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Squifflet P, Saad ED, Loibl S, van Mackelenbergh MT, Untch M, Rastogi P, Gianni L, Schneeweiss A, Conte P, Piccart M, Bonnefoi H, Jackisch C, Nekljudova V, Tang G, Valagussa P, Neate C, Gelber R, Poncet C, Heinzmann D, Denkert C, Geyer CE, Cortes J, Guarneri V, de Azambuja E, Cameron D, Ismael G, Wolmark N, Cortazar P, Buyse M. Re-Evaluation of Pathologic Complete Response as a Surrogate for Event-Free and Overall Survival in Human Epidermal Growth Factor Receptor 2-Positive, Early Breast Cancer Treated With Neoadjuvant Therapy Including Anti-Human Epidermal Growth Factor Receptor 2 Therapy. J Clin Oncol 2023; 41:2988-2997. [PMID: 36977286 DOI: 10.1200/jco.22.02363] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/16/2022] [Accepted: 02/09/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE Pathologic complete response (pCR) has prognostic importance and is frequently used as a primary end point, but doubts remain about its validity as a surrogate for event-free survival (EFS) and overall survival (OS) in human epidermal growth factor receptor 2 (HER2)-positive, early breast cancer. METHODS We obtained individual-patient data from randomized trials of neoadjuvant anti-HER2 therapy that enrolled at least 100 patients, had data for pCR, EFS, and OS, and a median follow-up of at least 3 years. We quantified the patient-level association between pCR (defined as ypT0/Tis ypN0) and both EFS and OS using odds ratios (ORs, with ORs >1.00 indicating a benefit from achieving a pCR). We quantified the trial-level association between treatment effects on pCR and on EFS and OS using R2 (with values above 0.75 considered as indicating strong associations). RESULTS Eleven of 15 eligible trials had data for analysis (3,980 patients, with a median follow-up of 62 months). Considering all trials, we found strong patient-level associations, with ORs of 2.64 (95% CI, 2.20 to 3.07) for EFS and 3.15 (95% CI, 2.38 to 3.91) for OS; however, trial-level associations were weak, with an unadjusted R2 of 0.23 (95% CI, 0 to 0.66) for EFS and 0.02 (95% CI, 0 to 0.17) for OS. We found qualitatively similar results when grouping trials according to different clinical questions, when analyzing only patients with hormone receptor-negative disease, and when using a more stringent definition of pCR (ypT0 ypN0). CONCLUSION Although pCR may be useful for patient management, it cannot be considered as a surrogate for EFS or OS in neoadjuvant trials of HER2-positive, operable breast cancer.
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Affiliation(s)
- Pierre Squifflet
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | - Everardo D Saad
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | | | | | | | | | - Luca Gianni
- San Raffaele Scientific Institute, Milan, Italy
| | | | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Martine Piccart
- Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Hervé Bonnefoi
- Institut Bergonié and Université de Bordeaux INSERM U916, Bordeaux, France
| | | | | | - Gong Tang
- University of Pittsburgh, Pittsburgh, PA
| | | | - Colin Neate
- F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Richard Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health and Frontier Science and Technology Research Foundation, Boston, MA
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Dominik Heinzmann
- Product Development-Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Carsten Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg, Marburg, Germany
| | | | - Javier Cortes
- IOB Institute of Oncology, Quiron Group, Madrid & Barcelona and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Evandro de Azambuja
- Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - David Cameron
- Edinburgh Cancer Research Centre, University of Edinburgh and NHS Lothian, Edinburgh, United Kingdom
| | | | | | | | - Marc Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
- Data Science Institute, I-BioStat, Hasselt University, Hasselt, Belgium
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Abberbock J, Anderson S, Rastogi P, Tang G. Assessment of effect size and power for survival analysis through a binary surrogate endpoint in clinical trials. Stat Med 2019; 38:301-314. [PMID: 30264471 DOI: 10.1002/sim.7981] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Revised: 04/09/2018] [Accepted: 09/04/2018] [Indexed: 01/03/2023]
Abstract
A strategy for early-stage breast cancer trials in recent years consists of a neoadjuvant trial with pathological complete response (pCR) at time of surgery as the efficacy endpoint, followed by the collection of long-term data to show efficacy in survival. To calculate an appropriate sample size to detect a survival difference based upon pCR data, it is necessary to relate the effect size in pCR with the effect size in survival. Here, we propose an exponential mixture model for survival time with parameters for the neoadjuvant pCR rates and an estimated benefit of achieving pCR to determine the treatment effect size. Through simulation studies, we demonstrated how to estimate the empirical power for detecting the survival efficacy under a parameter setting. We also showed a more efficient way to estimate the power for detecting the survival efficacy through estimated average hazard ratios and the Schoenfeld formula. Our method can be used to power future confirmatory adjuvant trials based on the preliminary data obtained from the neoadjuvant component.
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Affiliation(s)
- Judah Abberbock
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pennsylvania
| | - Stewart Anderson
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pennsylvania
| | - Priya Rastogi
- Department of Medicine, University of Pittsburgh, Pennsylvania
| | - Gong Tang
- Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pennsylvania
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DeMichele A, Yee D, Paoloni M, Berry D, Esserman LJ. Neoadjuvant as Future for Drug Development in Breast Cancer--Response. Clin Cancer Res 2016; 22:269. [PMID: 26728411 DOI: 10.1158/1078-0432.ccr-15-1643] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Douglas Yee
- University of Minnesota, Minneapolis, Minnesota
| | - Melissa Paoloni
- QuantumLeap Healthcare Collaborative, San Francisco, California
| | - Don Berry
- University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Laura J Esserman
- University of California, San Francisco, San Francisco, California
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