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Paoletti C, Schiavon G, Dolce EM, Darga EP, Carr TH, Geradts J, Hoch M, Klinowska T, Lindemann J, Marshall G, Morgan S, Patel P, Rowlands V, Sathiyayogan N, Aung K, Hamilton E, Patel M, Armstrong A, Jhaveri K, Im SA, Iqbal N, Butt F, Dive C, Harrington EA, Barrett JC, Baird R, Hayes DF. Circulating Biomarkers and Resistance to Endocrine Therapy in Metastatic Breast Cancers: Correlative Results from AZD9496 Oral SERD Phase I Trial. Clin Cancer Res 2018; 24:5860-5872. [PMID: 30082476 DOI: 10.1158/1078-0432.ccr-18-1569] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 07/16/2018] [Accepted: 07/31/2018] [Indexed: 11/16/2022]
Abstract
PURPOSE Common resistance mechanisms to endocrine therapy (ET) in estrogen receptor (ER)-positive metastatic breast cancers include, among others, ER loss and acquired activating mutations in the ligand-binding domain of the ER gene (ESR1LBDm). ESR1 mutational mediated resistance may be overcome by selective ER degraders (SERD). During the first-in-human study of oral SERD AZD9496, early changes in circulating tumor cells (CTCs) and circulating tumor DNA (ctDNA) were explored as potential noninvasive tools, alongside paired tumor biopsies, to assess pharmacodynamics and early efficacy. EXPERIMENTAL DESIGN CTC were enumerated/phenotyped for ER and Ki67 using CellSearch in serial blood draws. ctDNA was assessed for the most common ESR1LBDm by droplet digital PCR (BioRad). RESULTS Before starting AZD9496, 11 of 43 (25%) patients had ≥5 CTC/7.5 mL whole blood (WB), none of whom underwent reduction to <5 CTC/7.5 mL WB on C1D15. Five of 11 patients had baseline CTC-ER+, two of whom had CTC-ER+ reduction. CTC-Ki67 status did not change appreciably. Patients with ≥5 CTC/7.5 mL WB before treatment had worse progression-free survival (PFS) than patients with <5 CTC (P = 0.0003). Fourteen of 45 (31%) patients had ESR1LBDm + ctDNA at baseline, five of whom had ≥2 unique mutations. Baseline ESR1LBDm status was not prognostic. Patients with persistently elevated CTC and/or ESR1LBDm + ctDNA at C1D15 had worse PFS than patients who did not (P = 0.0007). CONCLUSIONS Elevated CTC at baseline was a strong prognostic factor in this cohort. Early on-treatment changes were observed in CTC-ER+ and ESR1LBDm + ctDNA, but not in overall CTC number. Integrating multiple biomarkers in prospective trials may improve outcome prediction and ET resistance mechanisms' identification over a single biomarker.
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Affiliation(s)
- Costanza Paoletti
- University of Michigan Rogel Cancer Center and the Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
| | - Gaia Schiavon
- IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Emily M Dolce
- University of Michigan Rogel Cancer Center and the Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Elizabeth P Darga
- University of Michigan Rogel Cancer Center and the Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - T Hedley Carr
- IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Joseph Geradts
- IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Matthias Hoch
- IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | | | | | - Gayle Marshall
- IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Shethah Morgan
- IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Parul Patel
- IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Vicky Rowlands
- IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | | | - Kimberly Aung
- University of Michigan Rogel Cancer Center and the Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Erika Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, PLLC, Nashville, Tennessee
| | - Manish Patel
- Sarah Cannon Research Institute/Florida Cancer Specialists, Sarasota, Florida
| | - Anne Armstrong
- The Christie NHS Foundation Trust and the University of Manchester, Manchester, United Kingdom
| | - Komal Jhaveri
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | - Nadia Iqbal
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Fouziah Butt
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | - Caroline Dive
- Cancer Research UK Manchester Institute, Manchester, United Kingdom
| | | | - J Carl Barrett
- IMED Biotech Unit, AstraZeneca, Cambridge, United Kingdom
| | - Richard Baird
- Cancer Research UK Cambridge Centre, Cambridge, United Kingdom
| | - Daniel F Hayes
- University of Michigan Rogel Cancer Center and the Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
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