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Yap JT, Locascio T, Najita JS, Mayer IA, Hobday TJ, Falkson CI, Dees EC, Gelman RS, Rimawi MF, Nanda R, Berkowitz J, Franchetti Y, Wolff AC, Winer EP, Lin NU, Van den Abbeele AD. P2-09-07: Metabolic Response by FDG-PET in Patients (pts) Receiving Trastuzumab (T) and Lapatinib (L) for HER2+ Metastatic Breast Cancer (MBC): Correlative Analysis of TBCRC 003. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p2-09-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
We evaluated the safety and efficacy of L+T in pts with 0–2 prior lines of chemotherapy (CT) for HER2+ MBC. In the context of this phase II trial, we evaluated metabolic response by FDG-PET and explored the relationship between metabolic response and clinical outcomes.
Methods: Pts with measurable, HER2+ MBC were eligible. Cohort 1: No prior T, L, or CT +T for MBC, and >1 yr from adjuvant T, if received. Cohort 2: 1–2 prior lines of CT for MBC, including T, or relapse within 1 yr of adjuvant T. Pts received L 1,000 mg QD + T (2 mg/kg weekly or 6 mg/kg Q3W). Staging studies were done with CT or MRI at baseline (BL) and every 2 cycles (1 cycle=4 weeks [wks]). Objective response was assessed by local investigator according to RECIST 1.0. FDG-PET/CT was performed at BL, Wk 1, and Wk 8 per NCI guidelines. Central quality assurance, review, and analysis were performed on FDG-PET studies. Up to 5 target lesions were identified on BL FDG-PET images based on hypermetabolic uptake. Percent change in the summed maximum standardized uptake value (SUVmax) of target lesions was calculated at Wk 1 or Wk 8, compared to BL. Metabolic response was assessed according to EORTC criteria for % change in SUVmax (progressive disease [PD]: ≥25% increase; partial response [PR]: ≥25% decrease; stable disease [SD]: <25% change). Metabolic response at Wk 1 was compared to Wk 8 as well as to clinical outcome, including objective response, clinical benefit, and progression-free survival (PFS).
Results: 87 pts were registered to the study. Of these, one pt did not begin protocol therapy and one pt did not have MBC on further testing, and are not included. 81/85 pts had FDG-PET data at Wk 1; 75/85 had data at Wk 8. Metabolic PR at Wk 1 was observed in 28/39 (72%) pts in Cohort 1 and 20/42 (48%) pts in Cohort 2. Metabolic PR at Wk 8 was observed in 27/34 (79%) pts in Cohort 1 and 18/41 (44%) pts in Cohort 2. Wk 1 and Wk 8 metabolic responses were similar. In cohort 1, 18/28 (64%) pts who achieved Wk 1 metabolic PR had clinical benefit by RECIST. Of pts with Wk 1 metabolic SD, 2/9 (22%) had clinical benefit. In cohort 2, 9/20 (45%) pts who achieved Wk 1 metabolic PR had clinical benefit; 5/22 (23%) who achieved Week 1 metabolic SD had clinical benefit. Exploratory analysis of progression-free survival (PFS) showed that pts in Cohort 1 who achieved Wk 1 metabolic PR experienced a median PFS of 9.3 months ([mos]; 95% CI 5.6−22.3); for pts with metabolic SD, median PFS was 1.9 mos (95% CI 0.8−5.5). For pts in Cohort 2, Wk 1 metabolic PR was associated with median PFS of 5.6 mos (95% CI 3.7−7.8), whereas for pts with metabolic SD, median PFS was 3.7 mos (95% CI 1.8−5.5).
Conclusions: L+T is associated with a high rate of early and sustained metabolic response by FDG-PET. Exploratory analyses suggest that metabolic PR may be associated with clinical benefit and longer PFS.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P2-09-07.
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Affiliation(s)
- JT Yap
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - T Locascio
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - JS Najita
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - IA Mayer
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - TJ Hobday
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - CI Falkson
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - EC Dees
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - RS Gelman
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - MF Rimawi
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - R Nanda
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - J Berkowitz
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - Y Franchetti
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - AC Wolff
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - EP Winer
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - NU Lin
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
| | - AD Van den Abbeele
- 1Dana-Farber Cancer Institute, Boston, MA; Vanderbilt-Ingram Cancer Center, Nashville, TN; Mayo Clinic, Rochester, MN; University of Alabama, Birmingham, AL; University of North Carolina at Chapel Hill, Chapel Hill, NC; Baylor College of Medicine, Houston, TX; University of Chicago, Chicago, IL; Johns Hopkins Kimmel Cancer Center, Baltimore, MD
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