-51.2%) in Cohort A and 0% in Cohort B (95% CI 0-41.0%). WES revealed more frequent alterations in TP53 (p < 0.05, q > 0.05) in patients without clinical benefit (disease control for < 24 weeks) which was not significant after multiple hypothesis correction. CONCLUSION Eribulin-HP had manageable toxicity and modest clinical activity in patients without prior pertuzumab exposure. This study provides a preliminary landscape of somatic alterations in this patient cohort. Our data add to the literature on how genomic alterations may predict for therapy response/resistance, as we work to individualize choices in a quickly evolving HER2+ MBC treatment landscape. TRIAL REGISTRATION www.clinicaltrials.gov , NCT01912963. Registered 24 July 2013.
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Affiliation(s)
- Sara M Balch
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1259, Boston, MA, 02215, USA
| | - Ines Vaz-Luis
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1259, Boston, MA, 02215, USA.,Institut Gustave Roussy, Unit INSERM 981, Villejuif, France
| | - Tianyu Li
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nabihah Tayob
- Department of Data Sciences, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Esha Jain
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1259, Boston, MA, 02215, USA
| | - Karla Helvie
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1259, Boston, MA, 02215, USA
| | - Jorge E Buendia-Buendia
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Cellarity, Inc., Cambridge, MA, USA
| | - Erin Shannon
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Steven J Isakoff
- Massachusetts General Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Nadine M Tung
- Harvard Medical School, Boston, MA, USA.,Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Ian E Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1259, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Nancy U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1259, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Nikhil Wagle
- The Broad Institute of MIT and Harvard, Cambridge, MA, USA.,Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1259, Boston, MA, 02215, USA.,Harvard Medical School, Boston, MA, USA
| | - Rachel A Freedman
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Avenue, Yawkey 1259, Boston, MA, 02215, USA. .,Harvard Medical School, Boston, MA, USA.
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Schettini F, Conte B, Buono G, De Placido P, Parola S, Griguolo G, Fabi A, Bighin C, Riccardi F, Cianniello D, De Laurentiis M, Puglisi F, Pelizzari G, Bonotto M, Russo S, Frassoldati A, Pazzola A, Montemurro F, Lambertini M, Guarneri V, Cognetti F, Locci M, Generali D, Conte P, De Placido S, Giuliano M, Arpino G, Del Mastro L. T-DM1 versus pertuzumab, trastuzumab and a taxane as first-line therapy of early-relapsed HER2-positive metastatic breast cancer: an Italian multicenter observational study. ESMO Open 2021; 6:100099. [PMID: 33819752 PMCID: PMC8047485 DOI: 10.1016/j.esmoop.2021.100099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/06/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background The current standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive (+) metastatic breast cancer is the combination of pertuzumab, trastuzumab and a taxane (P + T + taxane), while standard second-line is ado-trastuzumab-emtansine (T-DM1). The registration trial of pertuzumab, however, did not include early-relapsing patients, defined as patients experiencing tumor relapse ≤12 months from the end of (neo)adjuvant anti-HER2 therapy. Conversely, the pivotal trial of T-DM1 included some patients relapsing ≤6 months after the end of (neo)adjuvant trastuzumab. Thus, a proportion of early-relapsing patients are currently eligible to receive T-DM1 as first-line treatment. Nevertheless, no direct comparison exists between the two regimens in this clinical setting. Patients and methods We retrospectively compared T-DM1 versus P + T + taxane as first-line treatment in two cohorts of early-relapsing patients in an Italian ‘real-world’ setting, involving 14 public health care institutions. The primary endpoint was progression-free survival. Secondary endpoints included patients' characterization, overall survival and post-progression survival. Univariate and multivariate analyses were carried out. All tests were two-sided and a P ≤ 0.05 was considered statistically significant. Results Among 1252 screened patients, 75 met the inclusion criteria. Forty-four (58.7%) received P + T + taxane and 31 (41.3%) received T-DM1. The two cohorts showed similar characteristics of aggressiveness and no significant differences in treatment history. T-DM1, compared with P + T + taxane was associated with worse progression-free survival (adjusted hazard ratio: 2.26, 95% confidence interval: 1.13-4.52, P = 0.021) and overall survival (adjusted hazard ratio: 3.95, 95% confidence interval: 1.38-11.32, P = 0.010), irrespective of previous (neo)adjuvant treatment, age, hormone receptors status, time-to-relapse (≤6 months or within 6-12 months) and presence of visceral/brain metastases. No differences were observed in post-progression survival (P = 0.095). Conclusions Our study suggests superiority for P + T + taxane over T-DM1 as up-front treatment of early-relapsing HER2+ metastatic breast cancer, which merits further assessment in larger and prospective trials. This is the first study comparing pertuzumab + trastuzumab + taxane (P + T + taxane) with T-DM1 in early-relapsing HER2+ MBC. The majority of early-relapsing HER2+ MBC have high-grade, node-positive, large primary tumors. First-line T-DM1 compared with P + T + taxane is associated with worse progression-free survival. First-line T-DM1 compared with P + T + taxane is associated with worse overall survival. Post-progression survival does not differ between the two treatments cohorts.
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Affiliation(s)
- F Schettini
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy; Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain.
| | - B Conte
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G Buono
- Oncology Unit, San Rocco Hospital, Sessa Aurunca, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - S Parola
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Griguolo
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - A Fabi
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - C Bighin
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F Riccardi
- Medical Oncology, 'A. Cardarelli' Hospital, Naples, Italy
| | - D Cianniello
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - M De Laurentiis
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - F Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - G Pelizzari
- Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - M Bonotto
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - S Russo
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - A Frassoldati
- Oncology Unit, University Hospital St. Anna, Ferrara, Italy
| | - A Pazzola
- Division of Medical Oncology, AOU Sassari, Sassari, Italy
| | - F Montemurro
- Depertment of Medical Oncology, Candiolo Cancer Institute, Candiolo, Italy
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - V Guarneri
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - F Cognetti
- Department of Clinic and Molecular Medicine, 'La Sapienza' University of Rome, Rome, Italy
| | - M Locci
- Department of Neuroscience, Reproductive Medicine, Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - D Generali
- Breast Cancer Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - P Conte
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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