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Sonnenblick A, de Azambuja E, Agbor-Tarh D, Bradbury I, Campbell C, Huang Y, Dueck AC, Pritchard KI, Wolff AC, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Gomez H, Perez EA, Piccart M, Azim HA. Lapatinib-Related Rash and Breast Cancer Outcome in the ALTTO Phase III Randomized Trial. J Natl Cancer Inst 2016; 108:djw037. [PMID: 27098150 DOI: 10.1093/jnci/djw037] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 02/09/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Previously we have shown that early development of rash is associated with a higher chance of achieving pathological complete response to neoadjuvant lapatinib. In the current analysis, we investigate its impact on survival in the ALTTO phase III adjuvant trial. METHODS In ALTTO, patients with human epidermal growth factor receptor 2 (HER2)-positive early breast cancer were randomly assigned to adjuvant trastuzumab, lapatinib, their sequence, or their combination for a total duration of one year. We evaluated whether the development of early lapatinib-related rash (ie, within 6 weeks) is associated with disease-free (DFS) and overall survival (OS). Landmark analysis at eight weeks and time-dependent analysis were tested in a multivariable model stratifying on trial's stratification factors. All statistical tests were two-sided. RESULTS Out of 6098 lapatinib-treated patients, 3973(65.2%) were included in the landmark analysis, of whom 1389 (35.0%) had developed early rash. After median follow-up of 4.5 years, the development of early rash was associated with a trend of improved DFS (multivariable: hazard ratio [HR] = 0.87, 95% confidence interval [CI] = 0.73 to 1.03,P= .10) and statistically significantly improved OS (multivariable: HR = 0.63, 95% CI = 0.48 to 0.82,P< .001) compared with subjects without early rash. Compared with patients randomly assigned to trastuzumab (n = 2051), patients who were randomly assigned to trastuzumab/lapatinib combination and developed early rash (n = 692) had superior DFS (multivariable: HR = 0.72, 95% CI = 0.55 to 0.92,P= .01) and OS (multivariable: HR = 0.59, 95% CI = 0.39 to 0.90,P= .01). Time-dependent analysis suggests that the occurrence of rash is predictive of lapatinib benefit, both when given in combination or sequential to trastuzumab. CONCLUSIONS Our results indicate that early development of rash identifies patients who derive superior benefit from lapatinib-based therapy.
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Affiliation(s)
- Amir Sonnenblick
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Evandro de Azambuja
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Dominique Agbor-Tarh
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Ian Bradbury
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Christine Campbell
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Yingjie Huang
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Amylou C Dueck
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Kathleen I Pritchard
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Antonio C Wolff
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Christian Jackisch
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Istvan Lang
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Michael Untch
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Ian Smith
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Frances Boyle
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Binghe Xu
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Henry Gomez
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Edith A Perez
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Martine Piccart
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
| | - Hatem A Azim
- Department of Medicine, Breast European Adjuvant Study Team (BrEAST) Data Centre, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium (AS, EdA, MP, HAAJr); Frontier Science (Scotland) Ltd, Grampian View, Kincraig, Kingussie, UK (DAt, IB, CC); Novartis Pharmaceuticals Corporation, East Hanover, NJ (YH); Alliance Statistics and Data Center, Mayo Clinic, Section of Biostatistics, Scottsdale, AZ (ACD); Sunnybrook Odette Cancer Centre, the University of Toronto and the NCIC Clinical Trials Group, Toronto, Ontario, Canada (KIP); The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD (ACW); Sana Klinikum Offenbach, Offenbach, Germany (CJ); National Institute of Oncology, Budapest, Hungary (IL); Helios Klinikum Berlin-Buch, Berlin, Germany (MU); Royal Marsden Hospital NHS Trust, Sutton/Surrey, UK (IS); Patricia Ritchie Centre for Cancer Care and Research, The University of Sydney, Mater Hospital, North Sydney, Australia (FB); Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China (BX); Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru (HG); Mayo Clinic, Jacksonville, FL (EAP)
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