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Marín-Aguilera M, Jares P, Sanfeliu E, Villacampa G, Hernández-Lllán E, Martínez-Puchol AI, Shankar S, González-Farré B, Waks AG, Brasó-Maristany F, Pardo F, Manning DK, Abery JA, Curaba J, Moon L, Gordon O, Galván P, Wachirakantapong P, Castillo O, Nee CM, Blasco P, Senevirathne TH, Sirenko V, Martínez-Sáez O, Aguirre A, Krop IE, Li Z, Spellman P, Metzger Filho O, Polyak K, Michaels P, Puig-Butillé JA, Vivancos A, Matito J, Buckingham W, Perou CM, Villagrasa-González P, Prat A, Parker JS, Paré L. Analytical validation of HER2DX genomic test for early-stage HER2-positive breast cancer. ESMO Open 2024; 9:102903. [PMID: 38452436 PMCID: PMC10937240 DOI: 10.1016/j.esmoop.2024.102903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 02/01/2024] [Accepted: 02/02/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND HER2DX, a multianalyte genomic test, has been clinically validated to predict breast cancer recurrence risk (relapse risk score), the probability of achieving pathological complete response post-neoadjuvant therapy (pCR likelihood score), and individual ERBB2 messenger RNA (mRNA) expression levels in patients with early-stage human epidermal growth factor receptor 2 (HER2)-positive breast cancer. This study delves into the comprehensive analysis of HER2DX's analytical performance. MATERIALS AND METHODS Precision and reproducibility of HER2DX risk, pCR, and ERBB2 mRNA scores were assessed within and between laboratories using formalin-fixed paraffin-embedded (FFPE) tumor tissues and purified RNA. Robustness was appraised by analyzing the impact of tumor cell content and protocol variations including different instruments, reagent lots, and different RNA extraction kits. Variability was evaluated across intratumor biopsies and genomic platforms [RNA sequencing (RNAseq) versus nCounter], and according to protocol variations. RESULTS Precision analysis of 10 FFPE tumor samples yielded a maximal standard error of 0.94 across HER2DX scores (1-99 scale). High reproducibility of HER2DX scores across 29 FFPE tumors and 20 RNAs between laboratories was evident (correlation coefficients >0.98). The probability of identifying score differences >5 units was ≤5.2%. No significant variability emerged based on platform instruments, reagent lots, RNA extraction kits, or TagSet thaw/freeze cycles. Moreover, HER2DX displayed robustness at low tumor cell content (10%). Intratumor variability across 212 biopsies (106 tumors) was <4.0%. Concordance between HER2DX scores from 30 RNAs on RNAseq and nCounter platforms exceeded 90.0% (Cohen's κ coefficients >0.80). CONCLUSIONS The HER2DX assay is highly reproducible and robust for the quantification of recurrence risk, pCR likelihood, and ERBB2 mRNA expression in early-stage HER2-positive breast cancer.
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Affiliation(s)
| | - P Jares
- Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain; Molecular Biology Core, Hospital Clínic Barcelona, Barcelona, Spain
| | - E Sanfeliu
- Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - G Villacampa
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Statistical Unit, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | | | - S Shankar
- Department of Pathology, Center for Advanced Medical Diagnostics, Brigham and Women's Hospital, Boston, USA
| | - B González-Farré
- Pathology Department, Hospital Clínic of Barcelona, Barcelona, Spain
| | - A G Waks
- Department of Pathology, Center for Advanced Medical Diagnostics, Brigham and Women's Hospital, Boston, USA
| | - F Brasó-Maristany
- Scientific Department, Reveal Genomics, S.L., Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - F Pardo
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - D K Manning
- Department of Pathology, Center for Advanced Medical Diagnostics, Brigham and Women's Hospital, Boston, USA
| | - J A Abery
- Eremid Genomic Services, LLC, Kannapolis, USA
| | - J Curaba
- Eremid Genomic Services, LLC, Kannapolis, USA
| | - L Moon
- Eremid Genomic Services, LLC, Kannapolis, USA
| | - O Gordon
- Eremid Genomic Services, LLC, Kannapolis, USA
| | - P Galván
- Scientific Department, Reveal Genomics, S.L., Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - P Wachirakantapong
- Department of Pathology, Center for Advanced Medical Diagnostics, Brigham and Women's Hospital, Boston, USA
| | - O Castillo
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - C M Nee
- Department of Pathology, Center for Advanced Medical Diagnostics, Brigham and Women's Hospital, Boston, USA
| | - P Blasco
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - T H Senevirathne
- Department of Pathology, Center for Advanced Medical Diagnostics, Brigham and Women's Hospital, Boston, USA
| | - V Sirenko
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - O Martínez-Sáez
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain; Medical Oncology Department, Hospital Clinic Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain
| | - A Aguirre
- Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain
| | - I E Krop
- Yale Cancer Center, New Haven, USA
| | - Z Li
- Dana-Farber Cancer Institute, Boston, USA; Harvard Medical School, Boston, USA
| | - P Spellman
- Oregon Health and Science University, Portland, USA
| | - O Metzger Filho
- Department of Pathology, Center for Advanced Medical Diagnostics, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - K Polyak
- Dana-Farber Cancer Institute, Boston, USA; Harvard Medical School, Boston, USA
| | - P Michaels
- Department of Pathology, Center for Advanced Medical Diagnostics, Brigham and Women's Hospital, Boston, USA
| | - J A Puig-Butillé
- Molecular Biology Core, Hospital Clínic Barcelona, Barcelona, Spain
| | - A Vivancos
- Cancer Genomics Core, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Matito
- Scientific Department, Reveal Genomics, S.L., Barcelona, Spain; Cancer Genomics Core, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - W Buckingham
- Scientific Department, Reveal Genomics, S.L., Barcelona, Spain
| | - C M Perou
- Department of Genetics, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | | | - A Prat
- Scientific Department, Reveal Genomics, S.L., Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, IDIBAPS, Barcelona, Spain; Medical Oncology Department, Hospital Clinic Barcelona, Barcelona, Spain; Department of Medicine, University of Barcelona, Barcelona, Spain; Breast Cancer Unit, IOB-Quirón Salud, Barcelona, Spain
| | - J S Parker
- Department of Genetics, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - L Paré
- Scientific Department, Reveal Genomics, S.L., Barcelona, Spain.
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2
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Villacampa G, Tung NM, Pernas S, Paré L, Bueno-Muiño C, Echavarría I, López-Tarruella S, Roche-Molina M, Del Monte-Millán M, Marín-Aguilera M, Brasó-Maristany F, Waks AG, Pascual T, Martínez-Sáez O, Vivancos A, Conte PF, Guarneri V, Vittoria Dieci M, Griguolo G, Cortés J, Llombart-Cussac A, Muñoz M, Vidal M, Adamo B, Wolff AC, DeMichele A, Villagrasa P, Parker JS, Perou CM, Fernandez-Martinez A, Carey LA, Mittendorf EA, Martín M, Prat A, Tolaney SM. Association of HER2DX with pathological complete response and survival outcomes in HER2-positive breast cancer. Ann Oncol 2023; 34:783-795. [PMID: 37302750 PMCID: PMC10735273 DOI: 10.1016/j.annonc.2023.05.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 05/24/2023] [Accepted: 05/25/2023] [Indexed: 06/13/2023] Open
Abstract
BACKGROUND The HER2DX genomic test predicts pathological complete response (pCR) and survival outcome in early-stage HER2-positive (HER2+) breast cancer. Here, we evaluated the association of HER2DX scores with (i) pCR according to hormone receptor status and various treatment regimens, and (ii) survival outcome according to pCR status. MATERIALS AND METHODS Seven neoadjuvant cohorts with HER2DX and clinical individual patient data were evaluated (DAPHNe, GOM-HGUGM-2018-05, CALGB-40601, ISPY-2, BiOnHER, NEOHER and PAMELA). All patients were treated with neoadjuvant trastuzumab (n = 765) in combination with pertuzumab (n = 328), lapatinib (n = 187) or without a second anti-HER2 drug (n = 250). Event-free survival (EFS) and overall survival (OS) outcomes were available in a combined series of 268 patients (i.e. NEOHER and PAMELA) with a pCR (n = 118) and without a pCR (n = 150). Cox models were adjusted to evaluate whether HER2DX can identify patients with low or high risk beyond pCR status. RESULTS HER2DX pCR score was significantly associated with pCR in all patients [odds ratio (OR) per 10-unit increase = 1.59, 95% confidence interval 1.43-1.77; area under the ROC curve = 0.75], with or without dual HER2 blockade. A statistically significant increase in pCR rate due to dual HER2 blockade over trastuzumab-only was observed in HER2DX pCR-high tumors treated with chemotherapy (OR = 2.36 (1.09-5.42). A statistically significant increase in pCR rate due to multi-agent chemotherapy over a single taxane was observed in HER2DX pCR-medium tumors treated with dual HER2 blockade (OR = 3.11, 1.54-6.49). The pCR rates in HER2DX pCR-low tumors were ≤30.0% regardless of treatment administered. After adjusting by pCR status, patients identified as HER2DX low-risk had better EFS (P < 0.001) and OS (P = 0.006) compared with patients with HER2DX high-risk. CONCLUSIONS HER2DX pCR score and risk score might help identify ideal candidates to receive neoadjuvant dual HER2 blockade in combination with a single taxane in early-stage HER2+ breast cancer.
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Affiliation(s)
- G Villacampa
- SOLTI Breast Cancer Research Group, Barcelona; Oncology Data Science, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - S Pernas
- Medical Oncology Department, Catalan Institute of Oncology, L'Hospitalet de Llobregat, Barcelona
| | - L Paré
- Reveal Genomics, Barcelona
| | - C Bueno-Muiño
- Medical Oncology Department, Hospital Infanta Cristina (Parla), Fundación de Investigación Biomédica del H.U. Puerta de Hierro, Majadahonda, Madrid
| | - I Echavarría
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid
| | - S López-Tarruella
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid
| | - M Roche-Molina
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid
| | - M Del Monte-Millán
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid
| | | | - F Brasó-Maristany
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A G Waks
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston, USA
| | - T Pascual
- SOLTI Breast Cancer Research Group, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - O Martínez-Sáez
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A Vivancos
- Cancer Genomics Group, VHIO, Barcelona, Spain
| | - P F Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - M Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - G Griguolo
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - J Cortés
- International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona
| | - A Llombart-Cussac
- Arnau de Vilanova Hospital, Universidad Católica de Valencia, Valencia, Spain
| | - M Muñoz
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - M Vidal
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - B Adamo
- Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain
| | - A C Wolff
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore
| | - A DeMichele
- Department of Oncology, University of Pennsylvania, Philadelphia
| | | | - J S Parker
- Lineberger Comprehensive Cancer Center, Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill
| | - C M Perou
- Lineberger Comprehensive Cancer Center, Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill
| | - A Fernandez-Martinez
- Lineberger Comprehensive Cancer Center, Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill
| | - L A Carey
- Lineberger Comprehensive Cancer Center, Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill
| | - E A Mittendorf
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston, USA; Division of Breast Surgery, Department of Surgery, Brigham and Women's Hospital, Boston, USA
| | - M Martín
- Department of Medical Oncology, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CiberOnc, Madrid
| | - A Prat
- Reveal Genomics, Barcelona; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona; Department of Medical Oncology, Hospital Clinic of Barcelona, Barcelona, Spain; Institute of Oncology (IOB)-Quirón, Barcelona, Spain.
| | - S M Tolaney
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Institute of Oncology (IOB)-Quirón, Barcelona, Spain.
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3
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Waks AG, Cohen O, Kochupurakkal B, Kim D, Dunn CE, Buendia Buendia J, Wander S, Helvie K, Lloyd MR, Marini L, Hughes ME, Freeman SS, Ivy SP, Geradts J, Isakoff S, LoRusso P, Adalsteinsson VA, Tolaney SM, Matulonis U, Krop IE, D'Andrea AD, Winer EP, Lin NU, Shapiro GI, Wagle N. Reversion and non-reversion mechanisms of resistance to PARP inhibitor or platinum chemotherapy in BRCA1/2-mutant metastatic breast cancer. Ann Oncol 2020; 31:590-598. [PMID: 32245699 DOI: 10.1016/j.annonc.2020.02.008] [Citation(s) in RCA: 97] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/05/2020] [Accepted: 02/12/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Little is known about mechanisms of resistance to poly(adenosine diphosphate-ribose) polymerase inhibitors (PARPi) and platinum chemotherapy in patients with metastatic breast cancer and BRCA1/2 mutations. Further investigation of resistance in clinical cohorts may point to strategies to prevent or overcome treatment failure. PATIENTS AND METHODS We obtained tumor biopsies from metastatic breast cancer patients with BRCA1/2 deficiency before and after acquired resistance to PARPi or platinum chemotherapy. Whole exome sequencing was carried out on each tumor, germline DNA, and circulating tumor DNA. Tumors underwent RNA sequencing, and immunohistochemical staining for RAD51 foci on tumor sections was carried out for functional assessment of intact homologous recombination (HR). RESULTS Pre- and post-resistance tumor samples were sequenced from eight patients (four with BRCA1 and four with BRCA2 mutation; four treated with PARPi and four with platinum). Following disease progression on DNA-damaging therapy, four patients (50%) acquired at least one somatic reversion alteration likely to result in functional BRCA1/2 protein detected by tumor or circulating tumor DNA sequencing. Two patients with germline BRCA1 deficiency acquired genomic alterations anticipated to restore HR through increased DNA end resection: loss of TP53BP1 in one patient and amplification of MRE11A in another. RAD51 foci were acquired post-resistance in all patients with genomic reversion, consistent with reconstitution of HR. All patients whose tumors demonstrated RAD51 foci post-resistance were intrinsically resistant to subsequent lines of DNA-damaging therapy. CONCLUSIONS Genomic reversion in BRCA1/2 was the most commonly observed mechanism of resistance, occurring in four of eight patients. Novel sequence alterations leading to increased DNA end resection were seen in two patients, and may be targetable for therapeutic benefit. The presence of RAD51 foci by immunohistochemistry was consistent with BRCA1/2 protein functional status from genomic data and predicted response to later DNA-damaging therapy, supporting RAD51 focus formation as a clinically useful biomarker.
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Affiliation(s)
- A G Waks
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Broad Institute of MIT and Harvard, Cambridge, USA; Harvard Medical School, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - O Cohen
- Broad Institute of MIT and Harvard, Cambridge, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - B Kochupurakkal
- Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA
| | - D Kim
- Broad Institute of MIT and Harvard, Cambridge, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - C E Dunn
- Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA
| | - J Buendia Buendia
- Broad Institute of MIT and Harvard, Cambridge, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - S Wander
- Broad Institute of MIT and Harvard, Cambridge, USA; Harvard Medical School, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA; Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA
| | - K Helvie
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - M R Lloyd
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; University of Massachusetts Medical School, Worcester, USA
| | - L Marini
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA
| | - M E Hughes
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - S S Freeman
- Broad Institute of MIT and Harvard, Cambridge, USA
| | - S P Ivy
- Investigational Drug Branch, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, USA
| | - J Geradts
- City of Hope Comprehensive Cancer Center, Duarte, USA
| | - S Isakoff
- Harvard Medical School, Boston, USA; Massachusetts General Hospital Cancer Center and Department of Medicine, Harvard Medical School, Boston, USA
| | | | | | - S M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - U Matulonis
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - I E Krop
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - A D D'Andrea
- Harvard Medical School, Boston, USA; Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA; Department of Radiation Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, USA
| | - E P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - N U Lin
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA
| | - G I Shapiro
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Harvard Medical School, Boston, USA; Center for DNA Damage and Repair, Dana-Farber Cancer Institute, Boston, USA
| | - N Wagle
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Department of Medicine, Brigham and Women's Hospital, Boston, USA; Broad Institute of MIT and Harvard, Cambridge, USA; Harvard Medical School, Boston, USA; Center for Cancer Precision Medicine, Dana-Farber Cancer Institute, Boston, USA.
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4
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Mayer EL, DeMichele A, Rugo HS, Miller K, Waks AG, Come SE, Mulvey T, Jeselsohn R, Overmoyer B, Guo H, Barry WT, Huang Bartlett C, Koehler M, Winer EP, Burstein HJ. A phase II feasibility study of palbociclib in combination with adjuvant endocrine therapy for hormone receptor-positive invasive breast carcinoma. Ann Oncol 2019; 30:1514-1520. [PMID: 31250880 DOI: 10.1093/annonc/mdz198] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND The CDK4/6 inhibitor palbociclib prolongs progression-free survival in hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer when combined with endocrine therapy. This phase II trial was designed to determine the feasibility of adjuvant palbociclib and endocrine therapy for early breast cancer. PATIENTS AND METHODS Eligible patients with HR+/HER2- stage II-III breast cancer received 2 years of palbociclib at 125 mg daily, 3 weeks on/1 week off, with endocrine therapy. The primary end point was discontinuation from palbociclib due to toxicity, non-adherence, or events related to tolerability. A discontinuation rate of 48% or higher would indicate the treatment duration of 2 years was not feasible, and was evaluated under a binomial test using a one-sided α = 0.025. RESULTS Overall, 162 patients initiated palbociclib; over half had stage III disease (52%) and most received prior chemotherapy (80%). A total of 102 patients (63%) completed 2 years of palbociclib; 50 patients discontinued early for protocol-related reasons (31%, 95% CI 24% to 39%, P = 0.001), and 10 discontinued due to protocol-unrelated reasons. The cumulative incidence of protocol-related discontinuation was 21% (95% CI 14% to 27%) at 12 months from start of treatment. Rates of palbociclib-related toxicity were congruent with the metastatic experience, and there were no cases of febrile neutropenia. Ninety-one patients (56%) required at least one dose reduction. CONCLUSION Adjuvant palbociclib is feasible in early breast cancer, with a high proportion of patients able to complete 2 years of therapy. The safety profile in the adjuvant setting mirrors that observed in metastatic disease, with approximately half of the patients requiring dose-modification. As extended duration adjuvant palbociclib appears feasible and tolerable for most patients, randomized phase III trials are evaluating clinical benefit in this population. CLINICALTRIALS.GOV REGISTRATION NCT02040857.
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Affiliation(s)
- E L Mayer
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston.
| | - A DeMichele
- Division of Hematology and Oncology, University of Pennsylvania Abramson Cancer Center, Philadelphia
| | - H S Rugo
- Division of Hematology and Medical Oncology, University of California San Francisco Helen Diller Comprehensive Cancer Center, San Francisco
| | - K Miller
- Division of Hematology/Oncology, Indiana University Melvin and Bren Simon Cancer Center, Indianapolis
| | - A G Waks
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - S E Come
- Division of Hematology and Oncology, Beth Israel Deaconess Medical Center, Boston
| | - T Mulvey
- Division of Hematology and Oncology, Massachusetts General Hospital Cancer Center, Boston
| | - R Jeselsohn
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - B Overmoyer
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - H Guo
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston
| | - W T Barry
- Division of Biostatistics, Department of Data Sciences, Dana-Farber Cancer Institute, Boston
| | | | | | - E P Winer
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - H J Burstein
- Susan F. Smith Center for Women's Cancers, Department of Medical Oncology, Dana-Farber Cancer Institute, Boston
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5
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Metzger Filho O, Janiszewska M, Guo H, Yardley D, Mayer I, Spring L, Arteaga C, Wrabel E, DeMeo M, Freedman R, Tolaney S, Waks A, Bardia A, Parsons H, Partridge A, Mayer E, King T, Polyak K, Viale G, Winer E, Krop I. Abstract P1-15-01: Withdrawn. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-15-01] [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
This abstract was withdrawn by the authors.
Citation Format: Metzger Filho O, Janiszewska M, Guo H, Yardley D, Mayer I, Spring L, Arteaga C, Wrabel E, DeMeo M, Freedman R, Tolaney S, Waks A, Bardia A, Parsons H, Partridge A, Mayer E, King T, Polyak K, Viale G, Winer E, Krop I. Withdrawn [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-15-01.
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Affiliation(s)
- O Metzger Filho
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - M Janiszewska
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - H Guo
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - D Yardley
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - I Mayer
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - L Spring
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - C Arteaga
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - E Wrabel
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - M DeMeo
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - R Freedman
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - S Tolaney
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - A Waks
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - A Bardia
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - H Parsons
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - A Partridge
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - E Mayer
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - T King
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - K Polyak
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - G Viale
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - E Winer
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
| | - I Krop
- Dana-Farber Cancer Institute, Boston; Sarah Cannon Research Institute, Nashville; Vanderbilt University, Nashville; Massachusetts General Hospital, Boston; UT Southwestern, Dallas; European Institute of Oncology, Milan, Italy
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Cohen O, Buendia-Buendia J, Wander S, Nayar U, Mao P, Waks A, Kim D, Freeman S, Adalsteinsson V, Helvie K, Livitz D, Rosebrock D, Leshchiner I, Dellostritto L, Garrido-Castro A, Jain E, Periyasamy S, Mackichan C, Lloyd M, Marini L, Krop I, Garraway L, Getz G, Winer E, Lin N, Wagle N. Abstract PD9-02: Evolutionary analysis of 462 serial metastatic biopsies from 208 patients with estrogen receptor-positive (ER+) metastatic breast cancer (MBC) using whole exome sequencing (WES). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd9-02] [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: While great strides have been made in the treatment of ER+ MBC, therapeutic resistance is nearly universal. The genomic evolution of ER+ breast cancer in the metastatic setting under the selective pressure of multiple lines of therapies is not well understood. To address this, we analyzed the clonal dynamics of serial metastatic samples (mets) to evaluate how tumors evolve and to identify acquired resistance mechanisms.
Methods: We performed WES on 462 clinically annotated samples from 208 patients (pts) with ER+ MBC, including 67 primary tumor biopsies, 229 metastatic biopsies and 160 blood samples (cfDNA). Pts with multiple mets included cases with temporally concordant metastatic tumor and blood samples (48 pts) and cases with serial mets obtained over the course of treatment in the metastatic setting (69 pts). Treatments given between the serial mets included CDK4/6 inhibitors (23 pts), and selective estrogen receptor degraders (19 pts), among others.
Results: In the temporally-concordant mets, we found that cfDNA mutations (muts) largely overlap with muts found in tumor biopsies, capturing >85% of clonal tumor muts. However, we observed a higher level of heterogeneity in cfDNA compared to biopsies (p.value< 1.05e-19, Welch test) and a subset of high-confidence muts that were only detected in cfDNA, including in clinically important genes such as ESR1, PIK3CA, KRAS, and ERBB2. Analysis of serial mets was used to elucidate the evolutionary dynamics within the metastatic setting under the selective pressure of treatment. The median duration between mets was 112 days and the median number of inter-biopsy unique treatments was two. Most tumors continued to evolve within the metastatic setting, with 50 out of 69 pts (72%) acquiring a meaningful sub-clone (50% increase in relative cancer cell fraction) and 31 out of 69 (45%) acquiring muts in known cancer genes, including a subset acquiring a plausible resistance alteration such as alterations that dysregulate ER (5 out of 69 pts, 7%; ESR1 mut, FOXA1 amplification (amp), NCOR1 bi-allelic deletion (del)), ERBB (4%; ERBB2 amp, ERBB3 mut), RAS (4%; KRAS mut, NRAS amp, NF1 del), FGF/FGFR (12%; FGFR2 mut, FGFR1/2 amp, FGF3 amp), and cell cycle (13%; RB1 del, CDK4 amp, AURKA amp, CDKN2A del). Finally, in pts who had multiple mets, we observed several cases of evolutionary convergence toward equivalent resistance mechanisms including convergent RB1 loss as a mechanism of resistance to a CDK4/6 inhibitor and convergent BRCA2 reversion following resistance to a PARP inhibitor.
Conclusions: This study demonstrates that ER+ MBC continues to evolve under the selective pressure of treatments in the metastatic setting. These findings elucidate the challenge of studying high complexity and heavily treated tumors, while also highlighting some commonalities in the evolutionary trajectories selected by these treatments. The multiplicity of clinically relevant genomic alterations acquired in these advanced stages highlights the need for serial biopsies and the potential to inform post-progression therapeutic choices through targeting the acquired dependencies in post-progression tumors.
Citation Format: Cohen O, Buendia-Buendia J, Wander S, Nayar U, Mao P, Waks A, Kim D, Freeman S, Adalsteinsson V, Helvie K, Livitz D, Rosebrock D, Leshchiner I, Dellostritto L, Garrido-Castro A, Jain E, Periyasamy S, Mackichan C, Lloyd M, Marini L, Krop I, Garraway L, Getz G, Winer E, Lin N, Wagle N. Evolutionary analysis of 462 serial metastatic biopsies from 208 patients with estrogen receptor-positive (ER+) metastatic breast cancer (MBC) using whole exome sequencing (WES) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr PD9-02.
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Affiliation(s)
- O Cohen
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - J Buendia-Buendia
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - S Wander
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - U Nayar
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - P Mao
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - A Waks
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - D Kim
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - S Freeman
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - V Adalsteinsson
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - K Helvie
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - D Livitz
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - D Rosebrock
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - I Leshchiner
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - L Dellostritto
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - A Garrido-Castro
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - E Jain
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - S Periyasamy
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - C Mackichan
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - M Lloyd
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - L Marini
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - I Krop
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - L Garraway
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - G Getz
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - E Winer
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - N Lin
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
| | - N Wagle
- Broad Institute of MIT and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA; Brigham and Women's Hospital, Boston, MA; Massachusetts General Hospital Cancer Center, Charlestown, MA
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7
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Waks AG, Stover DG, Barry W, Dillon D, Gjini E, Rodig SJ, Brock J, Baltay M, Savoie J, Winer EP, Krop I, Tolaney SM. Abstract PD6-09: The immune microenvironment in hormone receptor-positive breast cancer patients and relationship to treatment outcome following preoperative chemotherapy plus bevacizumab. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd6-09] [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: Hormone receptor-positive (HR+) tumors have fewer tumor-infiltrating lymphocytes (TILs) and lower response rates to immune checkpoint inhibitors (ICI), either as single agents or in combination with chemotherapy, than triple negative cancers. However, some HR+ cancers do respond to ICI and biomarkers that accurately reflect the immune microenvironment may help guide the use of ICI therapy. Prior evidence suggests that macrophage-related immune pathways may be relevant to the pathophysiology of HR+ BC.
Methods: HR+/HER2- patients were identified from a prospective trial of preoperative bevacizumab (preop bev) followed by bev with adriamycin/cyclophosphamide/paclitaxel dose-dense chemotherapy (chemo). Tumor samples were collected at diagnosis and surgery (pre-tx and post-tx), and PD-L1 expression (by immunohistochemistry), TILs, and Nanostring PanCancer Immune Profiling Panel were evaluated on both pre-tx and post-tx specimens. Pre-tx whole transcriptome sequencing was performed. Pathologic response at surgery was centrally assessed by Miller-Payne (MP) and residual cancer burden (RCB) scores. An immune score was calculated for each pre-tx specimen by integrating 10 published immune signatures. Immune cell subsets were inferred from bulk transcriptional data using CIBERSORT and immune cell-specific signatures from MSigDB.
Results: 55 patients who received trial therapy and had at least 1 evaluable specimen were included for analysis. Pre-tx TILs and tumor PD-L1 (tPD-L1) scores are shown in the table. 18% of pre-tx tumors had “high” (≥10%) TILs and “high” TILs were associated with significantly higher immune signature score (p=0.004). Immune score correlated highly with proportion of CIBERSORT anti-tumor M1 macrophages as well as CD8 T-cell signatures (r>0.65 and p<0.001). Higher pre-tx TILs, tPD-L1, or immune score were each significantly associated with more favorable RCB and MP in unadjusted analyses (all Spearman p<0.01 for pathologic markers; ANOVA p<0.04 for immune score). After adjustment for age and tumor grade, higher pre-tx TILs and tPD-L1 were associated with favorable RCB (p<0.01 for both), and higher pre-tx tPD-L1 correlated with favorable MP (p=0.03). Pathologic complete response occurred in 4 pts; all 4 had high pre-tx TILs, pre-tx tPD-L1, or both. Among patients with residual disease, large changes (>5%) in TILs or tPD-L1 from pre-tx to post-tx were rare: 2 pts each had large changes in TIL or tPD-L1 score (N=38/N=31 pairs, respectively).
Conclusions: High levels of tumor-lymphocyte interaction were seen in only a minority of untreated HR+ breast tumors, and did not typically change with chemo plus bev. An immune score derived from bulk RNAseq correlated with histological observations in these specimens. Nonetheless, TILs, tPD-L1, and signature-derived immune score were significantly associated with pathologic response to preop treatment in HR+ disease. Early data suggest that the role of M1 macrophages in HR+ tumors warrants further investigation.
ScoreTILs (N=50 evaluable)Tumor PD-L1 (N=51)0%0 pts (0%)28 pts (55%)>0-5% (low)19 (38%)18 (35%)>5-10% (intermediate)22 (44%)3 (6%)>10% (high)9 (18%)2 (4%)
Citation Format: Waks AG, Stover DG, Barry W, Dillon D, Gjini E, Rodig SJ, Brock J, Baltay M, Savoie J, Winer EP, Krop I, Tolaney SM. The immune microenvironment in hormone receptor-positive breast cancer patients and relationship to treatment outcome following preoperative chemotherapy plus bevacizumab [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD6-09.
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Affiliation(s)
- AG Waks
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - DG Stover
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - W Barry
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - D Dillon
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - E Gjini
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - SJ Rodig
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - J Brock
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - M Baltay
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - J Savoie
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - I Krop
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
| | - SM Tolaney
- Dana-Farber Cancer Institute, Boston, MA; Brigham and Women's Hospital, Boston, MA
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Mayer EL, DeMichele AM, Guo H, Miller KD, Rugo HS, Schneider B, Waks AG, Come SE, Mulvey T, Huang Bartlett C, Koehler M, Barry W, Winer EP, Burstein HJ. Abstract PD5-06: Adjuvant palbociclib plus endocrine therapy for hormone receptor positive/HER2 negative breast cancer: A phase II feasibility study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd5-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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:
The CDK4/6 inhibitor palbociclib (P) combined with endocrine therapy (ET) prolongs progression-free survival in previously untreated and treated hormone receptor positive/HER2 negative (HR+/HER2-) metastatic breast cancer (MBC). The most common toxicity with P is neutropenia, typically non-cumulative and uncomplicated. Given observed benefits of P in metastatic BC, this single arm phase II trial was designed to determine the feasibility and toxicity of combination adjuvant P and ET for HR+/HER2- early BC (EBC).
Methods:
Eligible patients (pts) had HR+/HER2- stage II (not T2N0)-III EBC, with prior completion of 3-24 mo of ET (either AI or tamoxifen) without significant adverse events (AE). Pts received P at 125 mg daily, 3 wk on/1 wk off in a 28d cycle, plus continuous ET, for planned duration 2 yrs. Pts were removed from study for toxicity, non-adherence, or other events related to tolerability; pts who recurred or completed 2 yrs of therapy were censored for the primary endpoint. The primary objective was to evaluate the treatment discontinuation rate at 2 yrs; a rate of >50%, would indicated a non-feasible treatment duration (null hypothesis). Discontinuation rates at 2 yrs are estimated by Kaplan Meier with 95% confidence bands. A sample size of 160 pts provided 92% power to reject the null hypothesis using a one-sided alpha = 0.025 if the true rate of discontinuation is <33.3%, and accounting for a censoring rate of up to 20% over the 2 yrs. Secondary endpoints include toxicity, adherence, QOL, and pharmacogenomics.
Results:
Between 3/2014 and 11/2015, 162 pts initiated P; the majority had stage III EBC (52%) and received prior chemotherapy (63%). As of 05/2017, 120 (74%) have completed at least 1 yr of P + ET, and 50 (31%) have completed 2 yrs of P + ET. Early discontinuation of protocol treatment was reported for 59 pts (36%), including 49 events (30%) related to protocol-mandated (9%) and non-mandated (21%) tolerability. The cumulative rate of all discontinuations was 15.1% at 6 mos, 20.9% at 12 mos and 27.8% at 18 mos. Half of all non-mandated discontinuations occurred within the first 6 mos of initiation of therapy, and the rate decreased with greater provider and pt education. Median duration of pts still on treatment is 20 mos (inter-quartile range: 18 to 21 mos). The rate of grade 3/4 neutropenia was 77%, with 0 cases of febrile neutropenia. Other common all-grade P-related AE > 20% included fatigue 65%, alopecia 25%, mucositis 24%, and anemia 24%. 32% of pts required one dose reduction, 16% required two. There have been 2 BC recurrence events and 1 chemotherapy-related AML. Updated data for the primary analysis of feasibility and tolerability, as well as pharmacogenomics, QOL, and adherence, will be presented.
Conclusions:
In this single arm phase II trial, the majority of pts have completed at least 1 year of adjuvant P + ET therapy, with no new toxicity signals. Non-protocol discontinuations have decreased with education. Updated results for the primary analysis will be presented. As in the MBC setting, extended duration palbociclib appears feasible and tolerable for most pts. The efficacy of 2 years of P and ET will be addressed by the phase III PALLAS trial (NCT NCT02513394).
Citation Format: Mayer EL, DeMichele AM, Guo H, Miller KD, Rugo HS, Schneider B, Waks AG, Come SE, Mulvey T, Huang Bartlett C, Koehler M, Barry W, Winer EP, Burstein HJ. Adjuvant palbociclib plus endocrine therapy for hormone receptor positive/HER2 negative breast cancer: A phase II feasibility study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD5-06.
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Affiliation(s)
- EL Mayer
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - AM DeMichele
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - H Guo
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - KD Miller
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - HS Rugo
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - B Schneider
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - AG Waks
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - SE Come
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - T Mulvey
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - C Huang Bartlett
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - M Koehler
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - W Barry
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
| | - HJ Burstein
- Dana-Farber Cancer Institute, Boston, MA; University of Pennsylvania Abramson Cancer Center, Philadelphia, PA; Indiana University Melvin and Bren Simon Cancer Center, Indianapolis, IA; University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA; Beth Israel Deaconness Medical Center, Boston, MA; Massachusetts General Hospital Cancer Center, Boston, MA; Pfizer Inc, New York, NY
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Cohen O, Kim D, Oh C, Waks A, Oliver N, Helvie K, Marini L, Rotem A, Lloyd M, Stover D, Adalsteinsson V, Freeman S, Ha G, Cibulskis C, Anderka K, Tamayo P, Johannessen C, Krop I, Garraway L, Winer E, Lin N, Wagle N. Abstract S1-01: Whole exome and transcriptome sequencing of resistant ER+ metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-s1-01] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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: While great strides have been made in the treatment of estrogen receptor-positive (ER+) metastatic breast cancer (MBC), therapeutic resistance invariably occurs. A better understanding of the underlying resistance mechanisms is critical to enable durable control of this disease.
Methods: We performed whole exome sequencing (WES) and transcriptome sequencing (RNA-seq) on metastatic tumor biopsies from 88 patients with ER+ MBC who had developed resistance to one or more ER-directed therapies. For 27 of these patients, we sequenced the treatment-naïve primary tumors for comparison to the resistant specimens. Tumors were analyzed for point mutations, insertions/deletions, copy number alterations, translocations, and gene expression. Detailed clinicopathologic data was collected for each patient and linked to the genomic information.
Results: WES of all metastatic samples demonstrated several recurrently altered genes whose incidence differed significantly from primary, treatment-naïve ER+ breast cancers sequenced in the TCGA study (TCGA). These include ESR1 mutations (n=17, 19.3%; 32.86 fold enrichment, q.value<7.5e-12), CCND1 amplification (n=52, 59.1%; 2.3 fold enrichment, q.value<0.0073), and MAP2K4 biallelic inactivation (n=14, 15.9%; 3.04 fold enrichment, q.value< 0.054).
Comparing to matched primary samples from the same patient, many alterations were found to be acquired in several cases, including for ESR1, ERBB2, PIK3CA, PTEN, RB1, AKT1, and others. Initial analysis of RNA-seq data from metastatic samples (n=59) allowed classification of individual resistance mechanisms into broader resistance modes based on the observed transcriptional state.
Conclusions: We present a genomic landscape of resistant ER+ MBC using WES and RNA-seq. Multiple genes were recurrently altered in these tumors at significantly higher rates than in ER+ primary breast cancer. When compared with matched primary tumors from the same patient, alterations in these and other genes were often found to be acquired after treatment, suggesting a role in resistance to ER-directed therapies and/or metastasis. Potential resistance mechanisms appear to fall into several categories; integrating RNA-seq data may enhance the ability to identify these categories even when genomic alterations are not identified. Multiple clinically relevant genomic and molecular alterations are identified in metastatic biopsies– with implications for choice of next therapy, clinical trial eligibility, and novel drug targets.
Citation Format: Cohen O, Kim D, Oh C, Waks A, Oliver N, Helvie K, Marini L, Rotem A, Lloyd M, Stover D, Adalsteinsson V, Freeman S, Ha G, Cibulskis C, Anderka K, Tamayo P, Johannessen C, Krop I, Garraway L, Winer E, Lin N, Wagle N. Whole exome and transcriptome sequencing of resistant ER+ metastatic breast cancer [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr S1-01.
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Affiliation(s)
- O Cohen
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D Kim
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - C Oh
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - A Waks
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - N Oliver
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - K Helvie
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - L Marini
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - A Rotem
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - M Lloyd
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - D Stover
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - V Adalsteinsson
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - S Freeman
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - G Ha
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - C Cibulskis
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - K Anderka
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - P Tamayo
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - C Johannessen
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - I Krop
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - L Garraway
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - E Winer
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - N Lin
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
| | - N Wagle
- Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge, MA; Dana-Farber Cancer Institute, Boston, MA
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Stover DG, Waks AG, Erica ML, Brugge JS, Winer EP, Selfors LM. Abstract P3-07-31: Immune activation signatures identify a subset of ER+ breast cancers with increased pathologic complete response to neoadjuvant chemotherapy. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p3-07-31] [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: Proliferation is the strongest predictor of response to neoadjuvant chemotherapy in estrogen receptor-positive (ER+) breast cancer. Evidence of immune activation has also been associated with improved response to neoadjuvant chemotherapy in breast cancer. We hypothesized that immune signatures may be associated with response independent of proliferation in ER+ breast cancers.
Approach: We compiled microarray expression data from breast cancer biopsies obtained prior to neoadjuvant chemotherapy on 465 ER-positive/HER2-negative patients by reported pathologic receptor status. We evaluated the association of 118 published gene expression signatures with response to neoadjuvant chemotherapy, based on study-defined pathologic complete response (pCR) versus residual disease (RD).
Results: Overall, 42 of 118 signatures were significantly associated with response to neoadjuvant chemotherapy in ER+ breast cancer (FDR-corrected p<0.05, simple logistic regression). Of those signatures that achieved significance, 52% (22/42) of signatures were proliferation-associated based on correlation to the 11-gene PAM50 proliferation index (Pearson's R2>0.30, p<1e-10). Among signatures that were NOT proliferation-associated, 50% (10/20) were immune-related. Using unsupervised hierarchical clustering of all 118 signatures, these ten immune signatures formed a distinct cluster. Of the 10 signatures, nine were designed to reflect "immune activation" and were highly correlated with each other in ER+ tumors (R2>0.4, p<0.001). The mean of each of these nine signatures was significantly higher in patients with pCR versus RD (FDR-corrected p<0.05, t-test). Patients with higher "immune activation" signatures had increased likelihood of pCR within multiple subgroups of ER+ breast cancer, including luminal B and non-luminal PAM50 subgroups, as well as intermediate- and high-proliferation ER+ breast cancers. For luminal A or low-proliferation breast cancers, "immune activation" signatures were not significantly associated with response, though very few patients achieved pCR in these two subgroups.
Conclusions: Gene expression signatures associated with "immune activation" identify a subset of ER+ breast cancers with higher rates of pCR to neoadjuvant chemotherapy. These "immune activation" signatures appear to be proliferation-independent and may provide additional predictive information to existing gene expression-based approaches for ER+ breast cancer.
Citation Format: Stover DG, Waks AG, Erica ML, Brugge JS, Winer EP, Selfors LM. Immune activation signatures identify a subset of ER+ breast cancers with increased pathologic complete response to neoadjuvant chemotherapy. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P3-07-31.
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Affiliation(s)
- DG Stover
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - AG Waks
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - ML Erica
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - JS Brugge
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - EP Winer
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
| | - LM Selfors
- Dana-Farber Cancer Institute, Boston, MA; Harvard Medical School, Boston, MA
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Rat P, Waks A, Dutot M, De Moucheron B, Laprévote O, Warnet J. Beta-Amyloid induces toxic degenerative pathways on human retinal cells with P2X7 cell death receptor activation: Role in Age-Related Macular Degeneration (AMD). Toxicol Lett 2011. [DOI: 10.1016/j.toxlet.2011.05.819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
This paper addresses the problem of region identification in sequential brain sections and presents a recognition system that finds and tracks region boundaries in those sections. The characteristics of the areas of interest are unique in one sense because they are not stationary. Some regions are hardly discernible. In others, parts of the boundary are missing or so completely blurred that parts of the background may be considered as an extension of the region itself. Moreover, outliers are likely to exist in many cases. Due to the unique properties of brain regions, the emphasis is on robustification and efficiency. The region segmentation problem was expressed as a multi-hypothesis test seeking boundaries that maximize a performance criterion which is general in terms of blur and noise. Boundary candidates are restricted to an adaptive search area around a reference boundary which is usually the outcome of the algorithm from the previous section. The search for the maximum criterion uses a fast first order dynamic programing (DP) procedure, reducing the processing time. Outlier rejection techniques are integrated with the multi-hypothesis test to compensate for both outliers and noise. The result is the reference for the next section. Experimental results on boundary detection are presented. The algorithm is successful in tracing boundaries when the contrast is smaller than the noise power, and when parts of the outlines are missing.
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Affiliation(s)
- A Waks
- Image Processing Center, Drexel University, Philadelphia, PA 19104
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Dornfeld LP, Maxwell MH, Waks A, Tuck M. Mechanisms of hypertension in obesity. Kidney Int Suppl 1987; 22:S254-8. [PMID: 3323617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
We conclude that the following may explain the rise in blood pressure with obesity and the subsequent fall in blood pressure (Fig. 2): (1) An increase in calories, protein, or carbohydrate leads to an increase in plasma catecholamines, sympathetic nervous system activity, and insulin secretion. (2) These factors, in turn, lead to increased renal sodium retention and stimulation of the renin-aldosterone system which, in turn, leads to: (3) An increased cardiac output with an inability to appropriately adjust the peripheral resistance to maintain normotension with resultant hypertension. Conversely, the fall in blood pressure with weight reduction can be explained by (Fig. 3): (1) A decrease in calorie, carbohydrate, or protein intake which leads to: (2) A decrease in circulating plasma catecholamines, sympathetic nervous system activity, and insulin secretion which results in: (3) A natriuresis and decrease in the renin-aldosterone system, which causes a decrease in circulating blood volume and in cardiac output. This, in turn, lowers blood pressure towards normal. The unanswered question still remains: why do some obese patients become hypertensive and others remain normotensive? Perhaps there are weight-sensitive individuals and weight-resistant individuals just as there appear to be salt-sensitive and salt-resistant hypertensive patients. Perhaps the answer is genetic. These questions also remain to be answered.
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Affiliation(s)
- L P Dornfeld
- School of Medicine University of California, Los Angeles 90024
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