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Goetz MP, Bagegni NA, Batist G, Brufsky A, Cristofanilli MA, Damodaran S, Daniel BR, Fleming GF, Gradishar WJ, Graff SL, Grosse Perdekamp MT, Hamilton E, Lavasani S, Moreno-Aspitia A, O'Connor T, Pluard TJ, Rugo HS, Sammons SL, Schwartzberg LS, Stover DG, Vidal GA, Wang G, Warner E, Yerushalmi R, Plourde PV, Portman DJ, Gal-Yam EN. Lasofoxifene versus fulvestrant for ER+/HER2- metastatic breast cancer with an ESR1 mutation: results from the randomized, phase II ELAINE 1 trial. Ann Oncol 2023; 34:1141-1151. [PMID: 38072514 DOI: 10.1016/j.annonc.2023.09.3104] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 04/25/2023] [Revised: 08/24/2023] [Accepted: 09/13/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Acquired estrogen receptor alpha (ER/ESR1) mutations commonly cause endocrine resistance in ER+ metastatic breast cancer (mBC). Lasofoxifene, a novel selective ER modulator, stabilizes an antagonist conformation of wild-type and ESR1-mutated ER-ligand binding domains, and has antitumor activity in ESR1-mutated xenografts. PATIENTS AND METHODS In this open-label, randomized, phase II, multicenter, ELAINE 1 study (NCT03781063), we randomized women with ESR1-mutated, ER+/human epidermal growth factor receptor 2 negative (HER2-) mBC that had progressed on an aromatase inhibitor (AI) plus a cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) to oral lasofoxifene 5 mg daily or IM fulvestrant 500 mg (days 1, 15, and 29, and then every 4 weeks) until disease progression/toxicity. The primary endpoint was progression-free survival (PFS); secondary endpoints were safety/tolerability. RESULTS A total of 103 patients received lasofoxifene (n = 52) or fulvestrant (n = 51). The most current efficacy analysis showed that lasofoxifene did not significantly prolong median PFS compared with fulvestrant: 24.2 weeks (∼5.6 months) versus 16.2 weeks (∼3.7 months; P = 0.138); hazard ratio 0.699 (95% confidence interval 0.434-1.125). However, PFS and other clinical endpoints numerically favored lasofoxifene: clinical benefit rate (36.5% versus 21.6%; P = 0.117), objective response rate [13.2% (including a complete response in one lasofoxifene-treated patient) versus 2.9%; P = 0.124], and 6-month (53.4% versus 37.9%) and 12-month (30.7% versus 14.1%) PFS rates. Most common treatment-emergent adverse events with lasofoxifene were nausea, fatigue, arthralgia, and hot flushes. One death occurred in the fulvestrant arm. Circulating tumor DNA ESR1 mutant allele fraction (MAF) decreased from baseline to week 8 in 82.9% of evaluable lasofoxifene-treated versus 61.5% of fulvestrant-treated patients. CONCLUSIONS Lasofoxifene demonstrated encouraging antitumor activity versus fulvestrant and was well tolerated in patients with ESR1-mutated, endocrine-resistant mBC following progression on AI plus CDK4/6i. Consistent with target engagement, lasofoxifene reduced ESR1 MAF, and to a greater extent than fulvestrant. Lasofoxifene may be a promising targeted treatment for patients with ESR1-mutated mBC and warrants further investigation.
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Affiliation(s)
- M P Goetz
- Department of Oncology, Mayo Clinic, Rochester.
| | - N A Bagegni
- Division of Oncology, Washington University School of Medicine, St. Louis, USA
| | - G Batist
- Segal Cancer Centre, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - A Brufsky
- University of Pittsburgh Medical Center-Magee Women's Hospital, Pittsburgh
| | - M A Cristofanilli
- Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York
| | - S Damodaran
- The University of Texas MD Anderson Cancer Center, Department of Breast Medical Oncology, Houston
| | | | - G F Fleming
- The University of Chicago Medical Center, Chicago
| | - W J Gradishar
- Division of Hematology/Oncology, Northwestern University, Chicago
| | - S L Graff
- Lifespan Cancer Institute/Legorreta Cancer Center at Brown University, Providence
| | | | - E Hamilton
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville
| | - S Lavasani
- Division of Hematology and Medical Oncology, UC Irvine, Orange
| | | | - T O'Connor
- Roswell Park Comprehensive Cancer Center, Department of Medicine, Buffalo
| | - T J Pluard
- Saint Luke's Cancer Institute, Kansas City
| | - H S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco, San Francisco
| | - S L Sammons
- Dana Farber Cancer Institute, Harvard Medical School, Boston
| | | | - D G Stover
- Ohio State University Comprehensive Cancer Center, Ohio State University, Columbus
| | - G A Vidal
- Breast Oncology Division, West Cancer Center, Memphis
| | - G Wang
- Medical Oncology, Miami Cancer Institute at Baptist Health, Miami, USA
| | - E Warner
- Division of Medical Oncology, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - R Yerushalmi
- Rabin Medical Center, Beilinson Hospital, Petah Tikva, Tel-Aviv University, Tel-Aviv, Israel
| | | | | | - E N Gal-Yam
- Breast Oncology Institute, Sheba Medical Center, Ramat Gan, Israel
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Jhaveri K, Eli LD, Wildiers H, Hurvitz SA, Guerrero-Zotano A, Unni N, Brufsky A, Park H, Waisman J, Yang ES, Spanggaard I, Reid S, Burkard ME, Vinayak S, Prat A, Arnedos M, Bidard FC, Loi S, Crown J, Bhave M, Piha-Paul SA, Suga JM, Chia S, Saura C, Garcia-Saenz JÁ, Gambardella V, de Miguel MJ, Gal-Yam EN, Rapael A, Stemmer SM, Ma C, Hanker AB, Ye D, Goldman JW, Bose R, Peterson L, Bell JSK, Frazier A, DiPrimeo D, Wong A, Arteaga CL, Solit DB. Neratinib + fulvestrant + trastuzumab for HR-positive, HER2-negative, HER2-mutant metastatic breast cancer: outcomes and biomarker analysis from the SUMMIT trial. Ann Oncol 2023; 34:885-898. [PMID: 37597578 DOI: 10.1016/j.annonc.2023.08.003] [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: 05/21/2023] [Revised: 08/03/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND HER2 mutations are targetable alterations in patients with hormone receptor-positive (HR+) metastatic breast cancer (MBC). In the SUMMIT basket study, patients with HER2-mutant MBC received neratinib monotherapy, neratinib + fulvestrant, or neratinib + fulvestrant + trastuzumab (N + F + T). We report results from 71 patients with HR+, HER2-mutant MBC, including 21 (seven in each arm) from a randomized substudy of fulvestrant versus fulvestrant + trastuzumab (F + T) versus N + F + T. PATIENTS AND METHODS Patients with HR+ HER2-negative MBC with activating HER2 mutation(s) and prior cyclin-dependent kinase 4/6 inhibitor (CDK4/6i) therapy received N + F + T (oral neratinib 240 mg/day with loperamide prophylaxis, intramuscular fulvestrant 500 mg on days 1, 15, and 29 of cycle 1 then q4w, intravenous trastuzumab 8 mg/kg then 6 mg/kg q3w) or F + T or fulvestrant alone. Those whose disease progressed on F + T or fulvestrant could cross-over to N + F + T. Efficacy endpoints included investigator-assessed objective response rate (ORR), clinical benefit rate (RECIST v1.1), duration of response, and progression-free survival (PFS). Plasma and/or formalin-fixed paraffin-embedded tissue samples were collected at baseline; plasma was collected during and at end of treatment. Extracted DNA was analyzed by next-generation sequencing. RESULTS ORR for 57 N + F + T-treated patients was 39% [95% confidence interval (CI) 26% to 52%); median PFS was 8.3 months (95% CI 6.0-15.1 months). No responses occurred in fulvestrant- or F + T-treated patients; responses in patients crossing over to N + F + T supported the requirement for neratinib in the triplet. Responses were observed in patients with ductal and lobular histology, 1 or ≥1 HER2 mutations, and co-occurring HER3 mutations. Longitudinal circulating tumor DNA sequencing revealed acquisition of additional HER2 alterations, and mutations in genes including PIK3CA, enabling further precision targeting and possible re-response. CONCLUSIONS The benefit of N + F + T for HR+ HER2-mutant MBC after progression on CDK4/6is is clinically meaningful and, based on this study, N + F + T has been included in the National Comprehensive Cancer Network treatment guidelines. SUMMIT has improved our understanding of the translational implications of targeting HER2 mutations with neratinib-based therapy.
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Affiliation(s)
- K Jhaveri
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York.
| | - L D Eli
- Clinical Development, Puma Biotechnology, Los Angeles, USA
| | - H Wildiers
- University Hospitals Leuven, Leuven, Belgium
| | - S A Hurvitz
- David Geffen School of Medicine, UCLA, Los Angeles, Santa Monica, USA
| | - A Guerrero-Zotano
- Medical Oncology Department, Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - N Unni
- UT Southwestern Medical Center, Dallas
| | - A Brufsky
- Magee-Womens Hospital of UPMC, Pittsburgh
| | - H Park
- Washington University School of Medicine, St. Louis
| | - J Waisman
- City of Hope Comprehensive Cancer Center, Duarte
| | - E S Yang
- University of Alabama at Birmingham, Birmingham, USA
| | - I Spanggaard
- Department of Oncology, Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - S Reid
- Division of Hematology/Oncology (Breast Oncology), The Vanderbilt-Ingram Cancer Center, Nashville
| | - M E Burkard
- Division of Hematology/Oncology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison
| | - S Vinayak
- Seattle Cancer Care Alliance, Seattle, USA
| | - A Prat
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - M Arnedos
- Department of Medical Oncology, Gustave Roussy, Villejuif
| | - F-C Bidard
- Department of Medical Oncology, UVSQ/Paris-Saclay University, Institut Curie, Saint Cloud, France
| | - S Loi
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne; The Sir Peter MacCallum Department of Medical Oncology, The University of Melbourne, Parkville, Australia
| | - J Crown
- St. Vincent's University Hospital, Dublin, Ireland
| | - M Bhave
- Department of Hematology/Oncology, Emory University, Winship Cancer Institute, Atlanta
| | - S A Piha-Paul
- Department of Investigational Cancer Therapeutics, University of Texas MD Anderson Cancer Center, Houston
| | - J M Suga
- Kaiser Permanente, Department of Medical Oncology, Vallejo, USA
| | - S Chia
- Department of Medical Oncology, British Columbia Cancer Agency, Vancouver, Canada
| | - C Saura
- Medical Oncology Service, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona
| | - J Á Garcia-Saenz
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid
| | - V Gambardella
- Hospital Clínico de Valencia, Instituto de Investigación Sanitaria INCLIVA, Valencia
| | - M J de Miguel
- START Madrid - Hospital Universitario Madrid Sanchinarro, Madrid, Spain
| | - E N Gal-Yam
- Institute of Breast Oncology, Sheba Medical Center, Ramat Gan
| | - A Rapael
- Sourasky Medical Center, Tel Aviv
| | - S M Stemmer
- Davidoff Cancer Center, Rabin Medical Center, Petah Tikva; Tel Aviv University, Tel Aviv, Israel
| | - C Ma
- Division of Medical Oncology, Department of Medicine and Siteman Cancer Center, Washington University, St. Louis
| | - A B Hanker
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas
| | - D Ye
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas
| | | | - R Bose
- Division of Medical Oncology, Department of Medicine and Siteman Cancer Center, Washington University, St. Louis
| | - L Peterson
- Division of Medical Oncology, Department of Medicine and Siteman Cancer Center, Washington University, St. Louis
| | | | - A Frazier
- Clinical Development, Puma Biotechnology, Los Angeles, USA
| | - D DiPrimeo
- Clinical Development, Puma Biotechnology, Los Angeles, USA
| | - A Wong
- Clinical Development, Puma Biotechnology, Los Angeles, USA
| | - C L Arteaga
- UT Southwestern Simmons Comprehensive Cancer Center, Dallas
| | - D B Solit
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York
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Parsons HA, Blewett T, Chu X, Sridhar S, Santos K, Xiong K, Abramson VG, Patel A, Cheng J, Brufsky A, Rhoades J, Force J, Liu R, Traina TA, Carey LA, Rimawi MF, Miller KD, Stearns V, Specht J, Falkson C, Burstein HJ, Wolff AC, Winer EP, Tayob N, Krop IE, Makrigiorgos GM, Golub TR, Mayer EL, Adalsteinsson VA. Circulating tumor DNA association with residual cancer burden after neoadjuvant chemotherapy in triple-negative breast cancer in TBCRC 030. Ann Oncol 2023; 34:899-906. [PMID: 37597579 PMCID: PMC10898256 DOI: 10.1016/j.annonc.2023.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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: 03/17/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/21/2023] Open
Abstract
BACKGROUND We aimed to examine circulating tumor DNA (ctDNA) and its association with residual cancer burden (RCB) using an ultrasensitive assay in patients with triple-negative breast cancer (TNBC) receiving neoadjuvant chemotherapy. PATIENTS AND METHODS We identified responders (RCB 0/1) and matched non-responders (RCB 2/3) from the phase II TBCRC 030 prospective study of neoadjuvant paclitaxel versus cisplatin in TNBC. We collected plasma samples at baseline, 3 weeks and 12 weeks (end of therapy). We created personalized ctDNA assays utilizing MAESTRO mutation enrichment sequencing. We explored associations between ctDNA and RCB status and disease recurrence. RESULTS Of 139 patients, 68 had complete samples and no additional neoadjuvant chemotherapy. Twenty-two were responders and 19 of those had sufficient tissue for whole-genome sequencing. We identified an additional 19 non-responders for a matched case-control analysis of 38 patients using a MAESTRO ctDNA assay tracking 319-1000 variants (median 1000 variants) to 114 plasma samples from 3 timepoints. Overall, ctDNA positivity was 100% at baseline, 79% at week 3 and 55% at week 12. Median tumor fraction (TFx) was 3.7 × 10-4 (range 7.9 × 10-7-4.9 × 10-1). TFx decreased 285-fold from baseline to week 3 in responders and 24-fold in non-responders. Week 12 ctDNA clearance correlated with RCB: clearance was observed in 10 of 11 patients with RCB 0, 3 of 8 with RCB 1, 4 of 15 with RCB 2 and 0 of 4 with RCB 3. Among six patients with known recurrence, five had persistent ctDNA at week 12. CONCLUSIONS Neoadjuvant chemotherapy for TNBC reduced ctDNA TFx by 285-fold in responders and 24-fold in non-responders. In 58% (22/38) of patients, ctDNA TFx dropped below the detection level of a commercially available test, emphasizing the need for sensitive tests. Additional studies will determine whether ctDNA-guided approaches can improve outcomes.
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Affiliation(s)
- H A Parsons
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston.
| | - T Blewett
- Broad Institute of MIT and Harvard, Cambridge
| | - X Chu
- Data Science, Dana-Farber Cancer Institute, Boston
| | - S Sridhar
- Broad Institute of MIT and Harvard, Cambridge
| | - K Santos
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - K Xiong
- Broad Institute of MIT and Harvard, Cambridge
| | | | - A Patel
- Medical Oncology, Dana-Farber Cancer Institute, Boston
| | - J Cheng
- Broad Institute of MIT and Harvard, Cambridge
| | - A Brufsky
- University of Pittsburgh School of Medicine, Pittsburgh
| | - J Rhoades
- Broad Institute of MIT and Harvard, Cambridge
| | | | - R Liu
- Broad Institute of MIT and Harvard, Cambridge
| | - T A Traina
- Memorial Sloan Kettering Cancer Center, New York
| | - L A Carey
- The University of North Carolina Lineberger Comprehensive Cancer Center, Chapel Hill
| | - M F Rimawi
- Baylor College of Medicine Dan L. Duncan Comprehensive Cancer Center, Houston
| | - K D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - V Stearns
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore
| | - J Specht
- Seattle Cancer Care Alliance, Seattle
| | - C Falkson
- The University of Alabama at Birmingham, Birmingham
| | - H J Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston
| | - A C Wolff
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore
| | - E P Winer
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston
| | - N Tayob
- Data Science, Dana-Farber Cancer Institute, Boston
| | - I E Krop
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston
| | | | - T R Golub
- Broad Institute of MIT and Harvard, Cambridge
| | - E L Mayer
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Breast Oncology Program, Dana-Farber Brigham Cancer Center, Boston; Harvard Medical School, Boston.
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Viale G, Basik M, Niikura N, Tokunaga E, Brucker S, Penault-Llorca F, Hayashi N, Sohn J, Teixeira de Sousa R, Brufsky AM, O'Brien CS, Schmitt F, Higgins G, Varghese D, James GD, Moh A, Livingston A, de Giorgio-Miller V. Retrospective study to estimate the prevalence and describe the clinicopathological characteristics, treatments received, and outcomes of HER2-low breast cancer. ESMO Open 2023; 8:101615. [PMID: 37562195 PMCID: PMC10515285 DOI: 10.1016/j.esmoop.2023.101615] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [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: 04/12/2023] [Revised: 07/05/2023] [Accepted: 07/08/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Approximately 80% of all breast cancers (BCs) are currently categorized as human epidermal growth factor receptor 2 (HER2)-negative [immunohistochemistry (IHC) 0, 1+, or 2+/in situ hybridization (ISH) negative]; approximately 60% of BCs traditionally categorized as HER2-negative express low levels of HER2. HER2-low (IHC 1+ or IHC 2+/ISH-) status became clinically actionable with approval of trastuzumab deruxtecan to treat unresectable/metastatic HER2-low BC. Greater understanding of patients with HER2-low disease is urgently needed. PATIENTS AND METHODS This global, multicenter, retrospective study (NCT04807595) included tissue samples from patients with confirmed HER2-negative unresectable/metastatic BC [any hormone receptor (HR) status] diagnosed from 2014 to 2017. Pathologists rescored HER2 IHC-stained slides as HER2-low (IHC 1+ or IHC 2+/ISH-) or HER2 IHC 0 after training on low-end expression scoring using Ventana 4B5 and other assays at local laboratories (13 sites; 10 countries) blinded to historical scores. HER2-low prevalence and concordance between historical scores and rescores were assessed. Demographics, clinicopathological characteristics, treatments, and outcomes were examined. RESULTS In rescored samples from 789 patients with HER2-negative unresectable/metastatic BC, the overall HER2-low prevalence was 67.2% (HR positive, 71.1%; HR negative, 52.8%). Concordance was moderate between historical and rescored HER2 statuses (81.3%; κ = 0.583); positive agreement was numerically higher for HER2-low (87.5%) than HER2 IHC 0 (69.9%). More than 30% of historical IHC 0 cases were rescored as HER2-low overall (all assays) and using Ventana 4B5. There were no notable differences between HER2-low and HER2 IHC 0 in patient characteristics, treatments received, or clinical outcomes. CONCLUSIONS Approximately two-thirds of patients with historically HER2-negative unresectable/metastatic BC may benefit from HER2-low-directed treatments. Our data suggest that HER2 reassessment in patients with historical IHC 0 scores may be considered to help optimize selection of patients for treatment. Further, accurate identification of patients with HER2-low BC may be achieved with standardized pathologist training.
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Affiliation(s)
- G Viale
- Department of Pathology and Laboratory Medicine, IEO European Institute of Oncology IRCCS, Milan, Italy.
| | - M Basik
- Lady Davis Institute for Medical Research, Jewish General Hospital, Montreal, Canada
| | - N Niikura
- Tokai University School of Medicine, Isehara, Kanagawa Prefecture, Japan
| | - E Tokunaga
- National Hospital Organization Kyushu Cancer Center, Fukuoka, Fukuoka Prefecture, Japan
| | - S Brucker
- Research Institute for Women's Health, University of Tübingen, Tübingen, Germany
| | - F Penault-Llorca
- Centre Jean Perrin, Université Clermont Auvergne, INSERM, U1240 Imagerie Moléculaire et Stratégies Théranostiques, Clermont Ferrand, France
| | - N Hayashi
- St Luke's International Hospital, Tokyo, Tokyo Prefecture, Japan
| | - J Sohn
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | - A M Brufsky
- University of Pittsburgh Medical Center, Magee-Womens Hospital, Pittsburgh, USA
| | - C S O'Brien
- The Christie NHS Foundation Trust, Manchester, UK
| | - F Schmitt
- Medical Faculty of the University of Porto, CINTESIS@RISE (Health Research Network), Molecular Pathology Unit, Ipatimup, Porto, Portugal
| | - G Higgins
- Victorian Cancer Biobank, Melbourne, Australia
| | - D Varghese
- Epidemiology, Global Real World Evidence Generation, OBU Medical, AstraZeneca, Gaithersburg, USA
| | - G D James
- Medical Statistics Consultancy Ltd, London, UK
| | - A Moh
- Daiichi Sankyo, Inc., Basking Ridge, USA
| | - A Livingston
- Global Medical Affairs, Medical Breast, OBU Medical, AstraZeneca, City House, Cambridge, UK
| | - V de Giorgio-Miller
- Global Medical Affairs, Medical Breast, OBU Medical, AstraZeneca, City House, Cambridge, UK
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Goetz M, Plourde P, Stover D, Bagegni N, Vidal G, Brufsky A, Rugo H, Portman D, Gal-Yam E. LBA20 Open-label, randomized study of lasofoxifene (LAS) vs fulvestrant (Fulv) for women with locally advanced/metastatic ER+/HER2- breast cancer (mBC), an estrogen receptor 1 (ESR1) mutation, and disease progression on aromatase (AI) and cyclin-dependent kinase 4/6 (CDK4/6i) inhibitors. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.015] [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: 11/01/2022] Open
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Loibl S, Loirat D, Tolaney S, Punie K, Oliveira M, Rugo H, Bardia A, Hurvitz S, Brufsky A, Kalinsky K, Cortés J, O'Shaughnessy J, Dieras V, Carey L, Gianni L, Gharaibeh M, Moore L, Shi L, Piccart M. 257P Health-related quality of life (HRQoL) in the ASCENT study of sacituzumab govitecan (SG) in metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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O'Shaughnessy J, Brufsky A, Rugo H, Tolaney S, Diab S, Punie K, Sardesai S, Hamilton E, Loirat D, Traina T, Leon-Ferre R, Hurvitz S, Kalinsky K, Bardia A, Henry S, Mayer I, Hong Q, Phan S, Cortés J. 258P Analysis of patients (pts) without an initial triple-negative breast cancer (TNBC) diagnosis (Dx) in the phase III ASCENT study of sacituzumab govitecan (SG) in brain metastases-negative (BMNeg) metastatic TNBC (mTNBC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.541] [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: 10/20/2022] Open
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Rugo H, Liu X, Li B, McRoy L, Layman R, Brufsky A. 236P Real-world comparative effectiveness of palbociclib plus letrozole vs letrozole in older patients with metastatic breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.519] [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: 10/20/2022] Open
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Brufsky A, Kim S, Zvirbule Ž, Eniu A, Mebis J, Sohn J, Wongchenko M, Chohan S, Amin R, Yan Y, McNally V, Miles D, Loi S. A phase II randomized trial of cobimetinib plus chemotherapy, with or without atezolizumab, as first-line treatment for patients with locally advanced or metastatic triple-negative breast cancer (COLET): primary analysis. Ann Oncol 2021; 32:652-660. [DOI: 10.1016/j.annonc.2021.01.065] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 01/18/2021] [Accepted: 01/23/2021] [Indexed: 01/28/2023] Open
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Mamounas EP, Untch M, Mano MS, Huang CS, Geyer CE, von Minckwitz G, Wolmark N, Pivot X, Kuemmel S, DiGiovanna MP, Kaufman B, Kunz G, Conlin AK, Alcedo JC, Kuehn T, Wapnir I, Fontana A, Hackmann J, Polikoff J, Saghatchian M, Brufsky A, Yang Y, Zimovjanova M, Boulet T, Liu H, Tesarowski D, Lam LH, Song C, Smitt M, Loibl S. Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE. Ann Oncol 2021; 32:1005-1014. [PMID: 33932503 DOI: 10.1016/j.annonc.2021.04.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [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: 11/02/2020] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the KATHERINE study (NCT01772472), patients with residual invasive early breast cancer (EBC) after neoadjuvant chemotherapy (NACT) plus human epidermal growth factor receptor 2 (HER2)-targeted therapy had a 50% reduction in risk of recurrence or death with adjuvant trastuzumab emtansine (T-DM1) versus trastuzumab. Here, we present additional exploratory safety and efficacy analyses. PATIENTS AND METHODS KATHERINE enrolled HER2-positive EBC patients with residual invasive disease in the breast/axilla at surgery after NACT containing a taxane (± anthracycline, ± platinum) and trastuzumab (± pertuzumab). Patients were randomized to adjuvant T-DM1 (n = 743) or trastuzumab (n = 743) for 14 cycles. The primary endpoint was invasive disease-free survival (IDFS). RESULTS The incidence of peripheral neuropathy (PN) was similar regardless of neoadjuvant taxane type. Irrespective of treatment arm, baseline PN was associated with longer PN duration (median, 105-109 days longer) and lower resolution rate (∼65% versus ∼82%). Prior platinum therapy was associated with more grade 3-4 thrombocytopenia in the T-DM1 arm (13.5% versus 3.8%), but there was no grade ≥3 hemorrhage in these patients. Risk of recurrence or death was decreased with T-DM1 versus trastuzumab in patients who received anthracycline-based NACT [hazard ratio (HR) = 0.51; 95% confidence interval (CI): 0.38-0.67], non-anthracycline-based NACT (HR = 0.43; 95% CI: 0.22-0.82), presented with cT1, cN0 tumors (0 versus 6 IDFS events), or had particularly high-risk tumors (HRs ranged from 0.43 to 0.72). The central nervous system (CNS) was more often the site of first recurrence in the T-DM1 arm (5.9% versus 4.3%), but T-DM1 was not associated with a difference in overall risk of CNS recurrence. CONCLUSIONS T-DM1 provides clinical benefit across patient subgroups, including small tumors and particularly high-risk tumors and does not increase the overall risk of CNS recurrence. NACT type had a minimal impact on safety.
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Affiliation(s)
- E P Mamounas
- NSABP Foundation and; Department of Surgery, Orlando Health UF Health Cancer Center, Orlando, USA.
| | - M Untch
- AGO-B and Department of Gynecologic Oncology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - M S Mano
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - C-S Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C E Geyer
- NSABP Foundation and; NSABP Foundation and Department of Internal Medicine, Division of Hematology and Medical Oncology, Houston Methodist Cancer Center, Houston, USA
| | | | - N Wolmark
- NSABP Foundation and; NSABP Foundation and Department of Surgery, The University of Pittsburgh, Pittsburgh, USA
| | | | - S Kuemmel
- Breast Unit Kliniken Essen-Mitte, Essen, Germany; Klinik für Gynäkologie mit Brustzentrum Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M P DiGiovanna
- Yale University School of Medicine, Yale Cancer Center and Smilow Cancer Hospital, New Haven, USA
| | - B Kaufman
- Oncology Division, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - G Kunz
- GBG, Neu-Isenburg, Germany; St. Johannes Hospital Dortmund, Dortmund, Germany
| | - A K Conlin
- NSABP Foundation and; NSABP Foundation and Department of Medical Oncology, Providence Cancer Institute, Portland, USA
| | - J C Alcedo
- Department of Clinical Oncology, Centro Hemato Oncologico, Panama City, Panama
| | - T Kuehn
- AGO-B and Klinikum Esslingen, Esslingen, Germany
| | - I Wapnir
- NSABP Foundation and; NSABP Foundation and Stanford University School of Medicine, Stanford, USA
| | - A Fontana
- Division of Medical Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - J Hackmann
- GBG, Neu-Isenburg, Germany; Marien-Hospital Witten, SEG, Witten, Germany
| | - J Polikoff
- NSABP Foundation and; NSABP Foundation and Department of Hematology/Oncology, Kaiser Permanente, San Diego, USA
| | - M Saghatchian
- Breast Cancer Department, Institut Gustave Roussy, Villejuif, France
| | - A Brufsky
- NSABP Foundation and; NSABP Foundation and Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Y Yang
- Division of Hematology-Oncolog, Taichung Veterans General Hospital and School of Medicine, China Medical University, Taichung City, Taiwan
| | - M Zimovjanova
- Department of Oncology, Charles University and General University Hospital, Prague, Czech Republic
| | - T Boulet
- Department of Biostatistics, F. Hoffmann-La Roche, Basel, Switzerland
| | - H Liu
- Product Development Safety, Genentech, Inc., South San Francisco, USA
| | - D Tesarowski
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - L H Lam
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - C Song
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - M Smitt
- Product Development Oncology, Genentech, Inc., South San Francisco, USA; Seattle Genetics, South San Francisco, USA
| | - S Loibl
- GBG, Neu-Isenburg, Germany; Center for Haematology and Oncology Bethanien, Frankfurt, Germany
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11
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Ruiz-Borrego M, Chan A, Marx G, Brufsky A, Trudeau M, Egle D, McCulloch L, Tripathy D, Barcenas C. Bringing diarrhea under CONTROL: dose escalation reduces neratinib-associated diarrhea and improves tolerability in HER2-positive early-stage breast cancer. Breast 2021. [DOI: 10.1016/s0960-9776(21)00092-8] [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: 10/21/2022] Open
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12
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Barcenas CH, Hurvitz SA, Di Palma JA, Bose R, Chien AJ, Iannotti N, Marx G, Brufsky A, Litvak A, Ibrahim E, Alvarez RH, Ruiz-Borrego M, Chan N, Manalo Y, Kellum A, Trudeau M, Thirlwell M, Garcia Saenz J, Hunt D, Bryce R, McCulloch L, Rugo HS, Tripathy D, Chan A. Improved tolerability of neratinib in patients with HER2-positive early-stage breast cancer: the CONTROL trial. Ann Oncol 2020; 31:1223-1230. [PMID: 32464281 DOI: 10.1016/j.annonc.2020.05.012] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [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: 03/05/2020] [Revised: 04/27/2020] [Accepted: 05/07/2020] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Neratinib is an irreversible pan-HER tyrosine kinase inhibitor approved for extended adjuvant treatment in early-stage HER2-positive breast cancer based on the phase III ExteNET study. In that trial, in which no antidiarrheal prophylaxis was mandated, grade 3 diarrhea was observed in 40% of patients and 17% discontinued due to diarrhea. The international, open-label, sequential-cohort, phase II CONTROL study is investigating several strategies to improve tolerability. PATIENTS AND METHODS Patients who completed trastuzumab-based adjuvant therapy received neratinib 240 mg/day for 1 year plus loperamide prophylaxis (days 1-28 or 1-56). Sequential cohorts evaluated additional budesonide or colestipol prophylaxis (days 1-28) and neratinib dose escalation (DE; ongoing). The primary end point was the incidence of grade ≥3 diarrhea. RESULTS Final data for loperamide (L; n = 137), budesonide + loperamide (BL; n = 64), colestipol + loperamide (CL; n = 136), and colestipol + as-needed loperamide (CL-PRN; n = 104) cohorts, and interim data for DE (n = 60; completed ≥six cycles or discontinued; median duration 11 months) are available. No grade 4 diarrhea was observed. Grade 3 diarrhea rates were lower than ExteNET in all cohorts and lowest in DE (L 31%, BL 28%, CL 21%, CL-PRN 32%, DE 15%). Median number of grade 3 diarrhea episodes was one; median duration per grade 3 episode was 1.0-2.0 days across cohorts. Most grade 3 diarrhea and diarrhea-related discontinuations occurred in month 1. Diarrhea-related discontinuations were lowest in DE (L 20%, BL 8%, CL 4%, CL-PRN 8%, DE 3%). Decreases in health-related quality of life did not cross the clinically important threshold. CONCLUSIONS Neratinib tolerability was improved with preemptive prophylaxis or DE, which reduced the rate, severity, and duration of neratinib-associated grade ≥3 diarrhea compared with ExteNET. Lower diarrhea-related treatment discontinuations in multiple cohorts indicate that proactive management can allow patients to stay on neratinib for the recommended time period. CLINICALTRIALS.GOV: NCT02400476.
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Affiliation(s)
- C H Barcenas
- The University of Texas MD Anderson Cancer Center, Houston, USA.
| | - S A Hurvitz
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, USA
| | - J A Di Palma
- University of South Alabama College of Medicine, Mobile, USA
| | - R Bose
- Washington University School of Medicine, St Louis, USA
| | - A J Chien
- University of California San Francisco Comprehensive Cancer Center, San Francisco, USA
| | - N Iannotti
- Hematology Oncology Associates of the Treasure Coast, Port St. Lucie, USA
| | - G Marx
- Adventist Health Care, Wahroonga, Australia
| | - A Brufsky
- Magee-Womens Hospital of UPMC, Pittsburgh, USA
| | - A Litvak
- Saint Barnabas Medical Center, Livingston, USA
| | - E Ibrahim
- Redlands Community Hospital, Redlands, USA
| | - R H Alvarez
- Southeastern Regional Medical Center, Inc., Newnan, USA
| | | | - N Chan
- Rutger Cancer Institute of New Jersey, New Brunswick, USA
| | - Y Manalo
- Coastal Bend Cancer Center, Corpus Christi, USA
| | - A Kellum
- North Mississippi Medical Center Hematology and Oncology Clinic, Tupelo, USA
| | - M Trudeau
- Sunnybrook Research Institute, Toronto, Canada
| | - M Thirlwell
- McGill University Health Centre, Montreal, Canada
| | | | - D Hunt
- Puma Biotechnology Inc., Los Angeles, USA
| | - R Bryce
- Puma Biotechnology Inc., Los Angeles, USA
| | | | - H S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, USA
| | - D Tripathy
- The University of Texas MD Anderson Cancer Center, Houston, USA
| | - A Chan
- Breast Cancer Research Centre-WA & Curtin University, Perth, WA, Australia
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Rugo H, Cristofanilli M, Loibl S, Harbeck N, DeMichele A, Iwata H, Park Y, Brufsky A, Theall KP, Huang X, McRoy L, Bananis E, Turner N. 322P Prognostic factors for overall survival (OS) in patients with hormone receptor–positive/human epidermal growth factor receptor 2–negative advanced breast cancer (HR+/HER2− ABC): Analyses from PALOMA-3. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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14
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Brufsky A, Liu X, Li B, McRoy L, Layman R. 176P Real-world tumour response of palbociclib plus letrozole vs letrozole for metastatic breast cancer in US clinical practices. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.276] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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15
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Yardley DA, Coleman R, Conte P, Cortes J, Brufsky A, Shtivelband M, Young R, Bengala C, Ali H, Eakel J, Schneeweiss A, de la Cruz-Merino L, Wilks S, O'Shaughnessy J, Glück S, Li H, Miller J, Barton D, Harbeck N. nab-Paclitaxel plus carboplatin or gemcitabine versus gemcitabine plus carboplatin as first-line treatment of patients with triple-negative metastatic breast cancer: results from the tnAcity trial. Ann Oncol 2019; 29:1763-1770. [PMID: 29878040 PMCID: PMC6096741 DOI: 10.1093/annonc/mdy201] [Citation(s) in RCA: 78] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Background Metastatic triple-negative breast cancer (mTNBC) has a poor prognosis and aggressive clinical course. tnAcity evaluated the efficacy and safety of first-line nab-paclitaxel plus carboplatin (nab-P/C), nab-paclitaxel plus gemcitabine (nab-P/G), and gemcitabine plus carboplatin (G/C) in patients with mTNBC. Patients and methods Patients with pathologically confirmed mTNBC and no prior chemotherapy for metastatic BC received (1 : 1 : 1) nab-P 125 mg/m2 plus C AUC 2, nab-P 125 mg/m2 plus G 1000 mg/m2, or G 1000 mg/m2 plus C AUC 2, all on days 1, 8 q3w. Phase II primary end point: investigator-assessed progression-free survival (PFS); secondary end points included overall response rate (ORR), overall survival (OS), percentage of patients initiating cycle 6 with doublet therapy, and safety. Results In total, 191 patients were enrolled (nab-P/C, n = 64; nab-P/G, n = 61; G/C, n = 66). PFS was significantly longer with nab-P/C versus nab-P/G [median, 8.3 versus 5.5 months; hazard ratio (HR), 0.59 [95% CI, 0.38-0.92]; P = 0.02] or G/C (median, 8.3 versus 6.0 months; HR, 0.58 [95% CI, 0.37-0.90]; P = 0.02). OS was numerically longer with nab-P/C versus nab-P/G (median, 16.8 versus 12.1 months; HR, 0.73 [95% CI, 0.47-1.13]; P = 0.16) or G/C (median, 16.8 versus 12.6 months; HR, 0.80 [95% CI, 0.52-1.22]; P = 0.29). ORR was 73%, 39%, and 44%, respectively. In the nab-P/C, nab-P/G, and G/C groups, 64%, 56%, and 50% of patients initiated cycle 6 with a doublet. Grade ≥3 adverse events were mainly hematologic. Conclusions First-line nab-P/C was active in mTNBC and resulted in a significantly longer PFS and improved risk/benefit profile versus nab-P/G or G/C.
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Affiliation(s)
- D A Yardley
- Sarah Cannon Research Institute and Tennessee Oncology PLLC, Medical Oncology, Nashville, USA.
| | - R Coleman
- Department of Oncology and Metabolism, Weston Park Hospital, University of Sheffield, Sheffield, UK
| | - P Conte
- Department of Surgery, Oncology and Gastroenterology, University of Padova and Medical Oncology 2, Istituto Oncologico Veneto, Padova, Italy
| | - J Cortes
- Medical Oncology, Ramon y Cajal University Hospital, Madrid; Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - A Brufsky
- Hematology/Oncology, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - M Shtivelband
- Medical Oncology, Ironwood Physicians, PC, Chandler, USA
| | - R Young
- Medical Oncology, The Center for Cancer and Blood Disorders, Fort Worth, USA
| | - C Bengala
- Medical Oncology, Misericordia General Hospital, Grosseto, Italy
| | - H Ali
- Medical Oncology, Henry Ford Health System, Detroit, USA
| | - J Eakel
- Hematology and Oncology, Florida Cancer Specialists, Sarasota, USA
| | - A Schneeweiss
- Gynecology and Medical Oncology, Heidelberg University Hospital, Heidelberg, Germany
| | | | - S Wilks
- Hematology and Medical Oncology, Texas Oncology, San Antonio, USA
| | - J O'Shaughnessy
- Hematology, Medical Oncology, Baylor Sammons Cancer Center, Texas Oncology, US Oncology, Dallas, USA
| | - S Glück
- GMA Early Assets, Celgene Corporation, Summit, USA
| | - H Li
- Department of Biostatistics, Celgene Corporation, Summit, USA
| | - J Miller
- Clinical Research and Development, Hematology/Oncology, Celgene Corporation, Summit, USA
| | - D Barton
- Clinical Research and Development, Hematology/Oncology, Celgene Corporation, Summit, USA
| | - N Harbeck
- Breast Cancer Center, University of Munich, Munich, Germany
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Hartmaier RJ, Trabucco SE, Priedigkeit N, Chung JH, Parachoniak CA, Vanden Borre P, Morley S, Rosenzweig M, Gay LM, Goldberg ME, Suh J, Ali SM, Ross J, Leyland-Jones B, Young B, Williams C, Park B, Tsai M, Haley B, Peguero J, Callahan RD, Sachelarie I, Cho J, Atkinson JM, Bahreini A, Nagle AM, Puhalla SL, Watters RJ, Erdogan-Yildirim Z, Cao L, Oesterreich S, Mathew A, Lucas PC, Davidson NE, Brufsky AM, Frampton GM, Stephens PJ, Chmielecki J, Lee AV. Recurrent hyperactive ESR1 fusion proteins in endocrine therapy-resistant breast cancer. Ann Oncol 2019; 29:872-880. [PMID: 29360925 PMCID: PMC5913625 DOI: 10.1093/annonc/mdy025] [Citation(s) in RCA: 62] [Impact Index Per Article: 12.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background Estrogen receptor-positive (ER-positive) metastatic breast cancer is often intractable due to endocrine therapy resistance. Although ESR1 promoter switching events have been associated with endocrine-therapy resistance, recurrent ESR1 fusion proteins have yet to be identified in advanced breast cancer. Patients and methods To identify genomic structural rearrangements (REs) including gene fusions in acquired resistance, we undertook a multimodal sequencing effort in three breast cancer patient cohorts: (i) mate-pair and/or RNAseq in 6 patient-matched primary-metastatic tumors and 51 metastases, (ii) high coverage (>500×) comprehensive genomic profiling of 287-395 cancer-related genes across 9542 solid tumors (5216 from metastatic disease), and (iii) ultra-high coverage (>5000×) genomic profiling of 62 cancer-related genes in 254 ctDNA samples. In addition to traditional gene fusion detection methods (i.e. discordant reads, split reads), ESR1 REs were detected from targeted sequencing data by applying a novel algorithm (copyshift) that identifies major copy number shifts at rearrangement hotspots. Results We identify 88 ESR1 REs across 83 unique patients with direct confirmation of 9 ESR1 fusion proteins (including 2 via immunoblot). ESR1 REs are highly enriched in ER-positive, metastatic disease and co-occur with known ESR1 missense alterations, suggestive of polyclonal resistance. Importantly, all fusions result from a breakpoint in or near ESR1 intron 6 and therefore lack an intact ligand binding domain (LBD). In vitro characterization of three fusions reveals ligand-independence and hyperactivity dependent upon the 3' partner gene. Our lower-bound estimate of ESR1 fusions is at least 1% of metastatic solid breast cancers, the prevalence in ctDNA is at least 10× enriched. We postulate this enrichment may represent secondary resistance to more aggressive endocrine therapies applied to patients with ESR1 LBD missense alterations. Conclusions Collectively, these data indicate that N-terminal ESR1 fusions involving exons 6-7 are a recurrent driver of endocrine therapy resistance and are impervious to ER-targeted therapies.
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Affiliation(s)
- R J Hartmaier
- Foundation Medicine Inc., Cambridge; Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA.
| | | | - N Priedigkeit
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
| | | | | | | | - S Morley
- Foundation Medicine Inc., Cambridge
| | | | - L M Gay
- Foundation Medicine Inc., Cambridge
| | | | - J Suh
- Foundation Medicine Inc., Cambridge
| | - S M Ali
- Foundation Medicine Inc., Cambridge
| | - J Ross
- Foundation Medicine Inc., Cambridge
| | - B Leyland-Jones
- Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - B Young
- Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - C Williams
- Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - B Park
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, USA
| | - M Tsai
- Minnesota Oncology, Minneapolis, USA
| | - B Haley
- UT Southwestern Medical Center, Dallas, USA
| | - J Peguero
- Oncology Consultants Research Department, Houston, USA
| | | | | | - J Cho
- New Bern Cancer Care, New Bern, USA
| | - J M Atkinson
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
| | - A Bahreini
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, USA; Department of Genetics and Molecular Biology, Isfahan University of Medical Sciences, Isfahan, Iran
| | - A M Nagle
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
| | - S L Puhalla
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Foundation Medicine Inc., Cambridge; Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - R J Watters
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Department of Orthopaedic Surgery, University of Pittsburgh, Pittsburgh, USA
| | - Z Erdogan-Yildirim
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Department of Human Genetics, University of Pittsburgh, Pittsburgh, USA
| | - L Cao
- Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA; Central South University Xiangya School of Medicine, China
| | - S Oesterreich
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
| | - A Mathew
- Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - P C Lucas
- Department of Pathology, University of Pittsburgh, Pittsburgh, USA
| | - N E Davidson
- Foundation Medicine Inc., Cambridge; Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | - A M Brufsky
- Foundation Medicine Inc., Cambridge; Department of Molecular and Experimental Medicine, Avera Cancer Institute, Sioux Falls, USA
| | | | | | | | - A V Lee
- Department of Pharmacology and Chemical Biolog, UPMC Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA; Women's Cancer Research Center, Magee-Women's Research Institute, Pittsburgh, USA
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Untch M, Geyer C, Huang C, Loibl S, Wolmark N, Mano M, von Minckwitz G, Brufsky A, Pivot X, Polikoff J, Fontana A, Kaufman B, Alcedo J, Boulet T, Liu H, Song C, Mamounas E. Peripheral neuropathy (PN), thrombocytopenia (TCP) and central nervous system (CNS) recurrence: An update of the phase III KATHERINE trial of post-neoadjuvant trastuzumab emtansine (T-DM1) or trastuzumab (H) in patients (pts) with residual invasive HER2-positive breast cancer (BC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz446.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Untch M, Geyer C, Huang C, Loibl S, Wolmark N, Mano M, von Minckwitz G, Brufsky A, Pivot X, Polikoff J, Fontana A, Kaufman B, Alcedo J, Boulet T, Liu H, Song C, Mamounas E. Peripheral neuropathy (PN), thrombocytopenia (TCP) and central nervous system (CNS) recurrence: An update of the phase III KATHERINE trial of post-neoadjuvant trastuzumab emtansine (T-DM1) or trastuzumab (H) in patients (pts) with residual invasive HER2-positive breast cancer (BC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz394.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Cortes J, Calvo V, Ramírez-Merino N, O'Shaughnessy J, Brufsky A, Robert N, Vidal M, Muñoz E, Perez J, Dawood S, Saura C, Di Cosimo S, González-Martín A, Bellet M, Silva OE, Miles D, Llombart A, Baselga J. Adverse events risk associated with bevacizumab addition to breast cancer chemotherapy: a meta-analysis. Ann Oncol 2019; 30:1179. [PMID: 30624662 DOI: 10.1093/annonc/mdy535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/09/2023] Open
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Brufsky AM, Crozier JA, Grady I, Lomis T, Whitworth P, Rehmus E, Srkalovic G, Lee L, Blumencranz P, Baron P, Mavromatis B, Untch S, Blumencranz L, Yoder EB, Audeh W. Abstract OT1-13-01: MammaPrint, BluePrint, and full-genome data linked with clinical data to evaluate new gene expression profiles (FLEX). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-13-01] [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
BACKGROUND: Genomic signatures are revolutionizing the definition, identification, and treatment of breast cancer subtypes. The ability of genomic signatures to enable fine grained stratification of breast cancers to the granular disease level is still generally untested because of the difficulties in aggregating large clinical data sets. In order to stratify breast cancers into actionable subtypes both the full genome data and clinical data must be collected for patients at scale.
DESIGN & METHODS: FLEX is designed as a novel, large-scale, population based, prospective registry. All patients with stage I-III breast cancer who receive MammaPrint (MP) or BluePrint (BP) testing on a primary breast tumor are eligible. FLEX utilizes an adaptive design which enables additional study arms at low incremental effort and cost by allowing targeted substudies to be added. Patients who are enrolled in the initial study will also be eligible for inclusion in any additional study arm where they meet all criteria. Additional study arms and substudies may be investigator-initiated.
SPECIFIC AIMS:
Primary: Create a big-data registry of full genome expression data and clinical data to investigate new gene associations with prognostic and/or predictive value.
Secondary: Generate hypotheses for targeted subset analyses and trials based on full genome data. To date the following substudies have been proposed:
DR. JENNIFER A. CROZIER, BAPTIST MD ANDERSON CANCER CENTER
(1) MP and BP in male breast cancer TYPE: SUBSTUDY; NO ADDITIONAL CONSENT (ICF) REQUIRED. ARMS: ALL (2) MP BP evaluation in breast cancer patients ≥70. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL (3) FG evaluation in ILC. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL (4,5) MP BP relation to PR positivity, Ki67. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL (6) MP BP in metaplastic breast cancer. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL
DR. ADAM M. BRUFSKY, UNIVERSITY OF PITTSBURGH MEDICAL CENTER MAGEE WOMENS HOSPITAL
(1) Response to standard chemotherapy regimens in clinically ER+/PR+/HER2+ (triple positive) patients according to BP molecular subtypes. (2) Expression signatures by response to bisphosphonates in ER+ patients receiving adjuvant therapy, or for osteoporosis after primary treatment. (3) Gene expression in breast cancer patients with obesity. TYPE: SUBSTUDY; DUAL ICF UTILIZED. ARMS: NEOADJUVANT AND ADJUVANT
DR. IAN GRADY, NORTH VALLEY BREAST CLINIC
Impact of genomic risk classification on travel time to receive breast cancer care. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARMS: ALL
DR. THOMAS LOMIS, VALLEY BREAST CARE
Complementary data collection for patients participating in the ODM-201 trial. FLEX provides gene expression for exploratory and signature discovery. TYPE: COMPLEMENTARY; DUAL ICF UTILIZED. ARM: NEOADJUVANT
DR. PAT WHITWORTH, NASHVILLE BREAST CENTER
Genomic reclassification of large tumors eligible to receive NCT therapy. TYPE: SUBSTUDY; NO ADDITIONAL ICF REQUIRED. ARM: NEOADJUVANT
ELIGIBILITY, ACCRUAL
FLEX will enroll a minimum of 10000 patients aged ≥18 with stage I-III breast cancer who sign ICF. Enrollment began April 2017 and 623 patients have been enrolled as of June 2018.
Citation Format: Brufsky AM, Crozier JA, Grady I, Lomis T, Whitworth P, Rehmus E, Srkalovic G, Lee L, Blumencranz P, Baron P, Mavromatis B, Untch S, Blumencranz L, Yoder EB, Audeh W, FLEX Investigators Group. MammaPrint, BluePrint, and full-genome data linked with clinical data to evaluate new gene expression profiles (FLEX) [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 OT1-13-01.
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Affiliation(s)
- AM Brufsky
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - JA Crozier
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - I Grady
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - T Lomis
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - P Whitworth
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - E Rehmus
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - G Srkalovic
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - L Lee
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - P Blumencranz
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - P Baron
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - B Mavromatis
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - S Untch
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - L Blumencranz
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - EB Yoder
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
| | - W Audeh
- University of Pittsburgh Medical Center Magee Womens Hospital, Pittsburgh, PA; Baptist MD Anderson Cancer Center, Jacksonville, FL; North Valley Breast Clinic, Redding, CA; Valley Breast Care, Van Nuys, CA; Nashville Breast Center, Nashville, TN; Akron General Medical Center, Akron, OH; Sparrow Cancer Center, Lansing, MI; Comprehensive Cancer Center, Palm Springs, CA; Morton Plant Hospita, Clearwater, FL; Breast & Melanoma Specialists of Charleston, Charleston, SC; Western Maryland Health Systems, Cumberland, MD; Agendia, Irvine, CA
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Rich TA, Raymond VM, Ahn ER, Banks KC, Brufsky A, Lee C, Lippman M, Pluard TJ, Schwab RB, Lanman RB. Abstract P4-01-05: Cell free DNA analysis identifies actionable ERBB2 amplifications in patients with HER2 equivocal breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-05] [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:
Determination of ERBB2 (HER2) expression or amplification informs eligibility of HER2-targeted therapies. ASCO and NCCN guidelines recommend evaluation of HER2 status on primary invasive breast cancers and on a metastatic site if stage IV, where possible, as treatment is based on the status of the metastasis. Reassessment of HER2 status should also be considered in patients with disease recurrence as initially HER2-negative tumors may acquire HER2 amplification at progression. HER2 status can be complicated by equivocal results from in situ hybridization (ISH) and/or immunohistochemistry (IHC). Clarification requires reflex testing on the same tissue specimen or repeat testing on a new specimen, however some patients' tissue status remains equivocal. Furthermore, metastases to bone, lung, or brain may be difficult to re-biopsy or of low DNA quality. Rapid and non-invasive blood-based cell-free DNA (cfDNA) NGS may facilitate identification of HER2 targetable disease in advanced breast cancer.
Methods:
We assessed the frequency of ERBB2 amplification detectable by a blood-based cell-free DNA (cfDNA) assay among patients with metastatic breast cancer with equivocal HER2 results in tissue. cfDNA samples were ordered as part of routine clinical care using an assay validated for the detection of copy number amplification in ERBB2 (tests run between 03/2014-04/2017 by Guardant Health, Redwood City, CA). Submitted pathology reports were reviewed for HER2 status which was categorized as positive, negative, or equivocal based on the interpretation issued by the reading pathologist at the time the test was ordered. Patients were included if they had an equivocal result on IHC and/or ISH unless both assays were performed on the same specimen and one provided a definitive negative or positive HER2 result. Additionally, 4 patients with equivocal IHC or ISH results were excluded as biopsy of another tumor site revealed a positive HER2 result around the same time as the equivocal test. For the 349 patients with multiple cfDNA samples, the earliest pathology report was referenced.
Results:
Tissue HER2 status was available for 1,853 unique patients (98.8% female, median age at testing was 58y, range 26-91y). 141 patients (7.6%) had equivocal HER2 results in tissue; 99 by IHC alone, 14 by ISH alone, and 28 were equivocal by both assays. Among these, 126 patients (89.4%) had at least one sample with ctDNA detected. 12/126 (9.5%) had amplification of ERBB2 detected in at least one cfDNA sample. Samples were drawn a median of 267 days after tissue collection (range 4 days – 11.5 years). Frequency of ERBB2 amplification was similar regardless of time between tissue and blood collection but was higher among patients with ISH results alone (4/14, 36.4%) compared to those with IHC alone (6/89, 6.7%) or both assays (6/26, 7.6%; p=0.006).
Conclusion:
cfDNA testing identifies a significant number of patients with HER2-targetable advanced breast cancer whose tissue was HER2 equivocal. cfDNA testing may supplement tissue-based methods to help clarify HER2 status in metastatic disease as well as identify patients who may acquire HER2 amplification subsequent to their initial biopsy.
Citation Format: Rich TA, Raymond VM, Ahn ER, Banks KC, Brufsky A, Lee C, Lippman M, Pluard TJ, Schwab RB, Lanman RB. Cell free DNA analysis identifies actionable ERBB2 amplifications in patients with HER2 equivocal breast cancer [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 P4-01-05.
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Affiliation(s)
- TA Rich
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
| | - VM Raymond
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
| | - ER Ahn
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
| | - KC Banks
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
| | - A Brufsky
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
| | - C Lee
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
| | - M Lippman
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
| | - TJ Pluard
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
| | - RB Schwab
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
| | - RB Lanman
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Chicago; University of Pittsburgh Medical Center - Magee-Women's Hospital, Pittsburgh; University of Miami Miller School of Medicine, Miami; St. Luke's Cancer Institute, Kansas City; University of California San Diego Moores Cancer Center, La Jolla
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Klar NJ, Rosenzweig M, Diergaarde B, Brufsky A. Abstract P2-08-48: Features associated with long-term survival in metastatic breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-48] [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: 5-10% of women with metastatic breast cancer (MBC) survive ≥5 years. Predictors of long-term survival are not clearly elucidated. We used data from 122 long-term MBC survivors (≥5-year survival from date of MBC diagnosis) and 191 short-term MBC survivors (≤2-year survival from date from MBC diagnosis) to identify clinico-pathologic and socioeconomic features associated with MBC survival.
Methods: Women initially diagnosed with breast cancer (BC) in or after 1999, and diagnosed with MBC at Magee Women's Cancer Program of UPMC were included (N=313). Data abstracted from medical records included: stage at initial BC diagnosis, body mass index (BMI), Charlson Comorbidity Index (CCI), age, menopausal status at initial BC diagnosis, tumor receptor status at initial BC diagnosis, site of initial metastases, time to recurrence between initial diagnosis and MBC, household income, race, employment status, and partner status. Differences between groups were assessed using t-tests and Chi-square or Fisher's exact tests. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using multivariate logistic regression models.
Results: Long-term survivors were significantly (P<0.05) younger, had more ER positive, PR positive, and Her2 positive disease, lower CCI, more often premenopausal at initial diagnosis, lower rates of visceral metastases, higher household income, and more often partnered than short-term survivors. The association of premenopausal status at initial diagnosis with long-term survival remained significant after adjustment for stage at initial diagnosis, tumor receptor status, and CCI (OR: 1.96, 95% CI 1.02- 3.79). Long-term term survivors were also significantly more often diagnosed with de novo MBC compared to short-term survivors. The association of de novo MBC with long-term survival remained significant after adjustment for age, tumor receptor status, and CCI (OR: 3.0, 95% CI 1.6-5.4). Time to recurrence between initial diagnosis and MBC, BMI, race, and employment status were not associated with survival.
Conclusions: Diagnosis of de novo MBC, ER-, PR- and/or Her2-positive primary tumor, lower rates of visceral metastases, higher household income, younger age, lower CCI, premenopausal status, and having a partner are associated with long-term survival after diagnosis of MBC. This is one of the first studies to show a survival benefit in MBC for patients with de novo MBC, premenopausal status at initial diagnosis, positive partner status, and higher household income.
Citation Format: Klar NJ, Rosenzweig M, Diergaarde B, Brufsky A. Features associated with long-term survival in metastatic breast cancer [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 P2-08-48.
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Affiliation(s)
- NJ Klar
- University of Pittsburgh Medical Center, Pittsburgh, PA; University of Pittsburgh School of Nursing, Pittsburgh, PA; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; UPMC Hillman Cancer Center, Pittsburgh, PA
| | - M Rosenzweig
- University of Pittsburgh Medical Center, Pittsburgh, PA; University of Pittsburgh School of Nursing, Pittsburgh, PA; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; UPMC Hillman Cancer Center, Pittsburgh, PA
| | - B Diergaarde
- University of Pittsburgh Medical Center, Pittsburgh, PA; University of Pittsburgh School of Nursing, Pittsburgh, PA; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; UPMC Hillman Cancer Center, Pittsburgh, PA
| | - A Brufsky
- University of Pittsburgh Medical Center, Pittsburgh, PA; University of Pittsburgh School of Nursing, Pittsburgh, PA; Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA; UPMC Hillman Cancer Center, Pittsburgh, PA
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Yardley DA, Abu-Khalaf M, Boni V, Brufsky A, Emens LA, Gutierrez M, Hurvitz S, Im SA, Loi S, McCune SL, Schmid P, O'Hear C, Zhang X, Vidal GA. Abstract OT2-06-04: MORPHEUS: A phase Ib/II trial platform evaluating the safety and efficacy of multiple cancer immunotherapy combinations in patients with hormone receptor–positive and triple-negative breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot2-06-04] [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:
Cancer immunotherapy (CIT) has significantly improved overall survival across multiple tumor types, but only subsets of patients experience durable response with single-agent CIT. Combinations of CIT with targeted therapy or chemotherapy may be needed in order to target multiple cancer immune escape mechanisms simultaneously, thus providing personalized treatment options that extend clinical benefit to more patients. The MORPHEUS platform includes multiple phase Ib/II trials designed to identify early signals of safety and activity of CIT combinations. Using a randomized trial design, multiple CIT combination arms are compared with a single standard-of-care control arm. These trials have the flexibility to open new treatment arms with novel CIT combinations as they become available and to close arms that show minimal activity or unacceptable toxicity. Here we describe MORPHEUS trials in patients with metastatic or unresectable locally advanced hormone receptor–positive (HR+BC) or triple-negative breast cancer (TNBC), 2 patient populations in need of more treatment options.
Trial design:
MORPHEUS-HR+BC (NCT03280563) will enroll patients with metastatic or unresectable locally advanced HR+BC who have progressed during or after first-line treatment with a cyclin-dependent kinase (CDK) 4/6 inhibitor and whose tumors do not express human epidermal growth factor 2 (HER2). MORPHEUS-TNBC (NCT03424005) will enroll patients with metastatic or unresectable locally advanced TNBC who have progressed during or after first-line treatment with chemotherapy. For both studies, key inclusion criteria include Eastern Cooperative Oncology Group performance status of 0-1 (stage 1) or 0-2 (stage 2) and measurable disease per Response Evaluation Criteria in Solid Tumors (RECIST) v1.1. Key exclusion criteria include prior treatment with T-cell co-stimulating or immune checkpoint blockade therapies, and symptomatic, untreated, or actively progressing central nervous system metastases. Patients in both trials will be randomized to one of the CIT atezolizumab combination arms or a control arm (up to 5 arms in HR+BC and up to 6 arms in TNBC). Patients experiencing loss of clinical benefit or unacceptable toxicity in stage 1 may be eligible to switch to a different CIT atezolizumab combination arm in stage 2. Primary endpoints are safety measures and investigator-assessed objective response rate per RECIST v1.1. Progression-free survival, overall survival, duration of response, clinical benefit rate (HR+BC) or disease control rate (TNBC) are among the secondary endpoints. Exploratory biomarkers will also be examined.
Citation Format: Yardley DA, Abu-Khalaf M, Boni V, Brufsky A, Emens LA, Gutierrez M, Hurvitz S, Im S-A, Loi S, McCune SL, Schmid P, O'Hear C, Zhang X, Vidal GA. MORPHEUS: A phase Ib/II trial platform evaluating the safety and efficacy of multiple cancer immunotherapy combinations in patients with hormone receptor–positive and triple-negative breast cancer [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 OT2-06-04.
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Affiliation(s)
- DA Yardley
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - M Abu-Khalaf
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - V Boni
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - A Brufsky
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - LA Emens
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - M Gutierrez
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - S Hurvitz
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - S-A Im
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - S Loi
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - SL McCune
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - P Schmid
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - C O'Hear
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - X Zhang
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
| | - GA Vidal
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN; Thomas Jefferson University Hospital, Philadelphia, PA; START Madrid, Centro Integral Oncológico Clara Campal (CIOCC), Madrid, Spain; Medical Oncology, Magee-Women's Hospital of UPMC, Pittsburgh, PA; Bloomberg∼Kimmel Institute for Cancer Immunotherapy at Johns Hopkins, Baltimore, MD; Hackensack University Medical Center John Theurer Cancer Center, Hackensack, NJ; Geffen School of Medicine at UCLA, Los Angeles, CA; Seoul National University Hospital, Seoul, Korea; Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Northwest Georgia Oncology Centers, Marietta, GA; Barts Cancer Institute, Queen Mary University of London, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Tennessee West Cancer Center, Germantown, TN
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Vidula N, Goga A, Hwang J, Liu MC, Park BH, Nanda R, Pohlmann PR, Storniolo AM, Brufsky A, Abramson V, Rugo HS. Abstract OT3-04-04: A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease, with immunologic and genomic correlative studies. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-04-04] [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: Thirty percent of patients with breast cancer may experience chest wall recurrence, which is associated with a higher risk of developing distant metastases and a poor prognosis. Cancer cells may evade immune rejection through the programmed cell death 1 (PD-1) pathway. Pembrolizumab, an anti-PD-1 antibody, binds PD-1 and inhibits its interaction with the programmed death ligand 1 (PD-L1) to facilitate tumor immune rejection. We hypothesize that pembrolizumab may be an effective therapy in chest wall recurrence, given the inflammatory nature, and the high expression of PD-1 in tumors with lymphovascular invasion. Platinum agents may enhance anti-tumor immunity in a synergistic manner, and the combination of pembrolizumab and carboplatin has demonstrated efficacy in advanced lung cancer. In this study, the combination of pembrolizumab and carboplatin is being evaluated in breast cancer patients with chest wall disease.
Methods: This is a randomized phase II study of breast cancer patients with advanced, unresectable breast cancer involving the chest wall, being conducted through the Translational Breast Cancer Research Consortium (TBCRC). Patients may have hormone resistant disease (at least 2 prior lines of hormone therapy), triple negative breast cancer, or refractory HER2+ disease for enrollment. They may have other sites of distant metastases, have received any number of prior lines of therapy, have had prior surgery, but prior chest wall radiation is not necessary. Eighty-four patients at 7 TBCRC sites will be randomized 2:1 to treatment with pembrolizumab 200 mg IV and carboplatin AUC 5 IV every 3 weeks followed by pembrolizumab 200 mg IV alone every 3 weeks (Arm A, n=56) or carboplatin AUC 5 IV every 3 weeks (Arm B, n=28), with an option for patients in Arm B to cross-over to single agent pembrolizumab 200 mg IV every 3 weeks (arm Bx) on progression. Patients will undergo imaging with CT chest, abdomen, and pelvis at baseline and every 2 cycles of treatment for response evaluation. The primary endpoint is the disease control rate in the chest wall and distant sites at 18 weeks of treatment, and this study is powered to determine a 20% difference in disease control rates between arms A and B (hazard ratio of 0.52, α= 0.10, β= 0.20). After 18 patients are enrolled into Arm B, an interim analysis for futility will be conducted to enable early closure of that arm for lack of efficacy. Secondary endpoints in the study are toxicity, progression free survival, and response based on PD-L1 expression and irRECIST. Exploratory endpoints, which will be studied using peripheral blood testing and chest wall tumor biopsies at baseline and after 2 cycles of treatment, include determining associations of response with changes in tumor and peripheral blood immune composition, soluble PD-L1 expression, circulating tumor cells, cell free DNA, and tumor PD-L1 and MYC genomic expression. Ultimately this study promises to improve our understanding of checkpoint inhibition and chemotherapy for chest wall disease, and the underlying mechanism of action. This study is open for enrollment and 2 patients are currently enrolled. (NCT03095352).
Citation Format: Vidula N, Goga A, Hwang J, Liu MC, Park BH, Nanda R, Pohlmann PR, Storniolo AM, Brufsky A, Abramson V, Rugo HS. A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease, with immunologic and genomic correlative studies [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 OT3-04-04.
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Affiliation(s)
- N Vidula
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - A Goga
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - J Hwang
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - MC Liu
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - BH Park
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - R Nanda
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - PR Pohlmann
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - AM Storniolo
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - A Brufsky
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - V Abramson
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
| | - HS Rugo
- Massachusetts General Hospital, Boston, MA; University of California, San Francisco, San Francisco, CA; Mayo Clinic, Rochester, MN; Johns Hopkins University, Baltimore, MD; University of Chicago, Chicago, IL; Georgetown University, Washington, DC; Indiana University, Bloomington, IN; University of Pittsburg, Pittsburg, PA; Vanderbilt University, Nashville, TN
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Albain K, Gray RJ, Sparano JA, Makower DF, Pritchard KI, Hayes DF, Geyer CE, Dees EC, Goetz MP, Olson JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge GW. Abstract GS4-07: Race, ethnicity and clinical outcomes in hormone receptor-positive, HER2-negative, node-negative breast cancer: results from the TAILORx trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-gs4-07] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [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: Black race is associated with worse outcomes in localized hormone receptor (HR)-positive breast cancer in population-based and in clinical trial cohorts, whether using self-identified race (Albain et al. JNCI 2009 [PMID: 19584328; Sparano et al. JNCI 2012 [PMID: 22250182) or genetically-identified race (Schneider et al. J Precision Oncol 2017 [PMID: 29333527]). This disparity persists after adjustment for treatment delivery parameters (Hershman et al. JCO 2009 [PMID:19307504]). We evaluated clinicopathologic characteristics, treatment delivered and clinical outcomes in the Trial Assigning Individualized Options for Treatment (TAILORx) by race and ethnicity (Sparano et al. NEJM 2018 [PMID: 29860917]).
Methods: The analysis included 9719 evaluable TAILORx participants. The association between clinical outcomes and race (white, black, Asian, other/unknown) and ethnicity (Hispanic vs. non-Hispanic) was examined, including invasive disease-free survival (iDFS), distant relapse-free interval (DRFI), relapse-free interval (RFI), and overall survival (OS). Proportional hazards models were fit including age (5 categories), tumor size (>2 cm vs. <=2 cm), histologic grade (high vs. medium vs. low vs. unknown), continuous recurrence score (RS), race, and ethnicity in the overall population and randomized treatment arms in the RS 11-25 cohort.
Results: The study population included 8189 (84%) whites, 693 (7%) blacks, 405 (4%) Asians, and 432 (4%) with other/unknown race. Regarding ethnicity, 7635 (79%) were non-Hispanic, 889 (9%) Hispanic, and 1195 (12%) unknown. There was no significant difference in RS distribution (p=0.22) in blacks compared with whites, or in median (17 vs. 17) or mean RS (19.1 vs. 18.2). There was likewise no difference in Hispanic vs. non-Hispanic ethnicity for RS distribution (p=0.72) or median (17 vs. 17) or mean RS (18.5 vs. 18.0). Black race (39% vs. 30%) and Hispanic ethnicity (39% vs. 30%) were both associated with younger age (</=50 years) at diagnosis. The use and type of adjuvant chemotherapy and endocrine therapy, and duration of endocrine therapy, were similar in black (vs. white) and Hispanic (vs. non-Hispanic) populations. In proportional hazards models, black race (compared with white race) was associated with worse clinical outcomes in the entire population and in those with a RS 11-25 (see table). Hispanic ethnicity was generally associated with better outcomes (compared with non-Hispanic ethnicity). For the cohort with a RS of 11-25, there was no evidence for chemotherapy benefit for any racial or ethnic group.
Race (black vs.white) and clinical outcomes in proportional hazards modelsClinical endpointEntire Population (N=693 black) Hazard ratio for eventRS 11-25 (N=471 black) Hazard ratio for eveniDFS1.33 (p=0.005)1.49 (p=0.001)DRFI1.21 (p=0.28)1.60 (p=0.02)RFI1.39 (p=0.02)1.80 (p<0.001)OS1.52 (p=0.005)1.67 (p=0.003
Conclusions: In patients eligible and selected for participation in TAILORx, black women had worse clinical outcomes despite similar 21-gene assay RS results and comparable systemic therapy. This adds to an emerging body of evidence suggesting a biologic basis or other factors contributing to racial disparities in HR-positive breast cancer that requires further evaluation.
Citation Format: Albain K, Gray RJ, Sparano JA, Makower DF, Pritchard KI, Hayes DF, Geyer, Jr. CE, Dees EC, Goetz MP, Olson, Jr. JA, Lively T, Badve SS, Saphner TJ, Wagner LI, Whelan TJ, Ellis MJ, Paik S, Wood WC, Ravdin PM, Keane MM, Gomez HL, Reddy PS, Goggins TF, Mayer IA, Brufsky AM, Toppmeyer DL, Kaklamani VG, Berenberg JL, Abrams J, Sledge, Jr. GW. Race, ethnicity and clinical outcomes in hormone receptor-positive, HER2-negative, node-negative breast cancer: results from the TAILORx trial [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 GS4-07.
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Affiliation(s)
- K Albain
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - RJ Gray
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - JA Sparano
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - DF Makower
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - KI Pritchard
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - DF Hayes
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - CE Geyer
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - EC Dees
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - MP Goetz
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - JA Olson
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - T Lively
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - SS Badve
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - TJ Saphner
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - LI Wagner
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - TJ Whelan
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - MJ Ellis
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - S Paik
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - WC Wood
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - PM Ravdin
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - MM Keane
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - HL Gomez
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - PS Reddy
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - TF Goggins
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - IA Mayer
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - AM Brufsky
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - DL Toppmeyer
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - VG Kaklamani
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - JL Berenberg
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - J Abrams
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
| | - GW Sledge
- Loyola University Chicago Stritch School of Medicine, Maywood, IL; Dana Farber Cancer Institute, Boston, MA; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Sunnybrook Research Institute, Toronto, Canada; University of Michigan, Ann Arbor, MI; Virginia Commonwealth University School of Medicine and the Massey Cancer Center, Richmond, VA; University of North Carolina, Chapel Hill, NC; Mayo Clinic, Rochester, MN; University of Maryland School of Medicine, Baltimore, MD; National Institutes of Health, National Cancer Institute, Bethesda, MD; Indiana University School of Medicine, Indianapolis, IN; Vince Lombardi Cancer Clinic, Two Rivers, WI; Wake Forest University Health Service, Winston Salem, NC; McMaster University, Hamilton, Canada; Baylor College of Medicine, Houston, TX; Yonsei University College of Medicine, Seoul, South Korea; Emory University, Atlanta, GA; , San Antonio, TX; Cancer Trials Ireland, Dublin, Ireland; Instituto Nacional de Enfermedades Neoplasicas, Lima, Peru; C
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Vidula N, Goga A, Krummel M, Hwang J, Liu M, Park BH, Nanda R, Pohlmann P, Storniolo AM, Van Poznak C, Brufsky A, Abramson V, Wolff A, Rugo HS. Abstract OT1-02-03: TBCRC 044: A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-02-03] [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: Patients with breast cancer (BC) and chest wall disease have limited treatment options. We hypothesize that checkpoint inhibition may be an effective treatment approach due to the inflammatory nature of chest wall infiltration, and the association of PD-1 expression with lymphocytic infiltration. Platinum chemotherapy may facilitate anti-tumor immunity in a synergistic manner, and clinical studies of the PD-1 inhibitor pembrolizumab with platinum combinations have been effective in the treatment of advanced lung cancer. In this study, we will evaluate the combination of carboplatin and pembrolizumab in BC patients with chest wall disease.
Methods: This is a randomized phase II multicenter study in the TBCRC including patients with advanced, unresectable BC with hormone resistant or triple negative chest wall disease. Patients may have had prior surgery, prior chest wall radiation is not required, and other sites of distant metastases are allowed. Eighty-four patients at TBCRC sites will be randomized 2:1 to receive pembrolizumab and carboplatin (n=56, Arm A) or carboplatin alone (n=28, Arm B) until disease progression. Patients randomized to Arm B may cross-over following progression to pembrolizumab alone (Arm Bx). Patients in Arm A will be treated with pembrolizumab 200 mg IV and carboplatin AUC 5 IV every 3 weeks for at least 6 cycles followed by maintenance pembrolizumab 200 mg IV every 3 weeks if stable or responding disease. Patients in Arm B will be treated with carboplatin AUC 5 IV every 3 weeks until progression, then may cross-over to pembrolizumab 200 mg IV every 3 weeks alone (Arm Bx). An interim analysis for futility will be performed after 18 patients are enrolled into Arm B to allow early closure of that arm for lack of efficacy. The primary endpoint is disease control rate at 18 weeks of treatment; the study is powered to detect a 20% difference in disease control rates between arms (hazard ratio 0.52, α= 0.10, β= 0.20). Secondary endpoints include progression free survival, toxicity, and response based on PD-L1 expression and irRECIST. Exploratory endpoints include association of response with a number of biomarkers including tumor PD-L1 gene expression, tumor and peripheral blood immune composition and cytokine expression, peripheral T-cell PD-1 expression, circulating tumor DNA, circulating tumor cells, and tumor MYC genomic expression using tumor biopsy and peripheral blood testing before and after treatment. This study should be open to accrual by August of 2017. (NCT03095352)
Citation Format: Vidula N, Goga A, Krummel M, Hwang J, Liu M, Park BH, Nanda R, Pohlmann P, Storniolo AM, Van Poznak C, Brufsky A, Abramson V, Wolff A, Rugo HS. TBCRC 044: A randomized phase II study of pembrolizumab in combination with carboplatin versus carboplatin alone in breast cancer patients with chest wall disease [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 OT1-02-03.
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Affiliation(s)
- N Vidula
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - A Goga
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - M Krummel
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - J Hwang
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - M Liu
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - BH Park
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - R Nanda
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - P Pohlmann
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - AM Storniolo
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - C Van Poznak
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - A Brufsky
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - V Abramson
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - A Wolff
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
| | - HS Rugo
- Massachussets General Hospital; University of California San Francisco Comprehensive Cancer Center; Mayo Clinic, Rochester; Johns Hopkins University; University of Chicago; Georgetown; University of Indiana; University of Michigan; University of Pittsburgh; Vanderbilt University
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Raymond VM, Diaz J, Banks KC, Ahn E, Brufsky A, Ellis M, Lippman M, Lee C, Pluard T, Schreeder M, Schwab R, Lanman RB. Abstract P2-02-12: Cell free DNA analysis identifies actionable ERBB2 amplifications in patients with HER2 negative breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-02-12] [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
Identification of ERBB2 (HER2) overexpression in metastatic breast cancer informs utilization of HER2 targeted therapy. The NCCN recommends HER2 expression re-evaluation at the first disease recurrence in patients with negative or equivocal tissue status given results discrepancies due to inadequate tissue biopsy, tumoral heterogeneity, biopsy technique or fixation as well as discordance in ERBB2 (HER2) expression between primary and metastatic lesions. We examined the incidence of ERBB2 (HER2) negative to positive “flips” (e.g. to ERBB2-amplified in plasma) in a cohort of patients who underwent a blood-based cell-free DNA (cfDNA) assay at a CLIA-certified/CAP-accredited/NYSDOH-approved molecular diagnostic laboratory.
Laboratory database was queried for samples from patients with a breast cancer diagnosis. The query was filtered to ensure patients with multiple cfDNA timepoints were counted only once. Patients without a pathology report submitted at any cfDNA collection timepoint or the pathology report did not include ERBB2 (HER2) status, results were inconclusive or quantity not sufficient were excluded. Between March 2014 and April 2017, 1,853 unique patients were identified with reported ERBB2 (HER2) status. For patients with more than one cfDNA timepoint collected (N=349; 18.8%), the earliest pathology report was referenced. 1,386 patient tumor samples were negative for HER2 overexpression (74.8%), 325 (17.5%) were positive, and 142 (7.7%) were equivocal. Twenty-nine of the 1,386 patients with reported tumor negative HER2 status had amplification on subsequent cfDNA analysis (2.1%).
All 29 patients were female. Most patients (N=21) had a single cfDNA timepoint collected. Median age at cfDNA blood draw was 58 years (range 28–68). Median length of time between reported tissue negative status and cfDNA blood draw was 405 days (range 21–4,060). Median plasma ERBB2 copy number was 2.44 (greater than 50th-centile per laboratory data) (range 2.15–16.5).
Clinical follow-up was obtained for 19 patients (65%). Nine patients were lost to follow-up or succumbed to disease prior to initiation of a new therapeutic regimen. One patient was known HER2 positive prior to receipt of the cfDNA results. In the remaining nine patients, six initiated targeted HER2 therapy following receipt of the cfDNA results, with five of six (83%) demonstrating a clinical response. In one patient with known ER/PR positive, HER2 negative disease, progressing through multiple lines of therapy, addition of trastuzumab and pertuzumab to her paclitaxel regimen following identification of the cfDNA ERBB2 amplification resulted in a significant reduction in CEA levels (238 to 37.9 ng/mL) by week five. In a second patient, following identification of the cfDNA ERBB2 amplification, she was treated with trastuzumab and pertuzumab along with docetaxel and had a dramatic response. She continues on trastuzumab and pertuzumab alone.
Although a modest sample size, this is the second cfDNA series demonstrating that ERBB2 (HER2) status may flip from negative to positive upon recurrence or metastasis, and that targeting plasma-detected ERBB2 amplification with anti-HER2 has clinical benefit. cfDNA is a viable alternative to tissue rebiopsy in this patient population.
Citation Format: Raymond VM, Diaz J, Banks KC, Ahn E, Brufsky A, Ellis M, Lippman M, Lee C, Pluard T, Schreeder M, Schwab R, Lanman RB. Cell free DNA analysis identifies actionable ERBB2 amplifications in patients with HER2 negative breast cancer [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 P2-02-12.
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Affiliation(s)
- VM Raymond
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - J Diaz
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - KC Banks
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - E Ahn
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - A Brufsky
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - M Ellis
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - M Lippman
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - C Lee
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - T Pluard
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - M Schreeder
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - R Schwab
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
| | - RB Lanman
- Guardant Health, Redwood City, CA; Cancer Treatment Centers of America, Zion, IL; University of Pittsburgh Medical Center, Pittsburgh, PA; Baylor College of Medicine, Houston, TX; Sylvester Comprehensive Cancer Center; University of Miami Miller School of Medicine, Miami, FL; St. Luke's Health System, Kansas City, MO; Clear View Cancer Center, Huntsville, AL; University of California, San Diego, San Diego, CA
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Priedigkeit N, Vareslija D, Basudan A, Watters RJ, Lucas PC, Davidson NE, Blohmer JU, Denkert C, Machleidt A, Heppner BI, Brufsky AM, Oesterreich S, Young L, Lee AV. Abstract GS2-03: Highly recurrent transcriptional remodeling events in advanced endocrine resistant ER-positive breast cancers. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs2-03] [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: Although individual cancers are driven by heterogeneous processes, cancer mortality has a near universal cause—therapy resistance, recurrence and metastasis to vital organs. Characterizing more advanced tumors has borne valuable insight into cancer progression, yet studies of longitudinally collected breast cancer specimens are scarce given lengthy periods of cancer dormancy. In this study, we aimed to create the most comprehensive characterization of gene expression alterations to date between patient-matched pairs of primary and advanced ER-positive breast cancers.
MATERIALS/METHODS: Hybrid-capture RNA-sequencing was performed on 50 patient-matched pairs of primary and advanced ER-positive tumors from various recurrence sites (9 brain, 11 bone, 3 GI, 10 ovary, 17 local). Time to recurrence was up to 14.1 years with a median of 3.4 years. A shared variant analysis confirmed all paired samples were patient-matched. 1,380 cancer-related genes were analyzed for outlier expression fold-changes in matched recurrences versus primary tumors. Pair-specific, outlier fold-change thresholds were defined as Q1/Q3 +/- [1.5 X IQR]; using each pairs' fold-change values across all genes as the distribution. These discrete, longitudinal transcriptional remodeling events (LTREs) were assessed for recurrence across all sites and analyzed for enrichments within specific cohorts (Fisher's exact tests), such as locoregional vs. distant recurrences. To determine if LTREs represent acquired vulnerabilities, ex vivo and in vivo experiments targeting a recurrent, druggable LTRE gain of RET was performed.
RESULTS: The majority of advanced cancers were transcriptionally similar to patient-matched primaries with 23 of 33 distant metastases retaining PAM50 assignments of the matched primary—shifts to HER2 (n=4, 12%) or Luminal B (n=5, 15%) subtypes accounted for most metastatic discordances. Despite this intrinsic conservation, remarkably recurrent gene-level LTRE gains and losses were observed in advanced disease. Recurrent LTRE gains included NCAM1 [42%], FGFR4 [40%], IBSP [36%], ROBO2 [36%] and SPP1 [30%]. Notable LTRE losses included RELN [42%] and ESR1 [26%]. NCAM1 LTREs showed the most significant enrichments (p < 0.001) in distant disease (20 of 33, 61%) versus locoregional disease (1 of 17, 6%). A prominent LTRE enriched in brain metastasis (BrM) was RET (p-value = 0.003), expression of which showed outlier gains in 56% of ER-positive BrM. Marked anti-tumor activity was demonstrated with the RET inhibitor cabozantinib in ex vivo explant cultures of patient resected BrMs (n=3) and a BrM patient-derived xenograft.
CONCLUSIONS: Taken together, these results demonstrate profound, recurrent and metastatic site-specific LTREs in advanced breast cancers, which may be essential to our understanding of endocrine-therapy resistance and metastasis. Although current emphasis for longitudinal clinical profiling of tumors is on DNA-level alterations, these results suggest LTREs as a compelling, shared mechanism of cancer progression. Given remarkably high recurrence rates of specific LTREs across multiple cohorts, further preclinical and clinical investigations of LTREs are demanded, especially considering some (i.e. FGFR4 and RET) are readily druggable.
Citation Format: Priedigkeit N, Vareslija D, Basudan A, Watters RJ, Lucas PC, Davidson NE, Blohmer J-U, Denkert C, Machleidt A, Heppner BI, Brufsky AM, Oesterreich S, Young L, Lee AV. Highly recurrent transcriptional remodeling events in advanced endocrine resistant ER-positive breast cancers [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 GS2-03.
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Affiliation(s)
- N Priedigkeit
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - D Vareslija
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - A Basudan
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - RJ Watters
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - PC Lucas
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - NE Davidson
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - J-U Blohmer
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - C Denkert
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - A Machleidt
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - BI Heppner
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - AM Brufsky
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - S Oesterreich
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - L Young
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
| | - AV Lee
- University of Pittsburgh, Pittsburgh, PA; Royal College of Surgeons in Ireland, Dublin, Ireland; Fred Hutchinson Cancer Research Center, University of Washington, Seattle, WA; Charité University Hospital, Berlin, Germany
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Kalra M, Karuturi M, Tripathy D, Jankowitz R, McCann K, Brufsky A, Hurvitz S, Bogler O, Housri S, Housri N. Abstract P5-16-01: Documenting and sharing breast cancer knowledge from National Cancer Institute designated comprehensive cancer centers (NCI-CCCs) with community oncologists. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-16-01] [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
Introduction:Tumor boards (TB) at National Cancer Institute Designated Comprehensive Cancer Centers (NCI-CCC) are an important source of multidisciplinary education. Unfortunately, expert knowledge from NCI-CCCs is not systematically documented and made accessible to oncologists in the community. This represents a lost opportunity to capture and share clinical expertise that can impact patient care in community centers. Using an online oncologist-only social network, we sought to demonstrate the feasibility of systematically documenting expert insights from TBs and department conferences at NCI-CCCs in order to expand their reach and provide educational benefit to the greater oncology community.
Methods: A pilot program was developed at the University of Texas MD Anderson Cancer Center (MDACC) to design a process in which discussions at departmental breast cancer conferences would be distilled down to clinical questions and answers (Q&A) and posted on theMednet.org, an online social Q&A website of over 3,800 US oncologists. An educational breast cancer conference was selected during a site visit. A faculty member was selected to distil discussions about patient management from the selected conference into a question that addressed the clinical situation being discussed. After the question was posted, the oncologist leading the discussion answered the question on theMednet. The Q&A was then indexed and stored for easy search retrieval and disseminated in a weekly newsletter to all registered medical oncologists. A detailed manual was created to document operating procedures for implementation at additional institutions.
Results: After developing the process at MDACC, the program was expanded to 2 additional NCI-CCCs- University of Pittsburgh (UPMC) and UCLA. The educational breast cancer conferences selected varied by site and were the new patient planning conference at MDACC, tumor board at UPMC, and multidisciplinary clinic at UCLA. The most significant factor for success was involvement of one faculty member who regularly identified educational questions and additional faculty who posted their answers. Between December 2016 and May 2017, 17 answers to 17 questions were posted and shared with over 1,200 medical oncologists via an email newsletter. All questions were focused on topics not answered by NCCN or ASCO guidelines. The majority of questions focused on management decisions around chemotherapy and endocrine therapy. Answers were viewed by 339 oncologists at 260 institutions in 47 states. This included 190 community practices and 70 academic medical centers.
Conclusion: We developed a process of capturing and sharing expert knowledge at NCI-CCC breast cancer conferences on questions not answered by current guidelines. These discussions are otherwise not documented or shared outside of academic centers. By translating discussions into actionable Q&A on an online oncologist network, we made them easily accessible to oncologists at nearly 200 community practices. Future efforts will be aimed at implementing the program into the breast cancer programs at additional NCI-CCCs.
Citation Format: Kalra M, Karuturi M, Tripathy D, Jankowitz R, McCann K, Brufsky A, Hurvitz S, Bogler O, Housri S, Housri N. Documenting and sharing breast cancer knowledge from National Cancer Institute designated comprehensive cancer centers (NCI-CCCs) with community oncologists [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 P5-16-01.
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Affiliation(s)
- M Kalra
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
| | - M Karuturi
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
| | - D Tripathy
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
| | - R Jankowitz
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
| | - K McCann
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
| | - A Brufsky
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
| | - S Hurvitz
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
| | - O Bogler
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
| | - S Housri
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
| | - N Housri
- Indiana University, Indianapolis, IN; MD Anderson Cancer Center, Houston, TX; University of Pittsburgh Medical Center, Pittsburgh, PA; University of California, Los Angeles, Los Angeles, CA; Yale University, New Haven, CT; themednet.org
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Fournier MV, Chen J, Obenauer J, Goodwin EC, Tannenbaum SH, Brufsky AM. Abstract P2-10-08: A predictive test for neoadjuvant chemotherapy in breast cancer identifies a subset of triple negative patients with resistant disease and the poorest prognosis. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-10-08] [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
Prediction of pathological complete response (pCR) for neoadjuvant treatment is an area of unmet clinical need, especially for triple negative breast cancer (TNBC) as pCR is correlated with better outcomes. Predicting which patients will have residual disease (RD) provides an opportunity to improve treatment planning. We developed a test to predict which patients are likely to achieve pCR or RD to the standard of care (taxane-based) neoadjuvant chemotherapy using gene expression profiling of 325 previously identified novel biomarkers.
Three microarray datasets were used (GSE22226, GSE25055, and GSE25065) including a total of 594 stage II-III breast cancer patients of which 125 (21%) achieved pCR, and 469 (79%) RD. ER+ tumors were present in 57% of the patients and 52% were PGR+. Almost 90% of the patients were Her2-. Of 231 TNBC, 78 (33.8%) achieved pCR, while 153 (66.2%) RD. Of 303 ER+Her- patients 26 (8.6%) achieved pCR while 277 (91.4%) RD. The cohort was divided into balanced populations with 476 patients used for training (80%) and test (20%) rounds of model development, while 118 patients were reserved as a validation set. Combining a “winnowing” process to remove genes with least predictive power, and hundreds of thousands of step-wise runs, followed by ranking genes based on conditional probabilities, we developed a 17-gene cassette (BA100) which was locked-down in the validation set with ROC (AUC) = 0.818. With a cut-off of 83% sensitivity and 68% specificity (PPV 0.4; NPV 0.94), BA100 achieved a 16% true positive rate (true pCR) and 55% true negative rate (true RD) identifying 76% of the patients who achieved pCR, and 69% of the patients with RD. In TNBC, BA100 classified 29% as true positives (TP), 36% as false positive (FP), 30% true negative (TN), and 4.8% false negative (FN). Kaplan Meier (KM) curves showed a significant difference in 5-year disease-free survival (5Y DFS) between TP and TN (p=0.00453) or FP (p=2.09E-06). However, FP had even worse outcomes than TN patients. To improve the TP rate, additional genes expressed in TNBC plus the original 325 genes were subjected to a second round of gene selection to discriminate between TP and FP, resulting in a 16-gene cassette (BA100.1). With a cut-off of 95% sensitivity and 73% specificity (PPV 0.7; NPV 0.95), applying BA100.1 reduced the FP rates from 24% to 9%, while correctly identifying 88% of RD in the validation set. KM curves showed no significant difference in 5Y DFS between 124 TNBC (53.7%) classified as TN versus 29 TNBC (12.6%) classified as FP, while a significant difference in survival rate was found between TNBC classified as TN vs TP (Cox Proportional Harzard p=8.42e-05).
Taken together, we developed a predictive test consisting of two gene cassettes that accurately identified 71% (88/104) of pCR, and 88% (417/469) of RD patients. Gene cassettes include several transcriptional repressors, PI3K signal transduction, components of telomerase, DNA repair genes, fatty acid metabolism and estrogen-independent proliferation. The test stratified TNBC with differential response to chemotherapy and survival rates so that novel approaches can be used without delay. Further validation will confirm the test utility.
Citation Format: Fournier MV, Chen J, Obenauer J, Goodwin EC, Tannenbaum SH, Brufsky AM. A predictive test for neoadjuvant chemotherapy in breast cancer identifies a subset of triple negative patients with resistant disease and the poorest prognosis [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 P2-10-08.
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Affiliation(s)
- MV Fournier
- Bioarray Genetics Inc., Farmington, CT; Rancho Biosciences LLC, San Diego, CA; University of Connecticut Health Center, Farmington, CT; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - J Chen
- Bioarray Genetics Inc., Farmington, CT; Rancho Biosciences LLC, San Diego, CA; University of Connecticut Health Center, Farmington, CT; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - J Obenauer
- Bioarray Genetics Inc., Farmington, CT; Rancho Biosciences LLC, San Diego, CA; University of Connecticut Health Center, Farmington, CT; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - EC Goodwin
- Bioarray Genetics Inc., Farmington, CT; Rancho Biosciences LLC, San Diego, CA; University of Connecticut Health Center, Farmington, CT; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - SH Tannenbaum
- Bioarray Genetics Inc., Farmington, CT; Rancho Biosciences LLC, San Diego, CA; University of Connecticut Health Center, Farmington, CT; University of Pittsburgh School of Medicine, Pittsburgh, PA
| | - AM Brufsky
- Bioarray Genetics Inc., Farmington, CT; Rancho Biosciences LLC, San Diego, CA; University of Connecticut Health Center, Farmington, CT; University of Pittsburgh School of Medicine, Pittsburgh, PA
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Brufsky A, Davis K, Mitra D, Nagar S, McRoy L, Cotter M, Stearns V. Abstract P5-21-24: Retrospective assessment of treatment patterns and outcomes associated with palbociclib plus letrozole for postmenopausal women with HR+/HER2– advanced breast cancer enrolled in an early access program. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-21-24] [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: The objective of this study was to evaluate treatment patterns and clinical outcomes among patients who received palbociclib in combination with letrozole (P+L) for the treatment of HR+/HER2–advanced breast cancer (ABC) as part of an Expanded Access Program (EAP) in the United States.
Methods: Data were obtained by a retrospective chart review of patients previously enrolled in the EAP. Complete data from time of initial diagnosis of ABC until the date of chart abstraction (end of follow-up), including the post-EAP period, were obtained. Clinical outcomes assessed included clinical benefit rate (CBR), defined as complete response, partial response, or stable disease for ≥24 weeks from P + L initiation, progression free survival (PFS) and overall survival (OS). Survival outcomes were assessed using the Kaplan-Meier statistical analysis.
Results: Data from 126 patients were included in this analysis. Median age was 62.5 years at EAP enrollment, and a majority of patients were Caucasian (83%). Approximately 25% of patients had de novo metastatic disease. A majority of patients had a performance status of ECOG 0 (56%) or 1 (37%) at EAP enrollment. Visceral disease was present in 71% of patients and 16% had bone-only disease. The majority of patients in this cohort from the EAP were heavily pre-treated, having had up to 5 prior lines of therapy in the metastatic setting prior to initiating P + L therapy; nearly 59% received 3+ prior lines before initiating P + L. Only 11% of patients received P + L as their initial regimen for MBC. At the time of the last available record, 12 patients were still on P + L therapy, an average of 21 months after the start of the EAP program. Nearly 80% of patients had prior AI exposure and 69% had prior chemotherapy. CBR was 33% for the overall sample of patients treated with P + L and 22% in those with 3+ prior lines of treatment. Patients with prior AI exposure in the ABC setting (n=100) had a CBR of 27% while those without prior AI exposure had CBR of 58%. Patients with prior chemotherapy (n=87) had a CBR of 28% and those without prior chemotherapy had CBR of 46%. For the entire cohort, 6- and 12-month PFS rates were 40% and 25% respectively; 12- and 24-month OS rates were 66% and 44%, respectively. Patients receiving 3+ lines of prior therapy had 6- and 12-month PFS rates of 28% and 19%, respectively, and 12- and 24-month OS rates of 59% and 34% respectively.
Conclusions: Our results suggest that the majority of patients enrolled in the EAP program derived benefit from receiving treatment with P + L despite multiple prior lines of treatment and prior endocrine-based therapy, including prior AI. These findings further demonstrate the benefit of treatment with palbociclib combination therapy in HR+/HER2– MBC.
Citation Format: Brufsky A, Davis K, Mitra D, Nagar S, McRoy L, Cotter M, Stearns V. Retrospective assessment of treatment patterns and outcomes associated with palbociclib plus letrozole for postmenopausal women with HR+/HER2– advanced breast cancer enrolled in an early access program [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 P5-21-24.
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Affiliation(s)
- A Brufsky
- University of Pittsburgh Medical Center; RTI Health Solutions; Pfizer, Inc.; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - K Davis
- University of Pittsburgh Medical Center; RTI Health Solutions; Pfizer, Inc.; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - D Mitra
- University of Pittsburgh Medical Center; RTI Health Solutions; Pfizer, Inc.; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - S Nagar
- University of Pittsburgh Medical Center; RTI Health Solutions; Pfizer, Inc.; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - L McRoy
- University of Pittsburgh Medical Center; RTI Health Solutions; Pfizer, Inc.; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - M Cotter
- University of Pittsburgh Medical Center; RTI Health Solutions; Pfizer, Inc.; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | - V Stearns
- University of Pittsburgh Medical Center; RTI Health Solutions; Pfizer, Inc.; Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
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Dabbs DJ, Serdy K, Onisko A, Clark BZ, Bhargava R, Smalley S, Perkins S, Brufsky AM. Abstract P4-08-04: The clinical utility of oncotype Dx for patients with recurrence scores of 10 or less: A value based pathology study of tumor histopathology and outcomes analysis in an integrated delivery and finance health system. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-08-04] [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
Introduction
The majority of publications regarding breast cancer GEPTs rarely supply detailed breast tumor histopathology in their outcome studies. As a result, the cost effective role of clinical risk assessment with histopathology of breast carcinomas tends to be minimized. The aims of this study are to characterize the details of breast tumor histopathology of patients with Oncotype Dx Recurrence Scores (RS) of 10 or less, and determine if Oncotype Dx offers value and clinical utility for patients with these low grade tumors
Methods
A total of 459 patients (18%) with Oncotype Dx RS of 10 or less were retrieved from a registry of 2558 patients with Oncotype Dx results. Patients had five years of follow-up with tumor registry and were treated with endocrine therapy alone. Tissue slides were available to review on 441/459 patients. Recorded details included (1) histopathologic type of carcinoma (2) mitotic score (MS), tubule formation, nuclear pleomorphism and Notttingham histologc (NG) grade. (3) Estrogen (ER) and progesterone (PgR) semiquantitated by Allred Score and Histologic Score (H Score: strong 200-300, moderate 100-199, weak <100). (4) Lymph node status. (5) overall survival and breast cancer specific survival.
Results
Patient ages were 33-92, with mean/median age of 60, and all had endocrine therapy alone. 148 of 441(34%) patients had carcinomas of “special types”, notable for low grade/good prognosis including tubular 22(15%), cribriform 15 (10.1%), papillary 17 (11.5%), and mucinous 28 (21%), along with 63 (42.5%) low grade classic lobular carcinomas and 3 (2%) low grade mixed ductal and lobular carcinomas. All 148 tumors had a MS of 1, were NG1 and had high ER HScores (280 median/263 mean) (Allred Scores 7-8) and high PR HScores (210 median/201 mean) (Allred Scores 6-8). The remaining 293 tumors were ductal carcinomas of no special type (NST), and 261/293 (89%) of these had a MS of 1/NG2. Of the remaining cases, 10 (3%) had a MS of 2/NG2, 18 (6%) had MS of 2/NG3 and four (1%) were MS3/NG3. Estrogen receptor H Score/Allred Score was strong (Allred Score 7-8) in 395/441 (89.6%), moderate in 45 (10.2%) and weak in 1 patient (0.2%). Progesterone HScores were strong in (Allred Score 6-8) 269/441 (76%) and moderate in the remainder. Strong and moderate ER comprised 99.8% of tumors. Thus, tumors with MS1, and NG1, all with ER HScore >200 (Allred Score of 7-8) were enriched in the RS <10, and these features distinguished this group from other tumors with a MS1.
At 5 years, 433 patients (98%) were alive, 8 were dead, 1 from breast cancer due to distant recurrence. The 5-year breast cancer specific survival for this group was 99.7%. [95%CI 98.5-99.9.] 87 cases were accrued in the ongoing prospective study to date. There were 15/87 (17%) cases, 95% of which were correctly identified by pathologists as having an RS <10 using the criteria defined, with sensitivity 95%, specificity 86%, PPV 63% 95% CI(49.76-75.08), NPV 99% 95% CI(90.7-99.78). No patient had a recurrence score >22.
Conclusions
Pathologists can identify these low risk tumors with high accuracy. Oncotype Dx lacks clinical value and utility in this setting.
Citation Format: Dabbs DJ, Serdy K, Onisko A, Clark BZ, Bhargava R, Smalley S, Perkins S, Brufsky AM. The clinical utility of oncotype Dx for patients with recurrence scores of 10 or less: A value based pathology study of tumor histopathology and outcomes analysis in an integrated delivery and finance health system [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 P4-08-04.
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Affiliation(s)
- DJ Dabbs
- Magee-Womens Hospitalof UPMC, Pittsburgh, PA; UPMC Health Plan, Pittsburgh, PA
| | - K Serdy
- Magee-Womens Hospitalof UPMC, Pittsburgh, PA; UPMC Health Plan, Pittsburgh, PA
| | - A Onisko
- Magee-Womens Hospitalof UPMC, Pittsburgh, PA; UPMC Health Plan, Pittsburgh, PA
| | - BZ Clark
- Magee-Womens Hospitalof UPMC, Pittsburgh, PA; UPMC Health Plan, Pittsburgh, PA
| | - R Bhargava
- Magee-Womens Hospitalof UPMC, Pittsburgh, PA; UPMC Health Plan, Pittsburgh, PA
| | - S Smalley
- Magee-Womens Hospitalof UPMC, Pittsburgh, PA; UPMC Health Plan, Pittsburgh, PA
| | - S Perkins
- Magee-Womens Hospitalof UPMC, Pittsburgh, PA; UPMC Health Plan, Pittsburgh, PA
| | - AM Brufsky
- Magee-Womens Hospitalof UPMC, Pittsburgh, PA; UPMC Health Plan, Pittsburgh, PA
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Kaufman P, Hurvitz S, O'Shaughnessy J, Mason G, Yardley D, Brufsky A, Rugo H, Cobleigh M, Swain S, Tripathy D, Chu L, Antao V, Yoo B, Jahanzeb M. Baseline characteristics and first-line (1L) treatment of patients with HER2+ metastatic breast cancer (MBC) from the SystHERs registry. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.037] [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: 11/14/2022] Open
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Jahanzeb M, Tripathy D, Hurvitz S, O'Shaughnessy J, Mason G, Yardley D, Brufsky A, Rugo H, Cobleigh M, Swain S, Chu L, Antao V, Yoo B, Kaufman P. First-line treatment patterns by age for patients (pts) with HER2+ metastatic breast cancer (MBC) in the SystHERs registry. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx365.038] [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: 11/14/2022] Open
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Jahanzeb M, Tripathy D, Rugo H, Swain S, Kaufman PA, Mayer M, Hurvitz S, O'Shaughnessy J, Mason G, Yardley DA, Brufsky A, Chu L, Antao V, Beattie M, Yoo B, Cobleigh M. Abstract P5-08-27: Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p5-08-27] [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
Introduction In 2010, the cutoff for HR positivity in breast cancer was established as ≥1% of cells staining HR+, previously having varied from 1% to 10%. The impact of this change on treatment patterns and outcomes is poorly understood. SystHERs is a prospective, observational cohort registry of patients (pts) with HER2+ metastatic breast cancer (MBC) that commenced enrollment in 2012. To our knowledge, SystHERs is the largest registry to collect and analyze data for the HER2+ subgroup. We report baseline characteristics, treatment patterns, and early outcomes by %HR+ (1–9% vs 10–100%).
Methods SystHERs enrolled pts aged ≥18 years and within 6 months of HER2+ MBC diagnosis. For pts with locally-determined HR+ disease, defined as HR+ in primary or metastatic tissue, %HR+ is the highest percentage of ER+ or PR+ tissue in early breast cancer or MBC. The percentage of ER+ or PR+ cells was not reported for pts considered HR– by the investigator. Median overall survival (OS; Kaplan–Meier) and hazard ratios (Cox regression) were estimated.
Results As of Feb 1, 2016, data were available for 872 eligible pts with known HR status, of whom 608 (70%) had HR+ disease. Of the 608 pts, 53 (9%) had 1–9%HR+ and 496 (82%) had 10–100%HR+; %HR+ was not reported for 59 pts. Baseline characteristics were similar between %HR+ subgroups (Table 1).
As shown in Table 2, the 1–9%HR+ subgroup was less likely to receive first-line hormonal therapy (26%) than the 10–100%HR+ subgroup (56%). 87% and 79% of pts received chemotherapy, respectively.
Median time from MBC diagnosis was 16.5 months (range, 0.4–49.4 months). Median OS was not reached at the data cutoff. The number of deaths was 13 (25%) in the 1–9%HR+ subgroup, and 68 (14%) in the 10–100%HR+ subgroup (log-rank P=0.025). The OS hazard ratio (0.514, 95% CI 0.283–0.931) favored the 10–100%HR+ subgroup. OS did not differ significantly between pts with 1–9%HR+ vs HR– disease (log-rank P=0.582, hazard ratio 1.185, 95% CI 0.647–2.169).
Table 1. Baseline characteristics 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)Age at MBC diagnosis, median yrs (range)54 (30–86)57 (21–86)55 (28–88)Race, % White838372Black151320Premenopausal, %282522ECOG performance status, % 04654441463942≥2878MBC diagnosis type, % De novo404958Recurrent605142Visceral, %*686275*Non-hepatic abdominal, ascites, CNS, liver, lung, or pleural effusion sites of metastasis
Table 2. First-line treatment 1-9%HR+ (n=53)10-100%HR+ (n=496)HR– (n=264)HER2-targeted therapy, %969391Chemotherapy, %877989Hormonal therapy, %26564
Conclusions These preliminary observational data suggest potential differences in treatment patterns and survival outcomes in low vs moderate/high HR+ expressers, with the former being less likely to receive hormonal therapy (26% vs 56%). Furthermore, low HR positivity was associated with poorer OS and was similar to OS observed in pts with HR– disease.
Citation Format: Jahanzeb M, Tripathy D, Rugo H, Swain S, Kaufman PA, Mayer M, Hurvitz S, O'Shaughnessy J, Mason G, Yardley DA, Brufsky A, Chu L, Antao V, Beattie M, Yoo B, Cobleigh M. Treatment patterns and clinical outcomes in patients with hormone receptor (HR)+ HER2+ metastatic breast cancer and low vs high levels of HR positivity from the SystHERs Registry [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 P5-08-27.
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Affiliation(s)
- M Jahanzeb
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - D Tripathy
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - H Rugo
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - S Swain
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - PA Kaufman
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - M Mayer
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - S Hurvitz
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - J O'Shaughnessy
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - G Mason
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - DA Yardley
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - A Brufsky
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - L Chu
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - V Antao
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - M Beattie
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - B Yoo
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
| | - M Cobleigh
- University of Miami Sylvester Comprehensive Cancer Center; University of Texas MD Anderson Cancer Center; University of California San Francisco Helen Diller Family Comprehensive Cancer Center; Washington Cancer Institute, MedStar Washington Hospital Center; Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center; AdvancedBC.org; UCLA Jonsson Comprehensive Cancer Center and Translational Research in Oncology; Baylor Charles A. Sammons Cancer Center, Texas Oncology, US Oncology; Inflammatory Breast Cancer Research Foundation; Sarah Cannon Research Institute and Tennessee Oncology, PLLC; University of Pittsburgh Cancer Institute; Genentech, Inc.; Rush University Medical Center
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Farrugia DJ, Landmann A, McAuliffe PF, Diego EJ, Johnson R, Bonaventura M, Soran A, Dabbs DJ, Clark B, Lembersky BC, Puhalla SL, Brufsky A, Jankowitz R, Davidson NE, Ahrendt GM, Bhargava R. Abstract P6-09-14: Prognostic significance of a modified residual disease in breast and nodes (mRDBN) algorithm after neoadjuvant therapy for breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-09-14] [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: Patients achieving pathologic complete response to neoadjuvant chemotherapy have excellent disease free and overall survival. For patients with residual disease, the residual disease in breast and lymph node (RDBN) method provides useful prognostic information. RDBN is calculated as follows: 0.2*tumor size (in cm)+lymph node status (0-3) + tumor grade (1-3). pCR, low, intermediate and high risk of recurrence categories correspond to RDBN index of 0, 0.1 to 2.9, 3 to <4.4, and ≥ 4.4, respectively. We hypothesized that the prognostic accuracy of RDBN may be improved by also taking into account the residual tumor cellularity.
Methods: Retrospective review of 614 consecutive patients who underwent neoadjuvant therapy for breast cancer was performed. At our institution, tumor size/volume reduction in the breast is determined using the equation:
Estimated % tumor size reduction = [(pre-therapy clinical size – “revised” pathology tumor size)/pre-therapy clinical size]*100.
“Revised” pathology tumor size is calculated by multiplying the largest dimension of the gross tumor bed by the invasive tumor cellularity of the tumor bed (in comparison to the pre-therapy core biopsy sample). For example, if a 3 cm tumor bed has only 50% cellularity for invasive cancer (in comparison to pre-therapy core biopsy), the revised tumor size is 1.5 cm. Hence, we were able to use the “revised tumor size” for calculating the modified RDBN index (mRDBN). We also used gross tumor bed size for gross RDBN (gRDBN) to compare with mRDBN. mRDBN and gRDBN could be calculated on 459 of the 514 cases. Chi-Square statistical analysis was performed.
Results: Mean follow up was 33.1 months (median 31, range 4-70).
The results are shown in Table 1 & 2.
Table 1. Overall Recurrence and MortalityRDBN Score Category Overall Recurrence Mortality nn (%)RR95% CI; pn (%)RR95% CI; pmRDBN (n=459)High5829 (50.0)19.63[7.22, 53.40]; p=<0.000118 (31.0)16.24[4.97, 53.10]; p=<0.0001Intermed16433 (20.1)7.9[2.86, 21.78]; p=<0.000115 (9.1)4.79[1.41, 16.21]; p=0.006Low803 (3.8)1.47[0.34, 6.42]; p=0.694 (5.0)2.62[0.60, 11.41]; p=0.23pCR1574 (2.5)REF 3 (1.9)REF gRDBN (n=459)High8131 (38.3)15.02[5.49, 41.09]; p=<0.000119 (23.5)12.28[3.74, 40.26]; p=<0.0001Intermed14932 (21.5)8.43[3.05, 23.26]; p=<0.000116 (10.7)5.62[1.67, 18.89]; p=0.003Low722 (2.8)1.09[0.20, 5.82]; p=12 (2.8)1.45[0.25, 8.51]; p=1pCR1574 (2.5)REF 3 (1.9)REF
Table 2; Reclassification of gRDBN categoriesgRDBN mRDBN ReclassificationClassificationnLow (%)Intermed (%)High (%)Low7272 (100)0 (0)0 (0)Intermed1498 (5.4)140 (93.9)1 (0.7)High810 (0)24 (29.6)57 (70.4)
Conclusions: Both mRDBN and gRDBN provide prognostic information; however, separation of categories is improved with mRDBN (Table 1). mRDBN reclassified 30% of the high risk-gRDBN patients into intermediate risk category with a recurrence rate of 20%, leaving the 'true' high risk subgroup with a revised recurrence rate of 50% (Table 2). RDBN index also identified a group of low risk patients who have prognosis similar to patients with pCR.
Citation Format: Farrugia DJ, Landmann A, McAuliffe PF, Diego EJ, Johnson R, Bonaventura M, Soran A, Dabbs DJ, Clark B, Lembersky BC, Puhalla SL, Brufsky A, Jankowitz R, Davidson NE, Ahrendt GM, Bhargava R. Prognostic significance of a modified residual disease in breast and nodes (mRDBN) algorithm after neoadjuvant therapy for 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 P6-09-14.
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Affiliation(s)
- DJ Farrugia
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - A Landmann
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - PF McAuliffe
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - EJ Diego
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R Johnson
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - M Bonaventura
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - A Soran
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - DJ Dabbs
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - B Clark
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - BC Lembersky
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - SL Puhalla
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - A Brufsky
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R Jankowitz
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - NE Davidson
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - GM Ahrendt
- University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R Bhargava
- University of Pittsburgh Medical Center, Pittsburgh, PA
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Oesterreich S, Basudan A, Preideigkeit N, Hartmaier RJ, Bahreini A, Gyanchandani R, Leone JP, Lucas PC, Hamilton RL, Brufsky AM, Lee AV. Abstract P6-07-07: ESR1 amplification and 5'-3' exon imbalance in metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-07-07] [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: Growing evidence indicates that base pair mutations in ESR1 are relatively uncommon in newly diagnosed, treatment-naive breast cancer, but frequently acquired in hormone-resistant metastatic breast cancer (MBC). We and others have recently identified ESR1 gene fusion and amplification in MBC, with the ESR1 fusions generally encompassing AF1 and the DNA binding domain. The genomic break required for gene fusions often results in an imbalance in the DNA copy number of exons around the break. We examined ESR1 amplification and 5' and 3' exon copy number imbalance in MBC.
MATERIALS and METHODS: We designed NanoString DNA hybridization probes against coding and non-coding exons (n=9) in ESR1 and 15 reference probes. We analyzed 128 samples consisting of 61 ER-positive and 44 ER-negative metastases, and 23 primary breast cancers. DNA copy number (CN) was determined using nSolver, with >2.7CN as copy number gain, and >10 as CN amplification. ESR1 CN was calculated by averaging the DNA copy number obtained from all coding exons. The 5'-3' copy number ratio was the average copy number of the 5' exons (3-6) divided by the 3' exons (7-10).
RESULTS: 8 (13%) ER positive metastatic breast cancers showed ESR1 amplification with 5 (8%) having >2.7CN, and 3 (5%) with >10CN. In contrast, in ER-negative metastases, we did not detect any samples with amplification >10CN, and a gain (>2.7 CN) in one case. Similarly, in ER+ primary cancers we did not detect any samples with >10 CN amplifications and 2 samples with CN gain (>2.7 CN). ESR1 showed 5'-3' CN imbalance in 1 primary (5%) and in 5 metastatic (5%) breast cancers. We are currently confirming and expanding these data in a larger dataset.
CONCLUSIONS: In addition to ESR1 mutations, ESR1 CN amplifications and 5'-3' imbalance are represent frequent occurrences in endocrine resistant breast cancer. Future studies are aimed at understanding whether the observed exon imbalances are associated with generation of fusion proteins, and whether and how ESR1 amplifications cause changes in endocrine treatment response.
Citation Format: Oesterreich S, Basudan A, Preideigkeit N, Hartmaier RJ, Bahreini A, Gyanchandani R, Leone JP, Lucas PC, Hamilton RL, Brufsky AM, Lee AV. ESR1 amplification and 5'-3' exon imbalance in 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 P6-07-07.
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Affiliation(s)
- S Oesterreich
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - A Basudan
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - N Preideigkeit
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - RJ Hartmaier
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - A Bahreini
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - R Gyanchandani
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - JP Leone
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - PC Lucas
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - RL Hamilton
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - AM Brufsky
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
| | - AV Lee
- University Of Pittsburgh Cancer Institute, Pittsburgh, PA; Foundation Medicine, Cambridge, MA; University of Iowa Carver College of Medicine, Iowa City, IA
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Schroeder BE, Zhang Y, Stal O, Fornander T, Brufsky A, Sgroi DC, Schnabel CA. Abstract P2-05-14: Prognostic impact of genomic risk stratification with breast cancer index in patients with clinically low risk, hormone receptor-positive, node-negative, T1 breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-05-14] [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: Tumor size and nodal status are prognostic for risk of both early and late disease recurrence in patients with early stage, HR+ breast cancer, and are incorporated into both adjuvant chemotherapy and extended endocrine therapy treatment decisions. In a recent EBCTCG meta-analysis of over 46,000 patients [Pan H, et al. J Clin Oncol 34, 2016 (suppl; abstr 505)], risk of late distant recurrence was assessed in patient subsets based on nodal status and tumor size. Patients with T1N0 disease who were treated with 5 years endocrine therapy had a good overall prognosis, with 4%, 9%, and 14% risk of distant recurrence from years 5-10, 5-15, and 5-20, respectively. Breast Cancer Index (BCI) has been validated as prognostic biomarker for risk of both early and late distant recurrence in multiple randomized trial cohorts. The aim of this analysis was to assess distant recurrence (DR) risk stratification with BCI in patients with clinically low-risk T1N0 tumors.
Methods: Primary tumor samples from the subset of patients with T1N0 disease from 2 independent validation cohorts of HR+ breast cancer patients were examined [Stockholm randomized controlled trial (N=259) and a retrospective multi-institutional cohort (N=237)]. Patients in the Stockholm RCT cohort were treated with adjuvant tamoxifen only; patients in the multi-institutional cohort were treated with adjuvant tamoxifen +/- chemotherapy (20.3%). No patients received extended endocrine therapy. Kaplan-Meier analysis was used to assess the risk of DR within distinct BCI risk groups. Time dependent analysis was performed by combining BCI Low and Intermediate risk groups for risk of early recurrence (0-5y), and BCI Intermediate and High risk groups for risk of late recurrence (>5y).
Results: In the Stockholm cohort, BCI identified 13% of T1N0 patients as high risk for relapse within the first 5y, and these patients had a significantly reduced distant recurrence-free survival (DRFS, 85.3%) compared to BCI Low Risk patients (97.7%; P=0.0004). In patients disease-free at year 5, BCI identified 32% of patients as high risk for late recurrence; these patients had significantly lower DRFS (86.7%) between years 5-15 compared to BCI low risk patients (95.4%; P=0.0263). In the multi-institutional cohort, 22% of T1N0 patients were identified by BCI as high risk for relapse within the first 5y, and these patients had a significantly reduced DRFS (77.3%) compared to BCI low risk patients (96.2%; P<0.0001). In patients disease-free at year 5, 36% of patients were identified by BCI as high risk for late recurrence, with significantly lower DRFS (89.6%) between years 5-10 compared to BCI Low Risk patients (98.4%; P=0.008).
Conclusions: HR+ Patients with favorable clinical features (T1N0) have a good overall prognosis. However, results of this study demonstrated that adding molecular resolution on tumor biology with BCI identified a significant subset of women with higher risk of both early and late distant recurrence; findings support consideration of genomic classification in T1N0 patients to identify additional candidates for adjuvant chemotherapy and/or extended endocrine therapy, respectively.
Citation Format: Schroeder BE, Zhang Y, Stal O, Fornander T, Brufsky A, Sgroi DC, Schnabel CA. Prognostic impact of genomic risk stratification with breast cancer index in patients with clinically low risk, hormone receptor-positive, node-negative, T1 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 P2-05-14.
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Affiliation(s)
- BE Schroeder
- Biotheranostics, Inc., San Diego, CA; Linköping University, Linköping, Sweden; Karolinska Institute, Stockholm, Sweden; University of Pittsburgh Medical Center, Pittsburgh, PA; Massachesetts General Hospital, Boston, MA
| | - Y Zhang
- Biotheranostics, Inc., San Diego, CA; Linköping University, Linköping, Sweden; Karolinska Institute, Stockholm, Sweden; University of Pittsburgh Medical Center, Pittsburgh, PA; Massachesetts General Hospital, Boston, MA
| | - O Stal
- Biotheranostics, Inc., San Diego, CA; Linköping University, Linköping, Sweden; Karolinska Institute, Stockholm, Sweden; University of Pittsburgh Medical Center, Pittsburgh, PA; Massachesetts General Hospital, Boston, MA
| | - T Fornander
- Biotheranostics, Inc., San Diego, CA; Linköping University, Linköping, Sweden; Karolinska Institute, Stockholm, Sweden; University of Pittsburgh Medical Center, Pittsburgh, PA; Massachesetts General Hospital, Boston, MA
| | - A Brufsky
- Biotheranostics, Inc., San Diego, CA; Linköping University, Linköping, Sweden; Karolinska Institute, Stockholm, Sweden; University of Pittsburgh Medical Center, Pittsburgh, PA; Massachesetts General Hospital, Boston, MA
| | - DC Sgroi
- Biotheranostics, Inc., San Diego, CA; Linköping University, Linköping, Sweden; Karolinska Institute, Stockholm, Sweden; University of Pittsburgh Medical Center, Pittsburgh, PA; Massachesetts General Hospital, Boston, MA
| | - CA Schnabel
- Biotheranostics, Inc., San Diego, CA; Linköping University, Linköping, Sweden; Karolinska Institute, Stockholm, Sweden; University of Pittsburgh Medical Center, Pittsburgh, PA; Massachesetts General Hospital, Boston, MA
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Miles D, Kim SB, McNally V, Simmons B, Wongchenko M, Xu N, Brufsky A. Abstract OT2-01-02: COLET: A multistage, phase 2 study evaluating the safety and efficacy of a doublet regimen of cobimetinib (C) in combination with paclitaxel (P) or triplet regimens of C in combination with atezolizumab (atezo) plus either P or nab-paclitaxel (nab-P) in metastatic triple-negative breast cancer (TNBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-ot2-01-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Preclinical data suggest that upregulation of the MAPK pathway confers resistance to taxane chemotherapy. Mutations and gene amplifications in the MAPK pathway are present in many TNBC tumors and may contribute to taxane resistance. Preliminary data from an initial safety run-in stage of the COLET study (ClinicalTrials.gov ID, NCT02322814; EudraCT number, 2014-002230-32) suggest improvement of clinical outcomes when MEK inhibition is combined with taxane chemotherapy. Additionally, in preclinical models, MEK inhibition was shown to enhance anti–PD-L1 activity. The monoclonal antibody PD-L1 inhibitor atezo has shown promising activity in combination with nab-P in metastatic TNBC. Accordingly, the COLET protocol was amended to include the evaluation of triplet regimens combining atezo with MEK inhibition and taxane chemotherapy[SL1] . COLET is evaluating the safety and efficacy of various combinations of C as first-line treatment for metastatic or locally advanced TNBC. Key eligibility criteria include measurable disease per Response Evaluation Criteria in Solid Tumors, version 1.1 (RECIST v1.1) and left ventricular ejection fraction > institutional lower limit of normal or >50%. Neoadjuvant or adjuvant therapy is allowed if completed >6 months prior to study entry. COLET has 3 cohorts: I, II, and III. Cohort I has 2 stages: an initial safety run-in stage (n∼12) followed by an expansion stage (n∼90) of 1:1 randomization to C + P or placebo (PBO) + P. Patients received P 80 mg/m2 on days 1, 8, and 15 and C/PBO 60 mg/day on days 3-23 of each 28-day cycle. In the expansion stage of Cohort I, randomization is stratified by prior neoadjuvant/adjuvant taxane therapy and disease-free interval from last chemotherapy dose. Cohorts II and III will evaluate the safety and efficacy of adding atezo to C + P or nab-P, respectively. Each cohort has a safety run-in stage (n∼15) and an expansion stage (additional n∼15); each will receive atezo 840 mg on days 1 and 15 and C 60 mg/day on days 3-23 of every 28-day cycle. Cohort II will receive P 80 mg/m2 and Cohort III will receive intravenous nab-P 100 mg/m2 on days 1, 8, and 15. Patients will receive treatment until disease progression or toxicity. The primary efficacy end point is investigator-assessed progression-free survival (PFS) for the expansion stage (Cohort I), and the primary PFS analysis will be performed when 60 PFS events occur across the 2 arms. This provides 77% power to detect a hazard ratio of 0.5 at a two-sided significance level of 0.05. For Cohorts II and III, the primary efficacy end point is overall response rate per RECIST v1.1; secondary end points include duration of response, PFS, and overall survival. Recruitment into the safety run-in stage of Cohort I is complete. Accrual into the randomization stage of Cohort I and the initial safety run-in stage of Cohorts II and III are ongoing. Patients from sites across North America, Europe, and the Asia-Pacific region will be enrolled.
Citation Format: Miles D, Kim S-B, McNally V, Simmons B, Wongchenko M, Xu N, Brufsky A. COLET: A multistage, phase 2 study evaluating the safety and efficacy of a doublet regimen of cobimetinib (C) in combination with paclitaxel (P) or triplet regimens of C in combination with atezolizumab (atezo) plus either P or nab-paclitaxel (nab-P) in metastatic triple-negative breast cancer (TNBC) [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 OT2-01-02.
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Affiliation(s)
- D Miles
- Mount Vernon Cancer Centre, London, United Kingdom; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Roche Products Ltd., Welwyn Garden City, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - S-B Kim
- Mount Vernon Cancer Centre, London, United Kingdom; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Roche Products Ltd., Welwyn Garden City, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - V McNally
- Mount Vernon Cancer Centre, London, United Kingdom; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Roche Products Ltd., Welwyn Garden City, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - B Simmons
- Mount Vernon Cancer Centre, London, United Kingdom; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Roche Products Ltd., Welwyn Garden City, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - M Wongchenko
- Mount Vernon Cancer Centre, London, United Kingdom; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Roche Products Ltd., Welwyn Garden City, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - N Xu
- Mount Vernon Cancer Centre, London, United Kingdom; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Roche Products Ltd., Welwyn Garden City, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - A Brufsky
- Mount Vernon Cancer Centre, London, United Kingdom; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Roche Products Ltd., Welwyn Garden City, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
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Sanft T, Berkowitz A, Schroeder B, Hatzis C, Schnabel C, Aktas B, Brufsky A, Pusztai L, vanLonden GJ. Abstract P2-09-15: A multi-institutional, prospective study of incorporating the genomic platform breast cancer index as a tool for decision-making regarding extension of adjuvant endocrine therapy. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p2-09-15] [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: Extending adjuvant endocrine therapy (AET) for hormone responsive breast cancer (HRBC) from 5 to 10 years is beneficial for many in preventing late relapse. Current decision-making regarding extension relies on a decision-making process that weighs non-personalized recurrence risks against risks and benefits of extended AET. The Breast Cancer Index (BCI, BioTheranostics Inc) has been validated to quantify the risk of late recurrence and to predict likelihood of benefit from AET extension based on an individual's tumor genomic profile. The purpose of this study was to conduct a multi-institutional study to prospectively assess the impact of BCI i) on provider's recommendation using the BCI results; 2) the confidence with decision-making; and 3) patient's satisfaction regarding extension of AET.
Methods: Patients with stage I-III HRBC treated at Yale Cancer Center and University of Pittsburgh Medical Center (UPMC), who had completed at least 3.5 years of AET were eligible. BCI was performed on FFPE samples from the original tumor sample (bioTheranostics Inc.). Patients and physicians completed pre- and post-test questionnaires examining preferences for extending AET, patients also completed anxiety and decision-conflict surveys.
Results: 140 patients [mean age 61, 80% postmenopausal, 73% stage I] were included. No extended AET was recommended for 35.3% patients' pre-testing. Reasons physicians did not recommend extended AET were perceived low risk of recurrence (87%), risk of osteoporosis (25%) and side effects (13%). Extended therapy was recommended for 65.7% patients pre-testing. Integration of BCI resulted in a change in physician treatment recommendation in 29% of patients. The recommendation for no extended AET rose to 48% and recommendation for extended AET dropped to 52% (OR=1.76 95% CI 1.08-2.85; p=.003). Of the recommendations that changed (N=41), the majority (73%) was for not extending endocrine therapy. However, 27% of recommendations were to extend endocrine therapy because of high risk or high likelihood of benefit results. More physicians felt strongly confident in their recommendation after the test result (26.4%) than before (9.3%) (OR= 3.5 95% CI 1.77-6.95; p<.0001). Satisfaction of decision increased in 23% of patients (OR=2.72 95% CI 1.66-4.46; p<.0001). Patient reported concerns including the cost, safety and benefit of extended AET decreased from pre- to post-testing (p=.025; p<.0001; p=.0012 respectively)
Conclusions: Overall, incorporation of BCI into clinical practice resulted in significant changes in physician recommendations regarding AET duration, with the majority of recommendations for no extended AET. Physicians reported increased confidence for their recommendation when incorporating the test result. There was also a significant increase in patient satisfaction and decrease in patient reported concerns regarding cost, safety and benefit of extended AET. The BCI is a tool that could be incorporated into decision-making algorithms to enhance physician confidence and patient satisfaction with recommendations for extending AET.
Citation Format: Sanft T, Berkowitz A, Schroeder B, Hatzis C, Schnabel C, Aktas B, Brufsky A, Pusztai L, vanLonden GJ. A multi-institutional, prospective study of incorporating the genomic platform breast cancer index as a tool for decision-making regarding extension of adjuvant endocrine therapy [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 P2-09-15.
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Affiliation(s)
- T Sanft
- Yale School of Medicine; University of Pittsburg Medical Center; Biotheranostics, Inc.; Istanbul Medeniyet University Goztepe Research and Training Hospital
| | - A Berkowitz
- Yale School of Medicine; University of Pittsburg Medical Center; Biotheranostics, Inc.; Istanbul Medeniyet University Goztepe Research and Training Hospital
| | - B Schroeder
- Yale School of Medicine; University of Pittsburg Medical Center; Biotheranostics, Inc.; Istanbul Medeniyet University Goztepe Research and Training Hospital
| | - C Hatzis
- Yale School of Medicine; University of Pittsburg Medical Center; Biotheranostics, Inc.; Istanbul Medeniyet University Goztepe Research and Training Hospital
| | - C Schnabel
- Yale School of Medicine; University of Pittsburg Medical Center; Biotheranostics, Inc.; Istanbul Medeniyet University Goztepe Research and Training Hospital
| | - B Aktas
- Yale School of Medicine; University of Pittsburg Medical Center; Biotheranostics, Inc.; Istanbul Medeniyet University Goztepe Research and Training Hospital
| | - A Brufsky
- Yale School of Medicine; University of Pittsburg Medical Center; Biotheranostics, Inc.; Istanbul Medeniyet University Goztepe Research and Training Hospital
| | - L Pusztai
- Yale School of Medicine; University of Pittsburg Medical Center; Biotheranostics, Inc.; Istanbul Medeniyet University Goztepe Research and Training Hospital
| | - GJ vanLonden
- Yale School of Medicine; University of Pittsburg Medical Center; Biotheranostics, Inc.; Istanbul Medeniyet University Goztepe Research and Training Hospital
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Priedigkeit N, Hartmaier RJ, Chen Y, Vareslija D, Basudan A, Thomas R, Leone JP, Lucas PC, Bhargava R, Hamilton RL, Chmielecki J, Davidson NE, Oesterreich S, Brufsky AM, Young L, Lee AV. Abstract PD1-05: Breast cancer brain metastases show limited intrinsic subtype switching, yet exhibit acquired ERBB2 amplifications and activating mutations. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-pd1-05] [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: Metastasis is the major cause of mortality in breast cancer (BrCa) patients. Our understanding of brain metastasis (BrM) is limited, reflected by a lack of effective treatments. We aimed to (1) determine BrCa gene signature differences between primary tumors and matched BrM and (2) uncover BrM-specific alterations that may be clinically actionable.
MATERIALS and METHODS: NanoString expression profiling of 127 genes from 5 major prognostic tests (MammaPrint, EndoPredict, PAM50, OncotypeDX, MGI) was performed on 20 patient-matched primary (10 ER-neg, 10 ER-pos) and metastatic brain tumors. Subtype classification was performed using genefu. Protein changes in ER and HER2 (ERBB2) were confirmed by IHC. BrM-specific ERBB2 gains were corroborated in a publicly available dataset of 18 additional patient-matched cases (dbGAP phs000730.v1.p1). To test whether ERBB2 amplification and base pair mutation is metastasis-site specific, we further analyzed an expanded cohort of 7,884 breast tumors enriched for metastatic samples (52%) including liver (16.7%), lung (4.3%), bone (3.6%), and brain (2.0%) using comprehensive hybrid-capture sequencing of ERBB2.
RESULTS: 17/20 BrM retained the PAM50 subtype of the primary BrCa. Despite this concordance, 17/20 BrM harbored expression changes (< or > 2-fold) in clinically actionable genes including gains of FGFR4 (30%), FLT1 (20%), AURKA (10%) and loss of ESR1 expression (45%). The most recurrently upregulated gene was ERBB2, showing a >2-fold expression increase in 35% of BrM. 3 of 13 (23.3%) cases originally HER2-negative, and thus HER2-therapy naive, in the primary BrCa were IHC-positive (3+) in the paired BrM with an observed metastasis-specific amplification of the ERBB2 locus. In an independent dataset, 2 of 9 (22.2%) HER2-negative BrCa switched to HER2-positive with one BrM acquiring ERBB2 amplification and the other showing metastastic enrichment of the activating V777L ERBB2 mutation. Analysis of a large cohort of breast tumors (n=7,884) showed that across all organs ERBB2 amplification and/or base pair mutation was similar (p=0.18) between primary (13%) and metastatic disease (12%), however, a strong and significant enrichment was seen for BrM (primary 13% vs BrM 24%, p<0.0005).
CONCLUSIONS: Taken together, these results demonstrate that the majority (85%) of patient-matched BrM retain the intrinsic subtype of the primary cancer. However, despite this transcriptional similarity, alterations in clinically actionable genes are common, with BrM acquiring ERBB2 amplifications and/or base pair mutations at a frequency of ∼20%, even in HER2-therapy naive tumors. In a large cohort of primary and metastatic breast cancers, there is also a unique enrichment for ERBB2 alterations in BrM. This study provides a strong rationale to molecularly profile metastatic lesions to both better understand biological mechanisms of metastases and to perhaps refine therapeutic decision-making in advanced cancers.
Citation Format: Priedigkeit N, Hartmaier RJ, Chen Y, Vareslija D, Basudan A, Thomas R, Leone JP, Lucas PC, Bhargava R, Hamilton RL, Chmielecki J, Davidson NE, Oesterreich S, Brufsky AM, Young L, Lee AV. Breast cancer brain metastases show limited intrinsic subtype switching, yet exhibit acquired ERBB2 amplifications and activating mutations [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 PD1-05.
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Affiliation(s)
- N Priedigkeit
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - RJ Hartmaier
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - Y Chen
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - D Vareslija
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - A Basudan
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - R Thomas
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - JP Leone
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - PC Lucas
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - R Bhargava
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - RL Hamilton
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - J Chmielecki
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - NE Davidson
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - S Oesterreich
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - AM Brufsky
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - L Young
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
| | - AV Lee
- University of Pittsburgh, Pittsburgh, PA; Foundation Medicine Inc., Cambridge, MA; Royal College of Surgeons, Dublin, Leinster, Ireland; University of Iowa, Iowa City, IA
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Mayer IA, Arteaga CL, Nanda R, Miller KD, Jhaveri K, Brufsky AM, Rugo H, Yardley DA, Vahdat LT, Sadeghi S, Audeh MW, Rolfe L, Litten J, Knox A, Raponi M, Tankersley C, Isaacson J, Wride K, Morganstern DE, Vogel C, Connolly RM, Gradishar WJ, Patel R, Pusztai L, Abu-Khalaf M. Abstract P6-11-03: A phase 2 open-label study of lucitanib in patients (pts) with FGF aberrant metastatic breast cancer (MBC). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-11-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: Lucitanib is a potent, oral antiangiogenic tyrosine kinase inhibitor of Vascular Endothelial Growth Factor Receptors 1-3 (VEGFR1-3), Platelet-Derived Growth Factor Receptors alpha and beta (PDGFRα/β), and Fibroblast Growth Factor Receptors 1-3 (FGFR1-3). FGF aberrancies (amplification of FGFR1,or 11q[amplicon containing FGF ligands 3, 4, and 19]), are genomic alterations observed in over 20% of breast cancer pts and promote cancer proliferation and survival.
METHODS: MBC pts who had received at least 1 metastatic line of therapy were randomized 1:1 to 10 or 15 mg QD of lucitanib. Stratification was based on local assessment of FGF aberrancy; pts with both FGFR1 and 11q-amplified tumors were stratified as FGFR1 amplified. Central confirmation of FGFR1 or 11q amplification was done using Abbott FISH probes (FGFR1 or 11q copy number ≥ 6 and a ratio of FGFR1 or 11q to centromere ≥ 2). Investigator-assessed progression-free survival (PFS) was the primary endpoint. Secondary endpoints included objective response rate (ORR) per RECIST 1.1, disease control rate (DCR), duration of response (DR), and incidence of treatment-emergent adverse events (TEAE).
RESULTS: Enrollment completed in 3/2016; 178 pts that received at least 1 dose of lucitanib are included in this analysis (baseline characteristics in Table 1). Due to grade 3 hypertension in the 15 mg group (46% vs 37% in 10 mg group), enrollment to the 15 mg group was halted. Overall, most pts (97%) experienced at least 1 TEAE, with the most frequently (≥ 30%) occurring events being hypertension (73%), fatigue (48%), nausea (43%), hypothyroidism (40%), and headache (33%). Grade ≥ 3 TEAEs occurred in 66% of pts, with hypertension as the most frequent event (40%) followed by proteinuria and hyponatremia (both 6%). AEs were manageable with dose interruption or reduction, with approximately 8% of pts ending treatment due to an AE. Current median PFS is 3.5 mos (95% CI 2.8-4.6; range 0.62-12.95) and 2.6 mos (95% CI 1.8-2.9; range 0.82-18.87) respectively for the 10 mg and 15 mg treatment groups. No differences in clinical activity were observed by treatment group, FGF aberrancy, hormone receptor or HER2 status. Of the 168 evaluable pts, confirmed ORR was 3%; overall DCR was 27% (32% for pts in the 10 mg group compared to 20% for the 15 mg group); overall mean (standard deviation) DR of 3.3 (1.8) mos.
Baseline Characteristics 10 mg QD15 mg QD N=109N=69Age (years)Median5653Range27-8227-80SexFemale109 (100%)67 (97%)Male02 (3%)ECOG PSmissing5 (5%)2 (3%)051 (47%)30 (43%)153 (49%)37 (54%)Number of prior anticancer therapies in the metastatic setting> 332 (29%)21 (30%)3-648 (44%)32 (46%)> 629 (27%)16 (23%)Endocrine/HER2 statusmissing7 (6%)1 (1%)ER+ or PR+74 (68%)50 (73%)HER2+12 (11%)7 (10%)TNBC16 (15%)11 (16%)FGFR aberrancyFGFR1 amplified54 (49%)29 (42%)11q amplified31 (28%)24 (35%)FGFR1 and 11q amplified13 (12%)9 (13%)FGFR1 and 11q non-amplified11 (10%)7 (10%)
CONCLUSION: At 10 mg QD, lucitanib has modest activity with manageable toxicity in this heavily pretreated pt population. Future clinical development for lucitanib may focus on alternative biomarkers to identify sensitive tumors and rational combinations with other anti-cancer drugs.
Citation Format: Mayer IA, Arteaga CL, Nanda R, Miller KD, Jhaveri K, Brufsky AM, Rugo H, Yardley DA, Vahdat LT, Sadeghi S, Audeh MW, Rolfe L, Litten J, Knox A, Raponi M, Tankersley C, Isaacson J, Wride K, Morganstern DE, Vogel C, Connolly RM, Gradishar WJ, Patel R, Pusztai L, Abu-Khalaf M. A phase 2 open-label study of lucitanib in patients (pts) with FGF aberrant metastatic breast cancer (MBC) [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 P6-11-03.
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Affiliation(s)
- IA Mayer
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - CL Arteaga
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - R Nanda
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - KD Miller
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - K Jhaveri
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - AM Brufsky
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - H Rugo
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - DA Yardley
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - LT Vahdat
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - S Sadeghi
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - MW Audeh
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - L Rolfe
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - J Litten
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - A Knox
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - M Raponi
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - C Tankersley
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - J Isaacson
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - K Wride
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - DE Morganstern
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - C Vogel
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - RM Connolly
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - WJ Gradishar
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - R Patel
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - L Pusztai
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
| | - M Abu-Khalaf
- Vanderbilt-Ingram Cancer Center, Nashville, TN; University of Chicago Medical Center, Chicago, IL; Indiana University Simon Cancer Center, Indianapolis, IN; Memorial Sloan Kettering Cancer Center, New York, NY; University of Pittsburgh Cancer Institute, Pittsburgh, PA; University of California, San Francisco, San Francisco, CA; Sarah Cannon Research Institute, Nashville and Tennessee Oncology, PLLC, Nashville, TN; Weill Cornell Medicine, Iris Center Breast Center, New York, NY; University of California, Los Angeles, Los Angeles, CA; Cedars Sinai Medical Center, Los Angeles, CA; Clovis Oncology, San Francisco, San Francisco, CA; Clovis Oncology, Boulder, Boulder, CO; Dana Farber Cancer Institute, Boston, MA; University of Miami, Deerfield Beach, FL; John Hopkins Kimmel Cancer Center, Baltimore, MD; Northwestern University, Chicago, IL; Comprehensive Blood and Cancer Center, Bakersfield, CA; Yale University, New Haven, CT
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Brufsky A, Kim SB, Velu T, García-Saenz JA, Tan-Chiu E, Sohn JH, Dirix L, Borms MV, Liu MC, Moezi MM, Kozloff MF, Sparano JA, Xu N, Wongchenko M, Simmons B, McNally V, Miles D. Abstract P4-22-22: Cobimetinib (C) combined with paclitaxel (P) as a first-line treatment in patients (pts) with advanced triple-negative breast cancer (COLET study): Updated clinical and biomarker results. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-22-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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
Resistance to standard taxane-based chemotherapy is common in triple-negative breast cancer (TNBC). Mutations and gene amplifications in the MAPK pathway that upregulate MAPK signaling are present in many TNBC tumors. Upregulation of the MAPK signaling pathway can result in degradation of the pro-apoptotic protein BIM and upregulation of anti-apoptotic proteins, including BCL-2, BCL-XL, and MCL-1, thus promoting cell survival and desensitizing tumor cells to the pro-apoptotic effects of taxane chemotherapy. Updated data on clinical safety and efficacy are presented along with biomarker data evaluating the effects of treatment on induction of apoptosis.The COLET study (ClinicalTrials.gov ID, NCT02322814; EudraCT number, 2014-002230-32) consisted of a safety run-in (n∼12) followed by a blinded 1:1 randomized expansion stage (n∼90) to C + P or placebo (PBO) + P. The safety stage is complete and the randomized stage is enrolling pts. Two additional cohorts investigating the effect of adding atezolizumab will be recruiting and are out of scope of this submission. Pts in cohort I were treated with P 80 mg/m2 on days 1, 8, and 15 and C/PBO 60 mg/day on days 3–23 of each 28-day cycle until disease progression or unacceptable toxicity. Gene expression and apoptotic index were measured by RNA-Seq and TUNEL staining, respectively, to assess the biologic activity of C + P.Sixteen women (median age, 55.5 years) were enrolled in the safety run-in stage. At data snapshot (April 22, 2016), all 16 pts had received ≥1 dose of study treatment. Median time on treatment was 116 days (range, 7-336) for C and 84 days (range, 0-351) for P. Fifteen (94%) pts had ≥1 adverse event (AE); 5 (31%) pts had grade 1/2 AEs and 10 (63%) pts had grade 3 AEs (Table). No pts experienced grade 4–5 AEs. Among the 16 safety run-in patients, responses to date include partial response (PR; n = 8 [50.0%]), stable disease (SD, n = 4 [25.0%]), and progressive disease (n = 2 [12.5%]), as well as 2 pts with no post-baseline tumor assessment. Six pts maintained a PR at ∼20 weeks and three maintained a PR at ≥40 weeks. To date, matched pre- and on-treatment biopsies were evaluable for 2 pts, 1 with a PR and 1 with SD. In the patient who attained a PR, increased expression of pro-apoptosis genes, including BIM, was observed; but this was not seen in the patient experiencing SD. The PR patient also had an increase in apoptotic index. Updated biomarker data will be reported.This is the first study to evaluate C + P in TNBC. The safety profile of C + P is consistent with that of known safety profiles. Efficacy and safety will be further evaluated in the ongoing randomized stage.
Most common (any grade ≥20%) AEsTreatment-emergent AEs, n (%)C + P (safety run-in stage), N = 16 All gradesGrade 3Diarrhea10 (63)1 (6)Rash8 (50)0Nausea7 (44)0Alopecia5 (31)0Blood CPK level increase5 (31)1 (6)Stomatitis4 (25)2 (13)Asthenia4 (25)1 (6)Constipation4 (25)0Dyspnea4 (25)0Edema peripheral4 (25)0Pyrexia4 (25)0Vomiting4 (25)0AEs, adverse events; C, cobimetinib; CPK, creatinine phosphokinase; P, paclitaxel.
Citation Format: Brufsky A, Kim S-B, Velu T, García-Saenz JA, Tan-Chiu E, Sohn JH, Dirix L, Borms MV, Liu M-C, Moezi MM, Kozloff MF, Sparano JA, Xu N, Wongchenko M, Simmons B, McNally V, Miles D. Cobimetinib (C) combined with paclitaxel (P) as a first-line treatment in patients (pts) with advanced triple-negative breast cancer (COLET study): Updated clinical and biomarker results [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 P4-22-22.
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Affiliation(s)
- A Brufsky
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - S-B Kim
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - T Velu
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - JA García-Saenz
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - E Tan-Chiu
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - JH Sohn
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - L Dirix
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - MV Borms
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - M-C Liu
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - MM Moezi
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - MF Kozloff
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - JA Sparano
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - N Xu
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - M Wongchenko
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - B Simmons
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - V McNally
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
| | - D Miles
- University of Pittsburgh, Pittsburgh, PA; Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Chirec Cancer Institute, Brussels, Belgium; Hospital Clinico San Carlos, Madrid, Spain; Florida Cancer Research Institute, Plantation, FL; Severance Hospital, Yonsei University Health System, Seoul, Korea; Sint-Augustinuskliniek, Antwerp, Belgium; AZ Groeninge, Kortrijk, Belgium; Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan; Cancer Specialists of North Florida, Jacksonville, FL; Ingalls Memorial Hospital, Harvey, IL; Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY; Genentech, Inc., South San Francisco, CA; Roche Products Ltd., Welwyn Garden City, United Kingdom; Mount Vernon Cancer Centre, London, United Kingdom
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Wongchenko M, Miles D, Kim S, Xu N, Amler L, Yan Y, Simmons B, McNally V, Brufsky A. Exploratory biomarker analysis of first-line cobimetinib (C) + paclitaxel (P) in patients (pts) with advanced triple-negative breast cancer (TNBC) from the phase 2 COLET study. Eur J Cancer 2016. [DOI: 10.1016/s0959-8049(16)33041-6] [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: 10/20/2022]
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Miles D, Kim SB, Velu T, García-Saenz J, Tan-Chiu E, Sohn J, Dirix L, Vanˇásek J, Borms M, De Mingorance JI, Liu MC, Moezi M, Kozloff M, Sparano J, Xu N, Yan Y, Wongchenko M, Simmons B, McNally V, Brufsky A. First-line cobimetinib (C) + paclitaxel (P) in patients (pts) with advanced triple-negative breast cancer (TNBC): Updated results and tumoral immune cell infiltration data from the phase 2 COLET study. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw365.65] [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: 11/13/2022] Open
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Stearns V, Smith II JW, Patel R, Lu D, Perkins JJ, Cotter MJ, Brufsky AM. Abstract P4-13-05: Safety results of the US expanded access program (EAP) of palbociclib in combination with letrozole as treatment of post-menopausal women with hormone-receptor-positive (HR+), HER2-negative (HER2-) advanced breast cancer (ABC) for whom letrozole therapy is deemed appropriate. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-13-05] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: In the Phase I/II PALOMA-1 trial, a study in women with estrogen receptor (ER) positive advanced breast cancer (ABC) receiving initial therapy for their metastatic disease, combination of the CDK4/6 inhibitor palbociclib with letrozole improved progression free survival compared to letrozole. The aim of this open-label, single-arm EAP was to provide appropriate patients (pts) with ABC access to palbociclib pending marketing approval in the United States.
Methods: In the EAP, a total of 242 pts with HR+/HER2- ABC were treated at 42 sites in the US. Pts received palbociclib 125 mg/d (3 weeks on, 1 week off) in combination with letrozole 2.5 mg/d (continuous daily dosing) until disease progression, intolerable adverse event (AE), or commercial availability. AEs and serious AEs (SAEs) were assessed every cycle. Complete blood counts were assessed on day 1 and day 14 of the first two cycles and then at the beginning of each cycle thereafter. Tumor assessments were collected by investigators as per routine clinical practice.
Results: In this early analysis, we describe an initial cohort of 97 pts, with data collected during the first 3 months of study. Median duration of therapy was 31 days. Mean age was 62 yr (range 29-89). Baseline ECOG PS was 0, 1 or 2 in 36%, 49%, and 14% of pts, respectively. Common prior treatments (≥40% in any setting) included fulvestrant (59%), anastrozole (50%), paclitaxel (50%), exemestane (48%), cyclophosphamide (46%), tamoxifen (45%), doxorubicin (44%), and capecitabine (40%). Treatment-emergent AEs (TEAE; all grades) that occurred in greater than 10% of patients included neutropenia (28%), fatigue (19%), neutrophil count decreased (12%). Other hematologic TEAE rates included: anemia 9%, white blood cell count decreased 9% and thrombocytopenia 5%. All causality SAEs occurred in 6% of pts at the rate of 1 patient each for ankle fracture, constipation, disease progression, febrile neutropenia, lung infection, and pancytopenia. The rate of palbociclib dose reduction due to a TEAE was 4%. The rate of temporary delay of palbociclib due to TEAE was 36%. TEAEs leading to permanent discontinuation occurred in 1% of pts (Grade 3 nausea & vomiting). Grade 3 or 4 TEAEs were reported in 42% of pts, including neutropenia (Grade 3: 24%, Grade 4: 2%). There were no fatal outcomes due to TEAEs. This early data will be updated for final conference presentation to include the complete patient cohort and updated duration of therapy on study drug.
Conclusions: In this population of pts with HR+/HER2- ABC, palbociclib in combination with letrozole was well tolerated. Analysis of this early cohort indicates that the safety profile was consistent with that seen in the PALOMA-1 trial.
Clinical trial information: NCT02142868
Funding Source: Pfizer.
Citation Format: Stearns V, Smith II JW, Patel R, Lu D, Perkins JJ, Cotter MJ, Brufsky AM. Safety results of the US expanded access program (EAP) of palbociclib in combination with letrozole as treatment of post-menopausal women with hormone-receptor-positive (HR+), HER2-negative (HER2-) advanced breast cancer (ABC) for whom letrozole therapy is deemed appropriate. [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 P4-13-05.
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Affiliation(s)
- V Stearns
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD; Northwest Cancer Specialists PC, Portland, OR; Comprehensive Blood & Cancer Center, Bakersfield, CA; Pfizer, La Jolla, CA; Pfizer, New York City, NY; Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - JW Smith II
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD; Northwest Cancer Specialists PC, Portland, OR; Comprehensive Blood & Cancer Center, Bakersfield, CA; Pfizer, La Jolla, CA; Pfizer, New York City, NY; Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - R Patel
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD; Northwest Cancer Specialists PC, Portland, OR; Comprehensive Blood & Cancer Center, Bakersfield, CA; Pfizer, La Jolla, CA; Pfizer, New York City, NY; Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - D Lu
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD; Northwest Cancer Specialists PC, Portland, OR; Comprehensive Blood & Cancer Center, Bakersfield, CA; Pfizer, La Jolla, CA; Pfizer, New York City, NY; Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - JJ Perkins
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD; Northwest Cancer Specialists PC, Portland, OR; Comprehensive Blood & Cancer Center, Bakersfield, CA; Pfizer, La Jolla, CA; Pfizer, New York City, NY; Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - MJ Cotter
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD; Northwest Cancer Specialists PC, Portland, OR; Comprehensive Blood & Cancer Center, Bakersfield, CA; Pfizer, La Jolla, CA; Pfizer, New York City, NY; Magee-Womens Hospital of UPMC, Pittsburgh, PA
| | - AM Brufsky
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins School of Medicine, Baltimore, MD; Northwest Cancer Specialists PC, Portland, OR; Comprehensive Blood & Cancer Center, Bakersfield, CA; Pfizer, La Jolla, CA; Pfizer, New York City, NY; Magee-Womens Hospital of UPMC, Pittsburgh, PA
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Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky A, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Abstract S6-04: Patient-reported outcome (PRO) results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) vs tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-s6-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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 clinical results of NSABP B-35, phase III trial comparing 1 mg/day A to 20 mg/day tam, each given for 5 years, were reported at ASCO 2015. B-35 demonstrated a statistically significant benefit in breast cancer free interval for women assigned to A, primarily in women <60 years. A secondary endpoint of B-35 was quality of life (QOL) and symptom (SX) outcomes in the two treatment groups. The primary hypotheses of the PRO study were that there would be no differences in QOL between the two treatments, and that patients receiving A would report higher rates of hot flashes compared to patients receiving tam. Other SX comparisons were secondary endpoints.
Methods
QOL and SX were assessed at baseline (prior to randomization), and every 6 months thereafter for 5 years of treatment and in the following 12 months. QOL was measured with the SF-12 Physical Component Summary (PCS) and Mental Component Summary (MCS). SX were measured with selected scales from the BCPT symptom-checklist, and other standardized instruments. Stratification was by age (<60 v ≥60) as in the main trial. Study hypotheses and endpoints were examined by comparing PROs in the two treatment arms using a mixed model for repeated measures analysis with adjustment for the baseline scores, time point and age category, using an intention-to-treat principle and including only patients who completed the baseline and at least one follow-up questionnaire. Patients with protocol events were censored. Only data through 60 months are reported here. The accrual goal for the sub-study was 1,150 consecutive patients.
Results
Between January 6, 2003 and June 15, 2006, a total of 3,104 patients were entered and randomly assigned to NSABP Protocol B-35. Accrual to the PRO study of B-35 closed on December 28, 2004, at which time 1,275 patients were entered, with 1,193 patients included in this analysis. There were no medical or demographic differences between patients assigned to A or tam in the PRO sub-study, and they reflected the characteristics of the parent trial. Adherence to data collection across the 60 months was 87%. There were no significant differences in QOL outcomes by treatment for the PCS (p=0.16) or the MCS (p=0.38). SX subscales: hot flash scale was greater in tam group and this difference varied over time (p=0.001); musculoskeletal pain was significantly greater in A group for time points 6-24 months (all p<.001); vaginal problems were greater in A group (p=0.03). Hot flash and vaginal problems were significantly worse in women <60 years. Additional SX outcomes (depression, fatigue, sexual function) will be reported at presentation.
Conclusion
In this large, double-blind, placebo-controlled trial comparing A to tam in patients with DCIS, there was no significant difference in QOL between the two treatments. However, there were important treatment differences in SX outcomes, which should be considered as part of treatment decision-making discussions, along with the clinical breast cancer outcome results.
Support: CA-180868, 180822, 189867, 196067, 114732; AstraZeneca Pharmaceuticals LP.
Citation Format: Ganz PA, Cecchini RS, Julian TB, Margolese RG, Costantino JP, Vallow LA, Albain KS, Whitworth PW, Cianfrocca ME, Brufsky A, Gross HM, Soori GS, Hopkins JO, Fehrenbacher L, Sturtz K, Wozniak TF, Seay TE, Mamounas EP, Wolmark N. Patient-reported outcome (PRO) results, NRG Oncology/NSABP B-35: A clinical trial of anastrozole (A) vs tamoxifen (tam) in postmenopausal patients with DCIS undergoing lumpectomy plus radiotherapy. [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 S6-04.
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Affiliation(s)
- PA Ganz
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - RS Cecchini
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - TB Julian
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - RG Margolese
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - JP Costantino
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - LA Vallow
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - KS Albain
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - PW Whitworth
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - ME Cianfrocca
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - A Brufsky
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - HM Gross
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - GS Soori
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - JO Hopkins
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - L Fehrenbacher
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - K Sturtz
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - TF Wozniak
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - TE Seay
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - EP Mamounas
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
| | - N Wolmark
- NSABP/NRG Oncology; UCLA Schools of Medicine and Public Health and Jonsson Comprehensive Cance Center; University of Pittsburgh; Allegheny Cancer Center at Allegheny General Hospital; Jewish General Hospital, McGill University; NRG Oncology Statistics and Data Management Center (SDMC); Mayo Clinic; Loyola University Chicago Cardinal Benardin Cancer Center; Nashville Breast Center; Fox Chase and Northwestern (ECOG); Magee-Women's Hospital, University of Pittsburgh; Dayton NCORP; Missouri Valley Cancer Consortium; Novant Health; Kaiser Permanente Northern California; Colorado Cancer Research Program; Christiana Care CCOP; Atlanta Regional CCOP; UF Health Cancer Center at Orlando Health
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McAuliffe PF, Brown DD, Oesterreich S, Lee AV, Johnson RR, McGuire KP, Davidson NE, Brufsky AM, Dabbs DJ. Abstract P6-08-02: Developing in vitro models of ductal carcinoma in situ from primary tissue. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p6-08-02] [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: Because there are currently no reliable predictors for progression of ductal carcinoma in situ (DCIS) to invasive disease, nearly all patients receive aggressive therapy, leading to over-treatment in many cases. Few in vitro models for studying DCIS progression have been developed. We report here the successful culture and expansion of primary DCIS from surgical specimens using a conditional reprogramming protocol.
MATERIALS AND METHODS: From 2/2014 to 4/2015, patients with percutaneous core needle biopsy demonstrating DCIS were enrolled in a tissue banking protocol after informed consent was received. Under supervision of the surgical pathologist, fresh tissue measuring between 5-15 mm in length was taken from lumpectomy or mastectomy specimens. Tissue was divided such that half was mechanically and enzymatically dissociated and then cultured in medium conditioned by irradiated mouse fibroblasts and supplemented with rho-associated protein kinase (ROCK) inhibitor, and the second half, known as the "mirror image" remained as part of the clinical specimen.
RESULTS: Of 49 consented patients, mean age was 59 ± 10 years. 7 were excluded due to final pathology not consistent with DCIS: 4 upstaged to invasive ductal cancer, 2 had microinvasion and 1 showed pleomorphic lobular carcinoma in situ. Of the remaining 42, 9 were failures: 5 tissues were not received in lab and 4 cases were received, but no cells grew in culture. Of the remaining 33 cases of DCIS, 70% (n=23) and 27% (n=9) were nuclear grade 2 and 3 respectively. 91% (n=30) were ER-positive, with H-score ranging between 4 and 300. 19 (58%) were expanded in cell culture for up to two months in culture, and 14 were frozen immediately after mechanical dissociation for future growth. The 19 cell cultures could be cryopreserved and expanded. The cultures are almost exclusively composed of cytokeratin 8- and EpCAM-positive luminal cells and cytokeratin 14-, cytokeratin 5-, and p63-positive basal mammary epithelial cells, suggesting maintenance of heterogeneity in vitro. Furthermore, as assessed by luminal and basal marker expression, these cells retain their cellular identities both in the "conditionally reprogrammed" proliferative state and when conditioned media and ROCK inhibitor were withdrawn. When grown to 100% confluency, the cultures appear to organize into luminal and basal layers as well as luminal compartments surrounded by basal cells.
CONCLUSION: Primary cultures of DCIS derived directly from patient tissues may serve as in vitro models for the study of DCIS.
Citation Format: McAuliffe PF, Brown DD, Oesterreich S, Lee AV, Johnson RR, McGuire KP, Davidson NE, Brufsky AM, Dabbs DJ. Developing in vitro models of ductal carcinoma in situ from primary tissue. [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 P6-08-02.
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Affiliation(s)
- PF McAuliffe
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - DD Brown
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - S Oesterreich
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - AV Lee
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - RR Johnson
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - KP McGuire
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - NE Davidson
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - AM Brufsky
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
| | - DJ Dabbs
- University of Pittsburgh Cancer Institute, Pittsburgh, PA
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Mayer M, Sampayo I, Bell Dickson R, Citron ML, Brufsky AM. Abstract P1-11-06: The experience of caregivers of women with metastatic breast cancer: Insights from the Make Your Dialogue Count survey. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-11-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Introduction: Caregivers of patients with breast cancer have demonstrated persistent unmet needs, including reduced physical and psychosocial well-being. This may be particularly acute in caregivers of patients with metastatic breast cancer (MBC), whose ongoing treatments and increasing disability with disease progression offer particular challenges. While prevalence of MBC is currently unknown, caregivers of women with MBC represent a sizable group.
Objective: To explore the emotional, psychological, and social impact on caregivers of patients with MBC and to identify gaps in communications between patients and their caregivers and oncologists.
Methods: The "Make Your Dialogue Count" survey was conducted online, by paper, and by telephone (June-August 2014) among caregivers in the United States (age ≥18 y) who attended ≥50% of doctor visits of women with MBC (age ≥21 y). Survey responses were single- or multiple-response, numeric text, or rated on a 4-point Likert scale. Caregiver data were unweighted and representative only of those responding. Statistically significant differences between groups were determined by standard t-test of column proportions and means at the 95% confidence level.
Results: 234 caregivers responded; 73% were men, 44% were the patient's spouse/partner, and 27% were nonwhite. Median age was 44 y. The caregivers' loved ones had a median time from initial breast cancer diagnosis of 44 months prior, and 51% had recurred after early breast cancer. Most caregivers (76%) considered themselves to be extremely or very involved in treatment decisions, but a sizable fraction of caregivers were unaware of the HR (20%) or HER2 (29%) status of the patient's cancer, indicating a lack of basic information needed for informed decision-making. While most (93%) said they felt comfortable speaking with the treatment team about MBC treatment, 41% reported communication barriers. Over half of caregivers (53%) felt that nobody understands what they're going through, and most (86%) reported that their lives had been negatively affected in some way (such as sleep habits, relationships and social life, hobbies and personal time, and financial stability and employment). Most caregivers considered caregiving to be an emotional (77%) and physical (56%) burden and 36% felt unappreciated. At the time of initial MBC diagnosis, 69% of caregivers felt it was important/very important for their loved one's doctor to refer them to support services, but only 25% of caregivers reported receiving such a referral. Subgroup analysis of caregiver's gender revealed some differences in responses relating to communications with oncologists, treatment experience, and emotional impact.
Conclusions: While committed to their roles, these caregivers often found their role to be a physical and emotional burden, and many reported feeling isolated and unappreciated for their caregiving. Our findings indicate a strong need for support services specifically tailored to caregivers, including outreach to address emotional, financial, and practical needs stemming from caring for a loved one with MBC. They also indicate a need for improved disease and treatment information exchange between caregivers, patients, and healthcare providers.
Citation Format: Mayer M, Sampayo I, Bell Dickson R, Citron ML, Brufsky AM. The experience of caregivers of women with metastatic breast cancer: Insights from the Make Your Dialogue Count survey. [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 P1-11-06.
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Affiliation(s)
- M Mayer
- AdvancedBC.org, NY, NY; SHARE, NY, NY; Harris Poll, NY, NY; ProHEALTH Care Associates, Lake Success, NY; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - I Sampayo
- AdvancedBC.org, NY, NY; SHARE, NY, NY; Harris Poll, NY, NY; ProHEALTH Care Associates, Lake Success, NY; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - R Bell Dickson
- AdvancedBC.org, NY, NY; SHARE, NY, NY; Harris Poll, NY, NY; ProHEALTH Care Associates, Lake Success, NY; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - ML Citron
- AdvancedBC.org, NY, NY; SHARE, NY, NY; Harris Poll, NY, NY; ProHEALTH Care Associates, Lake Success, NY; University of Pittsburgh Medical Center, Pittsburgh, PA
| | - AM Brufsky
- AdvancedBC.org, NY, NY; SHARE, NY, NY; Harris Poll, NY, NY; ProHEALTH Care Associates, Lake Success, NY; University of Pittsburgh Medical Center, Pittsburgh, PA
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Kim SB, Miles D, Rhee J, Yan Y, Hsu J, Brufsky A. Abstract OT1-03-18: COLET: A multistage, phase 2 study evaluating the safety and efficacy of cobimetinib in combination with paclitaxel as first-line treatment for patients with metastatic triple-negative breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot1-03-18] [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: Cobimetinib (cobi) is a potent, highly selective inhibitor of MEK that has shown benefit when administered in combination with the BRAF inhibitor vemurafenib in BRAFV600-mutated metastatic melanoma. Preclinical data suggest that up-regulation of the MAPK pathway is a potential resistance mechanism against taxane chemotherapy. Clinically, the combination of MEK inhibition and taxane chemotherapy in non–small cell lung cancer patients (pts) has improved response rate (RR) and progression-free survival (PFS). Because most triple-negative breast cancer (TNBC) pts develop resistance to taxane chemotherapy and because genetic alterations (including mutations and gene amplifications) in the MAPK pathway are present in many TNBC tumors, the combination of taxane chemotherapy and MEK inhibition could be an effective treatment option.
Study design: COLET (WO29497) is a multistage study designed to evaluate the safety of and to estimate the efficacy of cobi paclitaxel in pts with metastatic or locally advanced TNBC who have not previously received systemic therapy for metastatic disease. The study will be conducted in 2 stages: an initial safety run-in stage of approximately 12 pts, followed by a randomized stage in which approximately 100 pts will be randomly assigned in a 1:1 ratio to receive either cobi + paclitaxel or placebo + paclitaxel. Pts will receive paclitaxel 80 mg/m2 on Days 1, 8, and 15 of each 28-day cycle and cobi/placebo 60 mg/day on Days 3-23 of each 28-day cycle until progression of disease or toxicity occurs.
Key eligibility criteria:
• Metastatic or locally advanced (not amenable to curative resection) TNBC
• No prior systemic therapy for metastatic or unresectable locally advanced TNBC
• Neoadjuvant or adjuvant chemotherapy or radiation therapy is allowed if completed >6 months before the start of study treatment
• Measureable disease using Response Evaluation Criteria In Solid Tumors, version 1.1 (RECIST v1.1)
• History of or active untreated or unstable brain metastases or requiring corticosteroids for brain metastases precludes eligibility
• Left ventricular ejection fraction (LVEF) greater than the institutional lower limit of normal or above 50%
Specific aims of the safety run-in stage: Determine the safety and tolerability of cobi when administered in combination with paclitaxel.
Specific aims of the randomized stage: Investigator-assessed PFS (primary end point); safety; pharmacokinetics; the effect of intrinsic subtypes and genetic alterations in PFS; mechanisms of resistance; and health-related quality of life.
Accrual: Approximately 112 pts from sites across Europe, North America, and the Asia-Pacific region.
Statistical methods: In the randomized stage, pts will be followed up until a total of 60 PFS events occur across the 2 arms. This provides 77% power to detect a hazard ratio of 0.5 at a two-sided significance level of 0.05.
Contact information: Registered with ClinicalTrials.gov, identifier NCT02322814. For more information, please contact Roche/Genentech trials, 888-662-6728 (US only) or reference study ID WO29479 at www.roche.com/about_roche/roche_worldwide.htm.
Citation Format: Kim S-B, Miles D, Rhee J, Yan Y, Hsu J, Brufsky A. COLET: A multistage, phase 2 study evaluating the safety and efficacy of cobimetinib in combination with paclitaxel as first-line treatment for patients with metastatic triple-negative breast cancer. [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 OT1-03-18.
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Affiliation(s)
- S-B Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Mount Vernon Cancer Centre, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - D Miles
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Mount Vernon Cancer Centre, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - J Rhee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Mount Vernon Cancer Centre, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - Y Yan
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Mount Vernon Cancer Centre, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - J Hsu
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Mount Vernon Cancer Centre, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
| | - A Brufsky
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea; Mount Vernon Cancer Centre, London, United Kingdom; Genentech, Inc., South San Francisco, CA; University of Pittsburgh, Pittsburgh, PA
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