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Frenel JS, Zeghondy J, Guérin-Charbonnel C, Mailliez A, Volant E, Poumeaud F, Patsouris A, Arnedos M, Bailleux C, Cabal J, Galland L, de Nonneville A, Guiu S, Dalenc F, Pistilli B, Bachelot T, Pierga JY, Le Du F, Bocquet F, Larrouquere L, Loirat D. Tucatinib Combination Treatment After Trastuzumab-Deruxtecan in Patients With ERBB2-Positive Metastatic Breast Cancer. JAMA Netw Open 2024; 7:e244435. [PMID: 38568692 PMCID: PMC10993071 DOI: 10.1001/jamanetworkopen.2024.4435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 04/05/2024] Open
Abstract
Importance Little is known regarding the outcomes associated with tucatinib combined with trastuzumab and capecitabine (TTC) after trastuzumab-deruxtecan exposure among patients with ERBB2 (previously HER2)-positive metastatic breast cancer (MBC). Objective To investigate outcomes following TTC treatment in patients with ERBB2-positive MBC who had previously received trastuzumab-deruxtecan. Design, Setting, and Participants This cohort study included all patients with MBC who were treated in 12 French comprehensive cancer centers between August 1, 2020, and December 31, 2022. Exposure Tucatinib combined with trastuzumab and capecitabine administered at the recommended dose. Main Outcomes and Measures Clinical end points included progression-free survival (PFS), time to next treatment (TTNT), overall survival (OS), and overall response rate (ORR). Results A total of 101 patients with MBC were included (median age, 56 [range, 31-85] years). The median number of prior treatment lines for metastatic disease at TTC treatment initiation was 4 (range, 2-15), including 82 patients (81.2%) with previous trastuzumab and/or pertuzumab and 94 (93.1%) with previous ado-trastuzumab-emtansine) exposure. The median duration of trastuzumab-deruxtecan treatment was 8.9 (range, 1.4-25.8) months, and 82 patients (81.2%) had disease progression during trastuzumab-deruxtecan treatment, whereas 18 (17.8%) had stopped trastuzumab-deruxtecan for toxic effects and 1 (1.0%) for other reasons. Tucatinib combined with trastuzumab and capecitabine was provided as a third- or fourth-line treatment in 37 patients (36.6%) and was the immediate treatment after trastuzumab-deruxtecan in 86 (85.1%). With a median follow-up of 11.6 (95% CI, 10.5-13.4) months, 76 of 101 patients (75.2%) stopped TTC treatment due to disease progression. The median PFS was 4.7 (95% CI, 3.9-5.6) months; median TTNT, 5.2 (95% CI, 4.5-7.0) months; and median OS, 13.4 (95% CI, 11.1 to not reached [NR]) months. Patients who received TTC immediately after trastuzumab-deruxtecan had a median PFS of 5.0 (95% CI, 4.2-6.0) months; median TTNT of 5.5 (95% CI, 4.8-7.2) months, and median OS of 13.4 (95% CI, 11.9-NR) months. Those who received TTC due to trastuzumab-deruxtecan toxicity-related discontinuation had a median PFS of 7.3 (95% CI, 3.0-NR) months. Best ORR was 29 of 89 patients (32.6%). Sixteen patients with active brain metastasis had a median PFS of 4.7 (95% CI, 3.0-7.3) months, median TTNT of 5.6 (95% CI, 4.4 to NR), and median OS of 12.4 (95% CI, 8.3-NR) months. Conclusions and Relevance In this study, TTC therapy was associated with clinically meaningful outcomes in patients with ERBB2-positive MBC after previous trastuzumab-deruxtecan treatment, including those with brain metastases. Prospective data on optimal drug sequencing in this rapidly changing therapeutic landscape are needed.
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Affiliation(s)
- Jean-Sebastien Frenel
- Department of Medical Oncology, Institut de Cancerologie de l’Ouest, Saint-Herblain, France
| | - Jean Zeghondy
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | | | - Audrey Mailliez
- Department of Medical Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Elsa Volant
- Department of Medical Oncology, Institut de Cancerologie de l’Ouest, Saint-Herblain, France
| | | | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancerologie de l’Ouest, Angers, France
| | - Monica Arnedos
- Department of Medical Oncology Bordeaux, Institut Bergonie, Bordeaux, France
| | - Caroline Bailleux
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Julie Cabal
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Loick Galland
- Department of Medical Oncology, Centre Georges Francois Leclerc, Dijon, France
| | | | - Séverine Guiu
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier, France
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Fanny Le Du
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - François Bocquet
- Data Factory, Institut de Cancerologie de l’Ouest, Saint-Herblain, France
| | | | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Paris, France
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Vanacker H, Treilleux I, Schiffler C, Bieche I, Campone M, Patsouris A, Arnedos M, Cottu PH, Jacquin JP, Dalenc F, Pinton A, Servant N, Attignon V, Rouleau E, Morel A, Legrand F, Jimenez M, Andre F, Bachelot T. p4EBP1 staining predicts outcome in ER-positive endocrine-resistant metastatic breast cancer patients treated with everolimus and exemestane. Br J Cancer 2024; 130:613-619. [PMID: 38182687 PMCID: PMC10876520 DOI: 10.1038/s41416-023-02549-8] [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: 06/07/2023] [Revised: 11/27/2023] [Accepted: 12/11/2023] [Indexed: 01/07/2024] Open
Abstract
BACKGROUND To identify patients most likely to respond to everolimus, a mammalian target of rapamycin (mTOR) inhibitor, a prospective biomarker study was conducted in hormone receptor-positive endocrine-resistant metastatic breast cancer patients treated with exemestane-everolimus therapy. METHODS Metastatic tumor biopsies were processed for immunohistochemical staining (p4EBP1, PTEN, pAKT, LKB1, and pS6K). ESR1, PIK3CA and AKT1 gene mutations were detected by NGS. The primary endpoint was the association between the p4EBP1 expression and clinical benefit rate (CBR) at 6 months of everolimus plus exemestane treatment. RESULTS Of 150 patients included, 107 were evaluable for the primary endpoint. p4EBP1 staining above the median (Allred score ≥6) was associated with a higher CBR at 6 months (62% versus 40% in high-p4EBP1 versus low-p4EBP1, χ2 test, p = 0.026) and a longer progression-free survival (PFS) (median PFS of 9.2 versus 5.8 months in high-p4EBP1 versus low-p4EBP1; p = 0.02). When tested with other biomarkers, only p4EBP1 remained a significant predictive marker of PFS in multivariate analysis (hazard ratio, 0.591; p = 0.01). CONCLUSIONS This study identified a subset of patients with hormone receptor-positive endocrine-resistant metastatic breast cancer and poor outcome who would derive less benefit from everolimus and exemestane. p4EBP1 may be a useful predictive biomarker in routine clinical practice. CLINICAL TRIAL REGISTRATION NCT02444390.
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Affiliation(s)
| | | | | | | | - Mario Campone
- Institut de cancérologie de l'ouest Pays de Loire Nantes-Angers, Saint-Herblain, France
| | - Anne Patsouris
- Institut de cancérologie de l'ouest Pays de Loire Nantes-Angers, Saint-Herblain, France
| | | | | | | | - Florence Dalenc
- ICR, Institut Universitaire du Cancer de Toulouse, Oncopole, Toulouse, France
| | | | | | | | | | - Alain Morel
- Institut de cancérologie de l'ouest Pays de Loire Nantes-Angers, Saint-Herblain, France
- Univ Angers, Nantes Université, Inserm, CNRS, CRCI2NA, SFR ICAT, F-49000, Angers, France
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Galvin A, Courtinard C, Bouteiller F, Gourgou S, Dalenc F, Jacot W, Arnedos M, Bailleux C, Dieras V, Petit T, Emile G, Dubray-Longeras P, Frenel JS, Bachelot T, Mailliez A, Brain E, Desmoulins I, Massard V, Patsouris A, Goncalves A, Grinda T, Delaloge S, Bellera C. First-line real-world treatment patterns and survival outcomes in women younger or older than 40 years with metastatic breast cancer in the real-life multicenter French ESME cohort. Eur J Cancer 2024; 196:113422. [PMID: 37977105 DOI: 10.1016/j.ejca.2023.113422] [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: 10/10/2023] [Accepted: 10/31/2023] [Indexed: 11/19/2023]
Abstract
AIM To describe first-line treatment patterns, overall survival (OS) and real-world progression-free survival (rwPFS) in young women (<40) with metastatic breast cancer (mBC), as compared to women aged 40-69. MATERIALS AND METHODS Data on adult women diagnosed with mBC (2008-2017) were extracted from the ESME mBC database (NCT03275311) which includes consecutive patients starting first-line metastatic treatment in one of the 18 French Comprehensive cancer centers. We reported first-line therapeutic strategy and prognostic factors of OS and rwPFS for women aged < 40 and 40-69. RESULTS In total, 14,897 mBC women were included (1512 aged <40). HR+ /HER2- mBC was the most frequent subtype. First-line treatment differed between young patients and older ones for HR+ /HER2- and Triple Negative (TN) mBC. Median OS for women aged < 40 and 40-69, respectively, was 46.9 and 46.2 months for HR+ /HER2- mBC; 13.5 and 15.2 for TN mBC; and, 60.7 and 55.1 for HER2 + mBC. Median rwPFS under first line treatment was 11.6 and 11.9 months for HR+ /HER2- in women aged < 40 and 40-69, respectively; 5.5 and 5.9 for TN, and, 13.3 and 12.9 for HER2 + . Factors associated with shorter OS and rwPFS were similar for both women aged < 40 and 40-69 and included ≥ 3 metastatic sites, visceral metastases, and longer MFI, with time-varying effects observed for several prognostic factors. CONCLUSION Young women presented more frequently with TN and HER2 + subtypes and aggressive mBC than women aged 40-69 did. Prognostic factors of OS and rwPFS were quite similar between age groups and mBC subtypes.
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Affiliation(s)
- Angéline Galvin
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, 33000 Bordeaux, France.
| | - Coralie Courtinard
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, 33000 Bordeaux, France; Unicancer, Data and Partnership Department, 101 Rue de Tolbiac, 75654 Paris, France
| | - Fanny Bouteiller
- Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000 Bordeaux, France
| | - Sophie Gourgou
- Biometrics unit, Institut du Cancer de Montpellier, 208 Rue des Apothicaires, 34298 Montpellier, France; University of Montpellier, 34000 Montpellier, France
| | - Florence Dalenc
- Department of Medical Oncology, Oncopole Claudius Regaud - IUCT, 1 Avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, 208 Rue des Apothicaires, 34298 Montpellier, France
| | - Monica Arnedos
- Department of Medical Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Caroline Bailleux
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189 Nice, France
| | - Véronique Dieras
- Department of Medical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de la Porte de l'Hôpital, 67000 Strasbourg, France
| | - George Emile
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000 Caen, France
| | - Pascale Dubray-Longeras
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011 Clermont Ferrand, France
| | - Jean-Sébastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Boulevard Jacques Monod, 44805 Nantes, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, 21079 Dijon, France
| | - Vincent Massard
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - Paul Papin, 15 rue André Boquel, 49055 Angers, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Thomas Grinda
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Carine Bellera
- University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene team, UMR 1219, 33000 Bordeaux, France; Inserm CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Comprehensive Cancer Center, 33000 Bordeaux, France
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Dupoiron D, Autier L, Lebrec N, Seegers V, Folliard C, Patsouris A, Campone M, Augereau P. Intrathecal Catheter for Chemotherapy in Leptomeningeal Carcinomatosis From HER2-Negative Metastatic Breast Cancer. J Breast Cancer 2023; 26:572-581. [PMID: 37704384 PMCID: PMC10761759 DOI: 10.4048/jbc.2023.26.e40] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 07/19/2023] [Accepted: 08/20/2023] [Indexed: 09/15/2023] Open
Abstract
PURPOSE Most oncological treatments for leptomeningeal metastasis (LM) do not cross the blood-brain barrier (BBB). One therapeutic option is intrathecal (IT) chemotherapy. Both the brain-implanted Omaya reservoir and lumbar puncture (LP) are classic routes for IT chemotherapy delivery. An intrathecal catheter (IC) connected to a subcutaneous port is a recently developed option for the management of chemotherapy infusions. It is essential to evaluate the efficacy and safety of chemotherapy infusion using such device. METHODS We conducted a retrospective monocentric study within Institut de cancerologie de l'Ouest at Angers, including all patients with advanced breast cancer (aBC) with LM implanted with an IT device for IT chemotherapy between January 2013 and May 2020. The primary endpoint was overall survival (OS) and secondary endpoints included surgical feasibility, patient safety, and progression-free survival (PFS). The catheter was inserted through an LP, the tip was positioned at the right level and connected to a subcutaneous port implanted under the skin of the anterior thoracic wall. IT chemotherapy is painless and easy for qualified nurses to administer on an outpatient basis. RESULTS Thirty women underwent the implantation. No failures occurred during the procedure. A total of 77% of patients reported no complications after implantation. Only three complications required surgical treatment. The median number of IT chemotherapy courses per patient was 8 (range, 2-27). The tolerance profile for iterative IT chemotherapy was manageable in ambulatory care. With a median follow-up of 76.5 months (95% confidence interval [CI], 11.6-not available), the median OS was 158 days (95% CI, 87-235), and the median PFS was 116 days (95% CI, 58-174). CONCLUSION Infusing chemotherapy using an implanted catheter is an efficient option for managing IT chemotherapy with a good tolerance profile. Patient-reported outcomes for the evaluation of IT chemotherapy toxicity are currently being developed.
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Affiliation(s)
- Denis Dupoiron
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France.
| | - Lila Autier
- Department of Medical Oncology, Institut de Cancerologie de l'Ouest, Angers, France
| | - Nathalie Lebrec
- Department of Anesthesiology and Pain Medicine, Institut de Cancerologie de l'Ouest, Angers, France
| | - Valérie Seegers
- Department of Epidemiology and Biostatistics, Institut de Cancerologie de l'Ouest, Angers, France
| | - Caroline Folliard
- Department of Pharmacy, Institut de Cancerologie de l'Ouest, Angers, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancerologie de l'Ouest, Angers, France
| | - Mario Campone
- Department of Medical Oncology, Institut de Cancerologie de l'Ouest, Angers, France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancerologie de l'Ouest, Angers, France
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de Moura A, Vuagnat P, Renouf B, Pierga JY, Loirat D, Vaflard P, Lafayolle de la Bruyère C, Chaumard-Billotey N, Hajjaji N, Ladoire S, Dabakuyo S, Patsouris A, Frenel JS, Nicolai V, Alexandre M, Dohollou N, Grenier J, Bourien H, Bidard FC. Atezolizumab and paclitaxel as first line therapy in advanced triple-negative breast cancer patients included in the French early access program. Sci Rep 2023; 13:13427. [PMID: 37596388 PMCID: PMC10439112 DOI: 10.1038/s41598-023-40569-9] [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: 03/12/2023] [Accepted: 08/13/2023] [Indexed: 08/20/2023] Open
Abstract
Following the results of the IMpassion130 trial, an early access program (EAP) was opened in France, allowing patients with PD-L1-positive advanced triple negative breast cancer (aTNBC) to receive a combination of paclitaxel and atezolizumab as first line therapy. This EAP was later discontinued when the IMpassion131 trial read out with negative results. We performed a retrospective multicentric analysis in patients who were prospectively enrolled in the French EAP. Efficacy and toxicity data were obtained on 64 patients treated from August 2019 to August 2020 in 10 French cancer centers. Median progression-free survival (PFS) and overall survival (OS) were 4.1 months (95% CI [3.0-5.8]) and 17.9 months (95% CI [12.4-NR]), respectively. The 6-months PFS rate was 28% (95% CI [16-40%]) (N = 18/64), while N = 33/64 patients (52%, 95% CI [38-63%]) experienced a tumor response. Exploratory subgroup analyses retrieved that corticosteroid use at inclusion in the EAP, before treatment initiation, was the only independent unfavorable prognostic factor for PFS (HR 2.7, 95% CI [1.3-5.6]). No new safety signal was observed. This real-life study, unique by its setting (EAP granted by anticipation and later withdrawn), suggests atezolizumab and paclitaxel has a limited efficacy in PD-L1-positive aTNBC, especially in patients receiving corticosteroids as comedication before treatment start.
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Affiliation(s)
- Alexandre de Moura
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France.
- UVSQ, Université Paris-Saclay, Saint Cloud, France.
| | - Perrine Vuagnat
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
- UVSQ, Université Paris-Saclay, Saint Cloud, France
| | - Benjamin Renouf
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
- Université Paris Cité, Paris, France
| | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | - Pauline Vaflard
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
| | | | | | - Nawale Hajjaji
- Department of Breast Cancer Oncology, Centre Oscar Lambret, Lille, France
- Inserm, U1192, Laboratoire Protéomique, Réponse Inflammatoire et Spectrométrie de Masse (PRISM), Univ. Lille, Lille, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Sandrine Dabakuyo
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Pays de Loire, Angers & Nantes/Saint-Herblain, France
| | - Jean Sébastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Pays de Loire, Angers & Nantes/Saint-Herblain, France
| | - Vincent Nicolai
- Department of Medical Oncology, Institut Claudius Regaud-IUCT Oncopole, Toulouse, France
| | - Marie Alexandre
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Nadine Dohollou
- Department of Medical Oncology, Polyclinique Bordeaux Nord Aquitaine, Bordeaux, France
| | - Julien Grenier
- Department of Medical Oncology, Institut Sainte-Catherine, Avignon, France
| | - Heloïse Bourien
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - François-Clément Bidard
- Department of Medical Oncology, Institut Curie, Paris & Saint Cloud, France
- UVSQ, Université Paris-Saclay, Saint Cloud, France
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Frenel JS, Lusque A, Delaloge S, Ferrero JM, Bachelot T, Desmoulins I, Levy C, Eymard JC, Gonçalves A, Patsouris A, Reynier MAM, Thery MJC, Petit T, Cabel L, Uwer L, Debled M, Chevrot M, Mailliez A, Jacot W, de La Motte Rouge T. Efficacy of front-line treatment for hormone receptor-positive HER2-negative metastatic breast cancer with germline BRCA1/2 mutation. Br J Cancer 2023; 128:2072-2080. [PMID: 37012318 PMCID: PMC10205708 DOI: 10.1038/s41416-023-02248-4] [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: 10/13/2022] [Revised: 03/06/2023] [Accepted: 03/20/2023] [Indexed: 04/05/2023] Open
Abstract
BACKGROUND Efficacy of endocrine therapy in HR+/HER2- metastatic breast cancer could differ depending on the presence of BRCA1/2 germline mutation. METHODS The ESME metastatic breast cancer platform (NCT03275311) is a French real world database. Multivariable models including a time-varying approach and landmark analyses assessed the association between time-dependent gBRCA status (categorised as gBRCAm, gBRCAwt (wild type), and untested), overall survival (OS), and first-line progression-free survival (PFS1). RESULTS A total of 170 patients were gBRCAm carriers, 676 gBRCAwt, and 12,930 were untested at baseline. In the multivariable analysis, gBRCAm carriers overall had a lower OS compared to gBRCAwt (adjusted HR [95% CI] 1.26 [1.03-1.55]). gBRCAm patients treated with front-line endocrine therapy had lower adjusted OS (adjusted HR [95% CI] = 1.54 [1.03-2.32]) and PFS1 (adjusted HR [95% CI] 1.58 [1.17-2.12]) compared to gBRCAwt patients. However, for patients who received frontline chemotherapy, neither OS nor PFS1 differed between gBRCAm carriers and the other groups (HR versus gBRCAwt for OS: 1.12 [0.88-1.41], p = 0.350; PFS1: 1.09 [0.90-1.31], p = 0.379). CONCLUSION In this large cohort of HR+/HER2- MBC patients treated in a pre-CDK4/6 inhibitors era, gBRCAm status was associated with a lower OS and lower PFS following first-line endocrine therapy, but not following first-line chemotherapy.
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Affiliation(s)
- J-S Frenel
- Medical Oncology, ICO Institut de Cancerologie de l'Ouest René Gauducheau, Saint-Herblain, France.
| | - A Lusque
- Biostatistics & Health Data Science Unit, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - S Delaloge
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - J-M Ferrero
- Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - T Bachelot
- Medical Oncology Department, Centre Léon Bérard, Lyon, France
| | - I Desmoulins
- Medical Oncology, Centre Georges-François Leclerc (Dijon), Dijon, France
| | - C Levy
- Medical Oncology, Centre Francois Baclesse, Caen, France
| | - J-C Eymard
- Medical Oncology, Institut Jean Godinot, Reims, France
| | - A Gonçalves
- Medical Oncology Department, Institute Paoli Calmettes, Marseille, France
| | - A Patsouris
- Medical Oncology Department, ICO - Institut de cancerologie de l'Ouest - Site Paul Papin, Angers, France
| | | | - M J-C Thery
- Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - T Petit
- Bas-Rhin, Centre Paul Strauss Centre de Lutte contre le Cancer, Strasbourg, France
| | - L Cabel
- Medical Oncology, Hôpital René Huguenin - Institut Curie, Saint-Cloud, France
| | - L Uwer
- Medical Oncology, Institut de Cancerologie de Lorraine - Alexis Vautrin, Vandoeuvre Les Nancy, France
| | - M Debled
- Medical Oncology, Institut Bergonié, Bordeaux, France
| | - M Chevrot
- Department of Real World Data, UNICANCER, Paris, France
| | - A Mailliez
- Medical Oncology, Centre Oscar Lambret, Lille, France
| | - W Jacot
- Medical Oncology Department, ICM Regional Cancer Institute of Montpellier, Montpellier University, INSERM U1194, Montpellier, France
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Moreau-Bachelard C, Robert M, Gourmelon C, Bourbouloux E, Patsouris A, Frenel JS, Campone M. Evaluating everolimus for the treatment of breast cancer. Expert Opin Pharmacother 2023:1-7. [PMID: 37183684 DOI: 10.1080/14656566.2023.2214677] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
INTRODUCTION Everolimus is an oral drug that inhibits mTOR with immunosuppressive and antiproliferative characteristics. It is commonly used in association with exemestane in hormone receptor (HR)-positive advanced breast cancer (ABC). AREAS COVERED The current review summarizes the publications relating to everolimus from clinical research in breast cancer. Everolimus showed treatment efficacy and an acceptable safety tolerance with prevention of side effects in Phase II/III studies. BOLERO-2 study showed a progression-free survival improvement in patients with HR-positive ABC previously treated with aromatase inhibitors (AI) and leading to its acceptance in this indication. The absence of a post CDK4/6 inhibitor (CDK4/6i.) study and the arrival of new drugs may raise questions about its current place in the therapeutic strategy. EXPERT OPINION Everolimus is relevant in the management of HR-positive ABC. Because of its efficacy, acceptable tolerability and the absence of drugs that have shown a greater benefit, it remains a second-line treatment option in HR-positive, HER2 negative (score 0) patients without BRCA mutation or visceral crisis and can be discuss with fulvestrant in second line after CDK4-6i. It is likely that within 5 years this treatment will be replaced in second line HR-positive breast cancer by new emerging treatments: drug-conjugated antibodies, tyrosine kinase inhibitors or immunotherapy in combination with chemotherapy.
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Affiliation(s)
| | - Marie Robert
- ICO Centre René Gauducheau, Oncology, Nantes, France
| | | | | | | | | | - Mario Campone
- ICO Centre René Gauducheau, Oncology, Nantes, France
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Richard M, FRENEL JS, Mathiot L, Campone M, Colombie M, Robert M, Patsouris A, Bigot F, Gavard J, André-Grégoire G, Guevel L. Abstract P3-11-09: Extracellular vesicle-based biomarker assay for the monitoring of the efficacy of frontline endocrine therapy + CDK4-6 inhibitors in metastatic breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-11-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
CONTEXT: Endocrine therapy combined with CDK4/6 inhibitor is the standard frontline treatment for the vast majority of HR+/HER2- metastatic breast cancer (MBC) patients. Despite an overall survival benefit, patients eventually progress and mechanisms of resistance to this combination are not well identified. Non-invasive monitoring of the efficacy of treatment could help into tailoring therapeutic regimen. Extracellular vesicles (EVs) are a group of heterogeneous nanosized bioparticles (30-1000nm), released by almost all cell types - including tumor, platelets, and immune cells – carrying informative biological material emanating from the mother cell and circulating in the blood stream. In this project, we ambition to assess whether the vesiclemia, i.e. plasmatic extracellular vesicle concentration can be used as a clinic-biological parameter to assist in the monitoring of patients. METHODS: EPICURE is an ongoing pilot prospective cohort study of heterogeneous and massive data integration, i.e. multi-omics approaches in MBC patients. The present study focused on patients with HR+/HER2- MBC receiving frontline endocrine therapy+iCDK4/6. Plasma samples were drawn every 3 months during the treatment until progression. The workflow for the enrichment of circulating EVs was developed from frozen plasma. A semi-automatized isolation procedure using size exclusion chromatography combined with the newly developed interference light microscopy apparatus Videodrop allowed to routinely separate plasmatic EVs and quantify vesiclemia in a fast and reliable manner for a large number of samples (longitudinal follow-up of MBC patients). RESULTS: 26 patients were included and monitored for vesiclemia. Median age was 58.5y (±13.7). Metastatic disease sites were distributed as follows: bone metastases (21; 84%), liver (21; 84%), thoracic (10; 40%), node (2; 8%), brain (1; 4%), others (2; 8%). Endocrine therapy included aromatase inhibitors (20; 77%), fulvestrant (6; 29%), GnRH agonists (5; 19%) and CDK4/6 inhibitors palbocilib (15; 57%), abemaciclib (8; 31%) and ribociclib (3; 11%). With a median follow-up time of 22.1 months (95%CI 21.2 - not reached), median progression free survival was 21.8 months (95%CI 18.1 - not reached). Median time on treatment was 19.4 months (IQR 11.6 - 22.1). Objective response rate was confirmed in 12 patients (6 with complete response). Out of the 26 patients, 12 stopped the frontline treatment due to disease progression. 135 longitudinal follow-up samples were analyzed for EVs. All patients who progressed rapidly after treatment initiation (i.e median PFS< 6 months) had an increased vesiclemia at the months 2 and 6 after inclusion. Conversely, patients who had a median PFS >18m had a stable vesiclemia during this period. CONCLUSION This study aims to use circulating EVs as a therapeutic companion to anticipate treatment resistance and tumor progression in MBC patients. Our preliminary data suggest that the vesiclemia could be used as a predictive tool to anticipate treatment failure, and thus might be used to tailor treatments in time.
Citation Format: Mathilde Richard, Jean Sebastien FRENEL, Laurent Mathiot, Mario Campone, Mathilde Colombie, Marie Robert, Anne Patsouris, Frederic Bigot, Julie Gavard, Gwennan André-Grégoire, Laetitia Guevel. Extracellular vesicle-based biomarker assay for the monitoring of the efficacy of frontline endocrine therapy + CDK4-6 inhibitors in metastatic breast cancer. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-11-09.
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Affiliation(s)
| | | | - Laurent Mathiot
- 3Institut de Cancérologie de l’Ouest (ICO), Saint-Herblain, France, Saint-Herblain, Pays de la Loire, France
| | - Mario Campone
- 4Institut de Cancérologie de l’Ouest, René Gauducheau, Saint-Herblain, France, Saint-Herblain, France
| | | | - Marie Robert
- 6Institut de Cancérologie de l’Ouest, René Gauducheau, Saint-Herblain, France, Saint-Herblain, France
| | | | | | | | - Gwennan André-Grégoire
- 10Cancerology and Integrated Immunology Recsearch Center (CRCI2NA) & Institut de Cancérologie de l’Ouest, Nantes, Pays de la Loire, France
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FRENEL JS, Azzouz FB, Bigot F, Dauve J, Heymann MF, Gouraud W, Guette C, Lasla H, Michel B, Morel A, Patsouris A, Robert M, Siekaniec G, Colombie M, Jézéquel P, Campone M. Abstract P5-02-37: Multi-omics approach to identify markers of resistance to endocrine therapy + CDK4/6 inhibitors in first line HR+/HER2- metastatic breast cancer (MBC) patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p5-02-37] [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: 03/06/2023]
Abstract
Abstract
CONTEXT: Endocrine therapy combined with CDK4/6 inhibitor is the standard frontline treatment for the vast majority of HR+/HER2- MBC patients. Despite an overall survival benefit, patients eventually progress and mechanisms of resistance to this combination are not well identified. METHODS: EPICURE is an ongoing pilot prospective cohort study of heterogeneous and massive data integration, ie. multi-omics approach in MBC patients. The present study aims at identifying progression markers in patients with HR+/HER2- MBC receiving frontline endocrine therapy+iCDK4/6 by means of transcriptomics, genomics and proteomics data. All patients had a tumor biopsy at the entry in the study (B1) and a biopsy was repeated at progression if feasible (B2). Transcriptomic (RNAseq: NextSeq550, Illumina), genomic (whole exome sequencing: NextSeq550, Illumina) and proteomic (DIA mass spectrometry: TimsTOFPro2, Bruker) were performed on B1 and B2 according to available tumor tissue. RESULTS: Fifty-one patients matching inclusion criteria were included. B1 was done at inclusion for all patients (B1) (n = 51) and B2 was performed in 8 patients. (B2) (n = 8). Eight metastatic sites were biopsied: node (n = 17); liver (n = 16); bone (n = 8); breast local recurrence (n = 5); chest wall (n = 5); skin (n = 4); pleural (n = 3); ovary (n = 1). Transcriptomic, genomic and proteomic analysis of paired biopsies (B1 and B2) was performed in parallel and separately for 8, 7 and 2 patients, respectively. Exploratory data analysis of transcriptomic and proteomic data showed that liver biopsies clustered together. In order to eliminate this anatomic bias, specific genes and proteins of liver metastases were identified by means of DESeq2 analysis (12 liver vs 39 other sites) for transcriptomic data (n = 2654) and LIMMA (4 liver vs 14 other sites) for proteomic data (n = 227), and excluded for the rest of the analysis. Differential analyses (ie. gene expression, non-synonymous mutations and protein expression) between B1 and B2 were performed for each patient. These three kind of lists were finally submitted to ToppGene, DAVID and GOrilla for Gene Ontology terms enrichment analyses. Transcriptomic analyses of the 8 paired biopsies highlighted immune response (IR) in seven B1, IR in four B2 and neurogenesis in three B2. Genomics data evaluation between B1 and B2 pointed out “transposon integration” as an important pathway. Proteomic data of the 2 paired biopsies analysed underlined high immune response in B1, and muscle development/contraction and response to tumor necrosis factor in B2 for one patient. For the second one, liver metabolism in B1 and extracellular matrix and p38 MAPK cascade were emphasised. CONCLUSION: This preliminary study based on transcriptomic, genomic and proteomic data represents an encouraging first step of the EPICURE project. In a near future, additional paired biopsies and other kinds of omics data (epigenetics, radiomics, microbiomics, exposomics) will be available. Furthermore, omics data will be analysed in an integrated manner (ie. artificial intelligence), which will make it possible to detect synergies across the different omics data.
Citation Format: Jean Sebastien FRENEL, Fadoua Ben Azzouz, Frederic Bigot, Jonathan Dauve, Marie Francoise Heymann, Wilfried Gouraud, Catherine Guette, Hamza Lasla, Bertrand Michel, Alain Morel, Anne Patsouris, Marie Robert, Grégoire Siekaniec, Mathilde Colombie, Pascal Jézéquel, Mario Campone. Multi-omics approach to identify markers of resistance to endocrine therapy + CDK4/6 inhibitors in first line HR+/HER2- metastatic breast cancer (MBC) patients. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P5-02-37.
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Affiliation(s)
| | | | | | | | - Marie Francoise Heymann
- 5Institut de Cancérologie de l’Ouest site Saint-Herblain, Saint-Herblain, Pays de la Loire, France
| | - Wilfried Gouraud
- 6Institut de Cancérologie de l’Ouest, Saint Herblain, Pays de la Loire, France
| | | | | | | | - Alain Morel
- 10institut de cancerologie de l’ouest, ANGERS CEDEX 02, Pays de la Loire, France
| | | | - Marie Robert
- 12Institut de Cancérologie de l’Ouest, René Gauducheau, Saint-Herblain, France, Saint-Herblain, France
| | | | | | | | - Mario Campone
- 16Institut de Cancérologie de l’Ouest, René Gauducheau, Saint-Herblain, France, Saint-Herblain, France
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Bourien H, Lefevre LB, Mouret-Reynier MA, Asselain B, Lucas B, Gavoille C, Cornila C, Gavoille L, Colomba E, Patsouris A, Fabbro M, Chakiba C, Toussaint P, Simon H, Berton D, Garbay D, Tixidre CG, Coeffic D, Morvan A, Collard O, DE LA Motte Rouge T. Real-World Data on Olaparib in Relapsed BRCA-mutated Ovarian Cancer: A Multicenter GINECO RETROLA Cohort Study. Anticancer Res 2023; 43:653-662. [PMID: 36697069 DOI: 10.21873/anticanres.16202] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2022] [Revised: 11/24/2022] [Accepted: 12/07/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND/AIM Olaparib was approved in 2014 by the European Medicines Agency (EMA) as maintenance treatment for patients with breast cancer gene (BRCA)-mutated platinum-sensitive relapsed high-grade epithelial ovarian cancer (EOC) following the results of the Study 19. We present the results of a national real-world study on the effectiveness of olaparib in relapsed BRCA-mutated EOC patients. PATIENTS AND METHODS Patients with EOC, peritoneal, and/or fallopian-tube cancer treated with olaparib in a French Center between May 2014 and March 2017 were included. The primary end-point of the study was progression-free survival. RESULTS Of the 128 patients analyzed, 89 were treated according to the EMA label. The median progression-free survival was 17.0 months. The most common treatment-related toxicity was fatigue. Treatment-related myelodysplastic syndrome (n=5) and a second cancer (n=1) were diagnosed. CONCLUSION In this real-life setting, olaparib confirmed its efficacy and safety profile, as previously shown in clinical trials.
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Affiliation(s)
| | | | | | | | | | - Celine Gavoille
- Institut de Cancérologie de Lorraine, Vandoeuvre Les Nancy, France
| | | | | | - Emeline Colomba
- Gustave Roussy Cancer Campus, Paris-Saclay University, Villejuif, France
| | | | - Michel Fabbro
- ICM Regional Cancer Institute of Montpellier, Montpellier, France
| | | | | | - Helene Simon
- Hôpital Morvan - Centre Hospitalier Universitaire, Brest, France
| | - Dominique Berton
- Institut de Cancérologie de l'Ouest (ICO) René Gauducheau, Saint-Herblain, France
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Jacot W, Lusque A, Vicier C, Mailliez A, de La Motte Rouge T, Cabel L, Levy C, Patsouris A, Desmoulins I, Uwer L, Thery JC, Robain M, Caron O, Tredan O, Filleron T, Frenel JS, Delaloge S. Outcomes of patients with HER2-negative metastatic breast cancer after platinum- and non-platinum-based first-line chemotherapy among patients with and without pathogenic germline BRCA1/2 mutations. Br J Cancer 2022; 127:1963-1973. [PMID: 36207609 PMCID: PMC9681869 DOI: 10.1038/s41416-022-02003-1] [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: 03/04/2022] [Revised: 09/13/2022] [Accepted: 09/26/2022] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The efficacy and added benefit of platinum-based chemotherapy (PtCT) for metastatic breast cancer (MBC) remain unclear in patients with and without germline BRCA1 or BRCA2 mutations (gBRCA1/2m and gBRCA1/2wt, respectively). METHODS We selected from the French national real-world multicentre ESME cohort (2008-2016) all patients with HER2-negative MBC with known gBRCA1/2 status at first-line chemotherapy initiation. Using multivariable Cox models, we compared the outcome (progression-free (PFS) and overall survival (OS)) of first-line PtCT and non-PtCT regimens based on the patients' gBRCA1/2 status and tumour subtype. RESULTS Patients who received PtCT had more aggressive tumour features. In the multivariable analysis, first-line PtCT was associated with better adjusted PFS and OS in gBRCA1/2m carriers (N = 300), compared with non-PtCT (HR 0.54, 95% CI 0.4-0.73, P < 0.001, and HR 0.70, 95% CI 0.49-0.99, P = 0.047, respectively). Conversely, outcomes were similar in gBRCA1/2wt patients (N = 922) treated with PtCT and non-PtCT, whatever the tumour subtype. Landmark analyses at months 3 and 6 post treatment initiation supported these results. CONCLUSIONS In this pre-PARP inhibitor real-world cohort, PFS and OS were better after PtCT than non-PtCT in patients with gBRCA1/2m, but not in those with gBRCA1/2wt. These results emphasise the need of early gBRCA1/2 testing in patients with MBC. CLINICAL TRIAL NUMBER NCT03275311.
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Affiliation(s)
- William Jacot
- Institut du Cancer de Montpellier (ICM), INSERM U1194, Montpellier University, Montpellier, 34298, France.
| | - Amélie Lusque
- Institut Claudius Regaud-IUCT Oncopole, Toulouse, France
| | - Cécile Vicier
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | | | - Luc Cabel
- Institut Curie-UMR 144-CNRS, Paris, France
| | | | - Anne Patsouris
- Institut de Cancérologie de l'Ouest, Pays de Loire, Angers, France
| | | | - Lionel Uwer
- Institut de Cancérologie de Lorraine-Alexis Vautrin, Vandoeuvre-lès-Nancy, France
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de Calbiac O, Lusque A, Mailliez A, Bachelot T, Uwer L, Mouret-Reynier MA, Emile G, Jouannaud C, Gonçalves A, Patsouris A, Diéras V, Leheurteur M, Petit T, Cottu P, Ferrero JM, D'Hondt V, Desmoulins I, Mourato-Ribeiro J, Martin AL, Frenel JS. Comparison of Management and Outcomes in ERBB2-Low vs ERBB2-Zero Metastatic Breast Cancer in France. JAMA Netw Open 2022; 5:e2231170. [PMID: 36107428 PMCID: PMC9478776 DOI: 10.1001/jamanetworkopen.2022.31170] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE ERBB2-low (ie, ERBB2 immunohistochemistry score of 1+ or 2+ in the absence of ERBB2 gene amplification) breast cancer (BC) is a new entity, with emerging dedicated treatments. Little is known about its prognosis and response to conventional therapy compared with ERBB2-zero breast tumors (ie, those with an immunohistochemistry score of 0). OBJECTIVE To compare the outcomes for patients with ERBB2-low metastatic BC (MBC) with those of patients with ERBB2-zero MBC. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted from the Epidemiological Strategy and Medical Economics MBC platform and included patients with MBC treated between 2008 and 2016 in 18 French comprehensive cancer centers. The data analysis was conducted from July 16, 2020, to April 1, 2022. MAIN OUTCOMES AND MEASURES The main outcome was overall survival (OS), and the secondary outcome was progression-free survival under first-line treatments (PFS1). RESULTS The median (range) age was 60.0 (22.0-103.0) years. Among 15 054 patients with MBC, 4671 (31%) had ERBB2-low MBC and 10 383 (69%) had ERBB2-zero MBC. The proportion of ERBB2-low cancers was higher among patients with hormone receptor-positive MBC than those with hormone receptor-negative disease (4083 patients [33.0%] vs 588 patients [21.0%]). With a median follow-up of 49.5 months (95% CI, 48.6-50.4 months), the median OS of the ERBB2-low group was 38.0 months (95% CI, 36.4-40.5 months) compared with 33.9 months (95% CI, 32.9-34.9 months) for the ERBB2-zero group (P < .001). After adjustment for age, visceral metastases, number of metastatic sites, de novo disease, period of care, and hormone receptor status, patients with ERBB2-low MBC had slightly better OS compared with patients with ERBB2-zero MBC (adjusted hazard ratio, 0.95; 95% CI, 0.91-0.99; P = .02). In contrast, PFS1 did not differ by ERBB2 status (adjusted hazard ratio, 0.99; 95% CI, 0.95-1.02; P = .45). No significant differences in OS and PFS1 were observed in multivariate analyses by hormone receptor status and types of frontline treatment. CONCLUSIONS AND RELEVANCE In this large cohort study, patients with ERBB2-low MBC had a slightly better OS than those with completely ERBB2-zero tumors, but identical PFS1, which could help guide treatment selection.
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Affiliation(s)
- Ombline de Calbiac
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest Nantes and Angers, Saint-Herblain, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Claudius Regaud–IUCT Oncopole, Toulouse, France
| | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, France
| | | | - George Emile
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, Reims, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest Nantes and Angers, Angers, France
| | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | | | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris and Saint-Cloud, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Véronique D'Hondt
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | | | | | - Jean-Sébastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest Nantes and Angers, Saint-Herblain, France
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Moinard-Butot F, Saint-Martin C, Pflumio C, Carton M, Jacot W, Cottu PH, Diéras V, Dalenc F, Goncalves A, Debled M, Patsouris A, Mouret-Reynier MA, Vanlemmens L, Leheurteur M, Emile G, Ferrero JM, Desmoulins I, Uwer L, Eymard JC, Cheaib B, Courtinard C, Bachelot T, Chevrot M, Petit T. Efficacy of trastuzumab emtansine (T-DM1) and lapatinib after dual HER2 inhibition with trastuzumab and pertuzumab in patient with metastatic breast cancer: Retrospective data from a French multicenter real-life cohort. Breast 2022; 63:54-60. [PMID: 35299035 PMCID: PMC8927850 DOI: 10.1016/j.breast.2022.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 03/07/2022] [Accepted: 03/09/2022] [Indexed: 12/30/2022] Open
Abstract
Purpose Trastuzumab-emtansine (T-DM1), as well as lapatinib plus capecitabine were proven effective in two Phase III studies, following first-line trastuzumab plus a taxane. The introduction of dual HER2 blockade by trastuzumab and pertuzumab as first-line has positioned T-DM1 into second-line, and lapatinib plus capecitabine beyond, without formal evaluation of these strategies. Methods ESME Data Platform (NCT03275311) included individual data from all patients aged ≥18 years, in whom first-line treatment for metastatic breast cancer (MBC) was initiated between January 1, 2008 and December 31, 2016 in one of the 18 French Comprehensive Cancer Centers. The efficacy of T-DM1 and lapatinib plus capecitabine combination, following double blockade associating trastuzumab and pertuzumab were evaluated in this national real-life database. Eligibility criteria were: female, MBC, HER2+ tumor, first-line taxane-based chemotherapy and dual HER2-blockage by trastuzumab plus pertuzumab. Cohort A received second-line T-DM1, and Cohort B second-line T-DM1 and third or fourth-line lapatinib plus capecitabine. Results Cohort A comprised 233 patients, and Cohort B 47 patients. Median progression-free survival (PFS) was 7.1 months in Cohort A and 4.6 months in Cohort B. Median overall survival were 36.7 months and 12.9 months, respectively. PFS was significantly dependent on the preceding treatment line's duration. In cohort A, HER2 expression status was a significant predictive factor of PFS. Conclusion First-line trastuzumab plus pertuzumab do not markedly diminish T-DM1's efficacy in second-line. Similarly, sequential treatment with trastuzumab plus pertuzumab then T-DM1 does not noticeably modify the efficacy of lapatinib plus capecitabine. French real-life cohort. Dual blockade HER2 does not markedly diminish T-DM1's activity in second-line and lapatinib's activity in third or fourth line. The second-line (T-DM1) PFS was significantly longer when the first-line treatment with trastuzumab plus pertuzumab was ≥12 months.
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Affiliation(s)
- Fabien Moinard-Butot
- Department of Medical Oncology, Institut de Cancérologie Strasbourg - Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033, Strasbourg, France.
| | - Caroline Saint-Martin
- Department of Biostatistics, Institut Curie, 35 Rue Dailly, 92210, Saint-Cloud, France
| | - Carole Pflumio
- Department of Medical Oncology, Institut de Cancérologie Strasbourg - Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033, Strasbourg, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, 35 Rue Dailly, 92210, Saint-Cloud, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, 208 Rue des Apothicaires, 34298, Montpellier, France; Institut de Recherche en Cancérologie de Montpellier (IRCM), INSERM U1194, Montpellier, France
| | - Paul-Henri Cottu
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005, Paris, France
| | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33000, Bordeaux, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Nantes & Angers, 15 Rue André Boquel, 49055, Angers, France
| | - Marie-Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011, Clermont Ferrand, France
| | - Laurence Vanlemmens
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue d'Amiens, 76000, Rouen, France
| | - George Emile
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000, Caen, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189, Nice, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Institut de Cancérologie de Bourgogne, 21079, Dijon, France
| | - Lionel Uwer
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Jean-Christophe Eymard
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue du Général Koenig, 51100, Reims, France
| | - Bianca Cheaib
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Coralie Courtinard
- Unicancer, Data Office, 101 Rue de Tolbiac, 75654, Paris, France; Université de Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, Bordeaux, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Michaël Chevrot
- Unicancer, Data Office, 101 Rue de Tolbiac, 75654, Paris, France
| | - Thierry Petit
- Department of Medical Oncology, Institut de Cancérologie Strasbourg - Europe (ICANS), 17 Rue Albert Calmette, BP 23025, 67033, Strasbourg, France
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14
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Domergue C, Martin E, Lemarié C, Jézéquel P, Frenel JS, Augereau P, Campone M, Patsouris A. Impact of HER2 Status on Pathological Response after Neoadjuvant Chemotherapy in Early Triple-Negative Breast Cancer. Cancers (Basel) 2022; 14:2509. [PMID: 35626113 PMCID: PMC9139240 DOI: 10.3390/cancers14102509] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 02/06/2023] Open
Abstract
PURPOSE Investigates the link between HER2 status and histological response after neoadjuvant chemotherapy in patients with early TNBC. METHODS We retrieved clinical and anatomopathological data retrospectively from 449 patients treated for the first time with standard neoadjuvant chemotherapy for early unilateral BC between 2005 and 2020. The primary endpoint was pathological complete response (pCR, i.e., ypT0 ypN0), according to HER2 status. Secondary endpoints included invasive disease-free survival (I-DFS) and overall survival (OS). RESULTS 437 patients were included, and 121 (27.7%) patients had HER2-low tumours. The pCR rate was not significantly different between the HER2-low group vs. the HER2-0 group (35.7% versus 41.8%, p = 0.284) in either univariate analysis or multivariate analysis adjusted for TNM classification and grade (odds ratio [OR] = 0.70, confidence interval [CI] 95% 0.45-1.08). With a median follow-up of 72.9 months, no significant survival differences were observed between patients with HER2-low tumours vs. patients with HER2-0 tumours in terms of I-DFS (p = 0.487) and OS (p = 0.329). CONCLUSIONS In our cohort, HER2 status was not significantly associated with pCR in a manner consistent with data published recently on TNBC. However, the prognostic impact of HER2-low expression among TNBC patients warrants further evaluation.
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Affiliation(s)
- Camille Domergue
- Medical Oncology Department, ICO Institut de Cancérologie de l’Ouest, 49000 Angers, France; (P.A.); (M.C.); (A.P.)
| | - Elodie Martin
- Clinical Trial Sponsor Unit/Biometry, ICO Institut de Cancérologie de l’Ouest, 44800 Saint-Herblain, France;
| | - Camille Lemarié
- Biopathology Department, ICO Institut de Cancérologie de l’Ouest, 44800 Saint-Herblain, France;
| | - Pascal Jézéquel
- Omics Data Science Unit, ICO Institut de Cancérologie de l’Ouest, 44800 Saint-Herblain, France;
| | - Jean-Sebastien Frenel
- Medical Oncology Department, ICO Institut de Cancérologie de l’Ouest, 44800 Saint-Herblain, France;
| | - Paule Augereau
- Medical Oncology Department, ICO Institut de Cancérologie de l’Ouest, 49000 Angers, France; (P.A.); (M.C.); (A.P.)
| | - Mario Campone
- Medical Oncology Department, ICO Institut de Cancérologie de l’Ouest, 49000 Angers, France; (P.A.); (M.C.); (A.P.)
| | - Anne Patsouris
- Medical Oncology Department, ICO Institut de Cancérologie de l’Ouest, 49000 Angers, France; (P.A.); (M.C.); (A.P.)
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15
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Gaillard T, Carton M, Mailliez A, Desmoulins I, Mouret-Reynier M, Petit T, Leheurteur M, Dieras V, Ferrero J, Uwer L, Guiu S, Gonc¸alves A, Levy C, Debled M, Dalenc F, Patsouris A, Bachelot T, Eymard J, Chevrot M, Conversano A, Robain M, Hequet D. Corrigendum to “De novo metastatic breast cancer in patients with a small locoregional tumour (T1-T2/N0): characteristics and prognosis” [Eur J Cancer 158 (2021) 181–188]. Eur J Cancer 2022; 166:311-312. [DOI: 10.1016/j.ejca.2022.02.021] [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: 11/03/2022]
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16
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Carausu M, Carton M, Cabel L, Patsouris A, Levy C, Verret B, Pasquier D, Debled M, Gonçalves A, Desmoulins I, Lecouillard I, Bachelot T, Ferrero JM, Eymard JC, Mouret-Reynier MA, Chevrot M, De Maio E, Uwer L, Frenel JS, Leheurteur M, Petit T, Darlix A, Bozec L. Clinicopathological characteristics and prognosis of breast cancer patients with isolated central nervous system metastases in the multicentre ESME database. Ther Adv Med Oncol 2022; 14:17588359221077082. [PMID: 35237352 PMCID: PMC8883300 DOI: 10.1177/17588359221077082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 06/07/2021] [Accepted: 01/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background: As a result of progress in diagnosis and treatment, there is a growing prevalence of metastatic breast cancer (MBC) with isolated CNS metastases. This study describes the largest-to-date real-life cohort of this clinical setting and compares it to other clinical presentations. Methods: We retrospectively analysed the French Epidemiological Strategy and Medical Economics (ESME) MBC database including patients who initiated treatment for MBC between 2008 and 2016. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan–Meier method. Descriptive statistics and multivariate Cox model were used. Results: Of 22,266 patients, 647 (2.9%) and 929 (4.2%) patients had isolated first-site CNS metastases or combined with extra-CNS metastases, with longer OS for the group with isolated CNS metastases (16.9 versus 13.9 months, adjusted HR = 1.69 (95% CI: 1.50–1.91), p < 0.001). Among the 541 (2.4%) patients with isolated CNS metastases and no intrathecal therapy (excluding leptomeningeal metastases), HER2+ cases were preponderant over TN or HR+ /HER2− cases (41.6% versus 26.1% versus 28.5%, respectively, p < 0.01). The treatment strategy consisted of a combination of local treatment and systemic therapy (49.2%), local treatment only (35.5%) or systemic therapy only (11.4%), or symptomatic therapy only (3.9%). Median PFS was 6.1 months (95% CI: 5.7–6.8). Median OS was 20.7 months (95% CI: 17.3–24.3), reaching 37.9 months (95% CI: 25.9–47.6) in the HR+ /HER2+ subgroup. Older age, TN subtype, MBC-free interval of 6–12 months, lower performance status, and WBRT were associated with poorer survival. Patients who received systemic therapy within 3 months from MBC diagnosis had longer OS (24.1 versus 16.1 months, p = 0.031), but this was not significant on multivariate analysis [HR = 1.0 (95% CI: 0.7–1.3), p = 0.806]. Conclusions: Patients with isolated CNS metastases at MBC diagnosis represent a distinct population for which the role of systemic therapy needs to be further investigated in prospective studies.
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Affiliation(s)
- Marcela Carausu
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, Angers, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Benjamin Verret
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - David Pasquier
- Department of Radiation Oncology, Centre Oscar Lambret, CRIStAL UMR CNRS 9189, Lille University, Lille, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | | | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | | | | | - Eleonora De Maio
- Department of Medical Oncology, Institut Claudius Regaud – IUCT Oncopole, Toulouse, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Jean-Sébastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest–René Gauducheau, Saint-Herblain, France
| | | | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - Amélie Darlix
- Department of Medical Oncology, Institut régional du Cancer de Montpellier (ICM), Institut de Génomique Fonctionnelle, INSERM U1191-CNRS UMR 5203, Université de Montpellier, Montpellier, France
| | - Laurence Bozec
- Department of Medical Oncology, Institut Curie, 35 rue Dailly, 92210 Saint-Cloud, France
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Bouron C, Mathie C, Seegers V, Morel O, Jézéquel P, Lasla H, Guillerminet C, Girault S, Lacombe M, Sher A, Lacoeuille F, Patsouris A, Testard A. Prognostic Value of Metabolic, Volumetric and Textural Parameters of Baseline [ 18F]FDG PET/CT in Early Triple-Negative Breast Cancer. Cancers (Basel) 2022; 14:cancers14030637. [PMID: 35158904 PMCID: PMC8833829 DOI: 10.3390/cancers14030637] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 01/22/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023] Open
Abstract
Simple Summary The aim of this study was to evaluate PET/CT parameters to determine different prognostic groups in TNBC, in order to select patients with a high risk of relapse, for whom therapeutic escalation can be considered. We have demonstrated that the MTV, TLG and entropy of the primary breast lesion could be of interest to predict the prognostic outcome of TNBC patients. Abstract (1) Background: triple-negative breast cancer (TNBC) remains a clinical and therapeutic challenge primarily affecting young women with poor prognosis. TNBC is currently treated as a single entity but presents a very diverse profile in terms of prognosis and response to treatment. Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose ([18F]FDG) is gaining importance for the staging of breast cancers. TNBCs often show high [18F]FDG uptake and some studies have suggested a prognostic value for metabolic and volumetric parameters, but no study to our knowledge has examined textural features in TNBC. The objective of this study was to evaluate the association between metabolic, volumetric and textural parameters measured at the initial [18F]FDG PET/CT and disease-free survival (DFS) and overall survival (OS) in patients with nonmetastatic TBNC. (2) Methods: all consecutive nonmetastatic TNBC patients who underwent a [18F]FDG PET/CT examination upon diagnosis between 2012 and 2018 were retrospectively included. The metabolic and volumetric parameters (SUVmax, SUVmean, SUVpeak, MTV, and TLG) and the textural features (entropy, homogeneity, SRE, LRE, LGZE, and HGZE) of the primary tumor were collected. (3) Results: 111 patients were enrolled (median follow-up: 53.6 months). In the univariate analysis, high TLG, MTV and entropy values of the primary tumor were associated with lower DFS (p = 0.008, p = 0.006 and p = 0.025, respectively) and lower OS (p = 0.002, p = 0.001 and p = 0.046, respectively). The discriminating thresholds for two-year DFS were calculated as 7.5 for MTV, 55.8 for TLG and 2.6 for entropy. The discriminating thresholds for two-year OS were calculated as 9.3 for MTV, 57.4 for TLG and 2.67 for entropy. In the multivariate analysis, lymph node involvement in PET/CT was associated with lower DFS (p = 0.036), and the high MTV of the primary tumor was correlated with lower OS (p = 0.014). (4) Conclusions: textural features associated with metabolic and volumetric parameters of baseline [18F]FDG PET/CT have a prognostic value for identifying high-relapse-risk groups in early TNBC patients.
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Affiliation(s)
- Clément Bouron
- Department of Nuclear Medicine, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France; (O.M.); (C.G.); (S.G.); (M.L.); (A.S.); (A.T.)
- Department of Nuclear Medicine, University Hospital of Angers, 4 rue Larrey, 49100 Angers, France;
- Correspondence:
| | - Clara Mathie
- Department of Medical Oncology, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France; (C.M.); (A.P.)
| | - Valérie Seegers
- Research and Statistics Department, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France;
| | - Olivier Morel
- Department of Nuclear Medicine, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France; (O.M.); (C.G.); (S.G.); (M.L.); (A.S.); (A.T.)
| | - Pascal Jézéquel
- Omics Data Science Unit, ICO Pays de la Loire, Bd Jacques Monod, CEDEX, 44805 Saint-Herblain, France; (P.J.); (H.L.)
- CRCINA, UMR 1232 INSERM, Université de Nantes, Université d’Angers, Institut de Recherche en Santé, 8 Quai Moncousu—BP 70721, CEDEX 1, 44007 Nantes, France
| | - Hamza Lasla
- Omics Data Science Unit, ICO Pays de la Loire, Bd Jacques Monod, CEDEX, 44805 Saint-Herblain, France; (P.J.); (H.L.)
| | - Camille Guillerminet
- Department of Nuclear Medicine, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France; (O.M.); (C.G.); (S.G.); (M.L.); (A.S.); (A.T.)
- Department of Medical Physics, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France
| | - Sylvie Girault
- Department of Nuclear Medicine, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France; (O.M.); (C.G.); (S.G.); (M.L.); (A.S.); (A.T.)
| | - Marie Lacombe
- Department of Nuclear Medicine, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France; (O.M.); (C.G.); (S.G.); (M.L.); (A.S.); (A.T.)
| | - Avigaelle Sher
- Department of Nuclear Medicine, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France; (O.M.); (C.G.); (S.G.); (M.L.); (A.S.); (A.T.)
| | - Franck Lacoeuille
- Department of Nuclear Medicine, University Hospital of Angers, 4 rue Larrey, 49100 Angers, France;
- CRCINA, University of Nantes and Angers, INSERM UMR1232 équipe 17, 49055 Angers, France
| | - Anne Patsouris
- Department of Medical Oncology, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France; (C.M.); (A.P.)
- INSERM UMR1232 équipe 12, 49055 Angers, France
| | - Aude Testard
- Department of Nuclear Medicine, ICO Pays de la Loire, 15 rue André Boquel, 49055 Angers, France; (O.M.); (C.G.); (S.G.); (M.L.); (A.S.); (A.T.)
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Mallet A, Lusque A, Levy C, Pistilli B, Brain E, Pasquier D, Debled M, Thery JC, Gonçalves A, Desmoulins I, De La Motte Rouge T, Faure C, Ferrero JM, Eymard JC, Mouret-Reynier MA, Patsouris A, Cottu P, Dalenc F, Petit T, Payen O, Uwer L, Guiu S, Sébastien Frenel J. Real-world evidence of the management and prognosis of young women (⩽40 years) with de novo metastatic breast cancer. Ther Adv Med Oncol 2022; 14:17588359211070362. [PMID: 35082924 PMCID: PMC8785354 DOI: 10.1177/17588359211070362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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] [Received: 07/09/2021] [Accepted: 12/13/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Breast cancer (BC) in young women merits a specific approach given the associated fertility, genetic and psychosocial issues. De novo metastatic breast cancer (MBC) in young women is an even more serious condition, with limited data available. Methods: We evaluated management of women aged ⩽40 years with de novo MBC in a real-life national multicentre cohort of 22,463 patients treated between 2008 and 2016 (NCT0327531). Our primary objective was to compare overall survival (OS) in young women versus women aged 41–69 years. The secondary objectives were to compare first-line progression-free survival (PFS1) and to describe treatment patterns. Results: Of the 4524 women included, 598 (13%) were ⩽40 years. Median age at MBC diagnosis was 36 years (range = 20–40). Compared with women aged 41–69 years, young women had more grade III tumours (49% versus 35.7%, p < 0.0001), human epidermal growth factor receptor 2 amplified (HER2+) disease (34.6% versus 26.4%, p < 0.0001) and HR–/HER2– disease known as “triple negative breast cancer” (TNBC) (17.1% versus 12.7%, p < 0.0001). BRCA testing was performed for 260 young women, with a BRCA1/2 mutation in 44 (17% of those tested) In young HR+/HER2– patients, chemotherapy (CT) was given as the frontline treatment more frequently compared with older ones (89.6% versus 68.8%, respectively, p < 0.0001). After median follow-up of 49.7 months (95% confidence interval, CI = 48.0–51.7), the median OS of young women was 58.5 months, 20.7 months and not attained in HR+/HER2–, TNBC and HER2+ subgroups, respectively. After adjustment for histological subtype, tumour grade, and number and type of metastasis, young women had significantly better OS compared with older ones, except for the TNBC subgroup, for which the outcome was similar. PFS1 was statistically different only in the TNBC subgroup, with 7.8 months for young women and 6.3 months for older women ( p = 0.0015). Conclusion: De novo MBC affects a significant proportion of young women. A subgroup of these patients achieves long OS and merits multidisciplinary care.
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Affiliation(s)
- Amélie Mallet
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest – René Gauducheau, Saint-Herblain, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Claudius Regaud – IUCT Oncopole, Toulouse, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Paris, France
| | - David Pasquier
- Department of Radiation Oncology, Centre Oscar Lambret, Lille, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonie, Bordeaux, France
| | | | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Christelle Faure
- Department of Surgery Oncology, Centre Léon Bérard, Lyon, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | | | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest – Paul Papin, Angers, France
| | - Paul Cottu
- Department of Medical Oncology, Etablissement Hospitalier Institut Curie, Paris, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud – IUCT Oncopole, Toulouse, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | - Olivier Payen
- Department of Real World Data, Data Unit, Unicancer, Paris, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | - Séverine Guiu
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Jean Sébastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest – René Gauducheau, Boulevard Jacques Monod, 44805 Saint-Herblain, France
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Lacombe V, Patsouris A, Delattre E, Lavigne C, Lacout C, Urbanski G. Évolution de la vitamine B12 plasmatique au cours des cancers solides sous traitement curatif ou palliatif. Rev Med Interne 2021. [DOI: 10.1016/j.revmed.2021.10.098] [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: 11/29/2022]
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20
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Bizot A, Karimi M, Rassy E, Heudel PE, Levy C, Vanlemmens L, Uzan C, Deluche E, Genet D, Saghatchian M, Giacchetti S, Grenier J, Patsouris A, Dieras V, Pierga JY, Petit T, Ladoire S, Jacot W, Benderra MA, De Jesus A, Delaloge S, Lambertini M, Pistilli B. Multicenter evaluation of breast cancer patients' satisfaction and experience with oncology telemedicine visits during the COVID-19 pandemic. Br J Cancer 2021; 125:1486-1493. [PMID: 34588616 PMCID: PMC8480754 DOI: 10.1038/s41416-021-01555-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 08/31/2021] [Accepted: 09/17/2021] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION During the COVID-19 pandemic, teleconsultation was implemented in clinical practice to limit patient exposure to COVID-19 while monitoring their treatment and follow-up. We sought to examine the satisfaction of patients with breast cancer (BC) who underwent teleconsultations during this period. METHODS Eighteen centres in France and Italy invited patients with BC who had at least one teleconsultation during the first wave of the COVID-19 pandemic to participate in a web-based survey that evaluated their satisfaction (EORTC OUT-PATSAT 35 and Telemedicine Satisfaction Questionnaire [TSQ] scores) with teleconsultation. RESULTS Among the 1299 participants eligible for this analysis, 53% of participants were undergoing standard post-treatment follow-up while 22 and 17% were currently receiving active anticancer therapy for metastatic and localised cancers, respectively. The mean satisfaction scores were 77.4 and 73.3 for the EORTC OUT-PATSAT 35 and TSQ scores, respectively. In all, 52.6% of participants had low/no anxiety. Multivariable analysis showed that the EORTC OUT-PATSAT 35 score correlated to age, anxiety score and teleconsultation modality. The TSQ score correlated to disease status and anxiety score. CONCLUSION Patients with BC were satisfied with oncology teleconsultations during the COVID-19 pandemic. Teleconsultation may be an acceptable alternative follow-up modality in specific circumstances.
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Affiliation(s)
- Alexandra Bizot
- Medical Oncology Department, Gustave Roussy, Villejui, France
| | - Maryam Karimi
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, University Paris-Saclay, Labeled Ligue Contre le Cancer, Villejuif, France
| | - Elie Rassy
- Medical Oncology Department, Gustave Roussy, Villejui, France
| | | | - Christelle Levy
- Institut Normand du Sein, Centre Francois Baclesse, Caen, France
| | | | - Catherine Uzan
- Breast and Gynecologic Surgery, Assistance Publique - Hopitaux De Paris, Paris, France
| | - Elise Deluche
- Medical Oncology Department, CHU Limoges - Hopital Dupuytren, Limoges, France
| | - Dominique Genet
- Medical Oncology Department, Clinique Chenieux, Limoges, France
| | | | | | - Juline Grenier
- Medical Oncology Department, Institut Ste Catherine, Avignon, France
| | - Anne Patsouris
- Medical Oncology Department, ICO - Institut de Cancérologie de l'Ouest Nantes-Angers, Angers, France
| | - Véronique Dieras
- Medical Oncology Department, Centre Eugene - Marquis, Rennes, France
| | - Jean-Yves Pierga
- Medical Oncology Department, Institut Curie & St Cloud, Université de Paris, Paris, France
| | - Thierry Petit
- Medical Oncology Department, Centre Paul Strauss Centre de Lutte contre le Cancer, Strasbourg, France
| | - Sylvain Ladoire
- Medical Oncology Department, Centre Georges-François Leclerc (Dijon), Dijon, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, INSERM, U1194, Montpellier, France
| | | | - Anne De Jesus
- Patient Relationship Coordination, Gustave Roussy, Villejuif, France
| | | | - Matteo Lambertini
- Medical Oncology Department, IRCCS Ospedale Policlinico San Martino, Genova, Italy
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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21
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Gaillard T, Carton M, Mailliez A, Desmoulins I, Mouret-Reynier MA, Petit T, Leheurteur M, Dieras V, Ferrero JM, Uwer L, Guiu S, Gonçalves A, Levy C, Debled M, Dalenc F, Patsouris A, Bachelot T, Eymard JC, Chevrot M, Conversano A, Robain M, Hequet D. De novo metastatic breast cancer in patients with a small locoregional tumour (T1-T2/N0): Characteristics and prognosis. Eur J Cancer 2021; 158:181-188. [PMID: 34689042 DOI: 10.1016/j.ejca.2021.09.021] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/20/2021] [Accepted: 09/22/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The estimated rate of de novo metastatic breast cancer (dnMBC) at the time of diagnosis is between 5 to 12%. International guidelines recommend metastatic work-up (MWU) only in women with advanced breast cancer. The purpose of this study was to describe the characteristics and prognosis of patients with dnMBC diagnosed without an initial indication for MWU. METHODS We conducted a retrospective, comparative study in dnMBC patients selected from the ESME-MBC cohort. Patients were treated in France between 2008 and 2016. We compared two populations: patients in whom dnMBC was diagnosed by staging although not indicated by guidelines (non-guideline staging [NGS]) and those in whom dnMBC was diagnosed by guideline staging (GS). RESULTS During the study period, 22,463 patients with MBC were included in the ESME cohort. Among them, 6698 were dnMBC patients. In 247 of these patients (6% of dnMBC and 1% of the overall population), dnMBC was diagnosed by non-guideline staging. Women in this group were significantly younger (57 vs. 59 years, p = 0.02) and had fewer metastatic sites at diagnosis than dnMBC-GS patients. The two groups were not significantly different in terms of the other characteristics. Overall survival (OS) and progression-free survival (PFS) were better in the dnMBC-NGS group than in the dnMBC-GS group. The impact on survival was confirmed by univariate and multivariate analysis (HR 1.83 [1.31-2.57], p < 0.01). CONCLUSION This study provides the first description of a very specific population. These patients with dnMBC-NGS were younger and more likely to have oligometastatic disease with a better prognosis.
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Affiliation(s)
- T Gaillard
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France.
| | - M Carton
- Department of Biostatistics, Institut Curie, Paris & Saint-Cloud, France
| | - A Mailliez
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - I Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - M A Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, Clermont-Ferrand, France
| | - T Petit
- Department of Medical Oncology, ICANS Centre Paul Strauss, Strasbourg, France
| | - M Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - V Dieras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - J M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - L Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Nancy, France
| | - S Guiu
- Department of Medical Oncology, Institut de Cancérologie de Montpellier, Montpellier, France
| | - A Gonçalves
- Department of Medical Oncology, Institut Paoli Calmette, Marseille, France
| | - C Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - M Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - F Dalenc
- Department of Medical Oncology, IUCT-Oncopole Institut Claudius Regaud, Toulouse, France
| | - A Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Angers & Nantes, France
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - J C Eymard
- Department of Medical Oncology, Institut Jean Godinot, Reims, France
| | - M Chevrot
- Real World Data Department, Unicancer Data Office, Paris, France
| | - A Conversano
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - M Robain
- Real World Data Department, Unicancer Data Office, Paris, France
| | - D Hequet
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France
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Frenel JS, Lusque A, Mailliez A, Bachelot T, Uwer L, Mouret Reynier M, Levy C, Jouannaud C, Gonçalves A, Patsouris A, Dieras V, Leheurteur M, Petit T, Cottu P, Ferrero JM, Villacroux O, D'Hondt V, Desmoulins I, Delaloge S, De Calbiac O. 291P HER2-low metastatic breast cancer (MBC): Management and prognosis of a new breast cancer entity in a real-world setting. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.574] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Autier L, Augereau P, Lebrec N, Seegers V, Soulié P, Patsouris A, Campone M, Dupoiron D. 322P Intrathecal catheter for chemotherapy in leptomeningeal metastatic breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.605] [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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Domergue C, Martin E, Lemarié C, Jézéquel P, Frenel JS, Augereau P, Campone M, Patsouris A. 156P Impact of HER2 status (HER2-low versus HER2-0) on complete histologic response after neoadjuvant chemotherapy in early triple-negative breast cancer (TNBC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.437] [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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Frenel JS, Lusque A, Delaloge S, Ferrero JM, Bachelot T, Desmoulins I, Levy C, Eymard JC, Gonçalves A, Patsouris A, Reynier MM, Leheurteur M, Petit T, Cabel L, Uwer L, Debled M, Chevrot M, Mailliez A, Jacot W, De La Motte Rouge T. 231P Prognosis and efficacy of frontline treatment for HR+ HER2- metastatic breast cancer occurring in gBRCA1/2 carriers. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.514] [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: 11/17/2022] Open
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Lacombe V, Chabrun F, Lacout C, Ghali A, Capitain O, Patsouris A, Lavigne C, Urbanski G. Persistent elevation of plasma vitamin B12 is strongly associated with solid cancer. Sci Rep 2021; 11:13361. [PMID: 34172805 PMCID: PMC8233305 DOI: 10.1038/s41598-021-92945-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 06/15/2021] [Indexed: 12/17/2022] Open
Abstract
Elevated plasma vitamin B12 has been associated with solid cancers, based on a single B12 measurement. We evaluated the incidence of solid cancers following B12 measurement in patients with persistent elevated B12, compared to patients without elevated B12 and to patients with non-persistent elevated B12. The study population included patients with at least two plasma B12 measurements without already known elevated-B12-related causes. Patients with elevated plasma B12 (≥ 1000 ng/L) at first measurement (n = 344) were matched for age and sex with patients having 2 normal B12 measurements (< 1000 ng/L) (NN group, n = 344). The patients with elevated plasma B12 at first measurement were split into 2 groups, according to the presence (EE group, n = 144) or the absence (EN group, n = 200) of persistent elevated plasma B12 at second measurement. We compared the cancer-free survival during 60 months between the groups after adjustment for the other elevated-B12-related causes in a survival competing risk model. Compared to the NN group, a persistent elevated plasma B12 ≥ 1000 ng/mL was strongly associated with the occurrence of solid cancer (HR 5.90 [95% CI 2.79-12.45], p < 0.001), contrary to non-persistent plasma B12 elevation (p = 0.29). These results could help to select patients in whom the screening for solid cancers would be of interest.
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Affiliation(s)
- Valentin Lacombe
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Floris Chabrun
- Department of Biochemistry and Genetics, Angers University Hospital, Angers, France
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Alaa Ghali
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | | | | | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France
| | - Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, Angers, France.
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 4 rue Larrey, 49000, Angers, France.
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Bouron C, Mathie C, Seegers V, Guillerminet C, Campone M, Morel O, Jézéquel P, Patsouris A, Testard A. Abstract PS3-19: Prognostic value of textural associated with metabolic parameters of baseline 18FDG-PET/CT in early triple-negative breast cancer (TNBC). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps3-19] [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 : Triple negative breast cancer (TNBC) represents 10-17 % of all diagnosed early breast cancers, occurs more frequently in young women (< 50 years old) and has a poor prognosis. TNBC remains a clinical and therapeutic challenge dealing with a paradox: a high-risk of metastatic relapse despite a high rate of clinical and histological response after neoadjuvant chemotherapy with contrasting but disappointing results of targeted therapies. However, TNBCs are treated as a single entity and due to their phenotypic heterogeneity and various molecular pathogenesis, this subtype has a very different profile in terms of prognosis and response to treatment. Positron emission tomography/computed tomography (PET/CT) with 18F-fluorodeoxyglucose (18FDG) is gaining importance for the staging of patients with large or locally advanced breast cancer. TNBCs often show high 18FDG uptake and several studies demonstrate correlations between standard uptake value (SUV) and histoprognostic factors such as grade or KI67%. Recently, a new approach is growing interest in medical imaging: textural analysis. Some studies have shown correlations between metabolic parameters with overall survival (OS) and disease free survival (DFS) in other carcinoma, such as lung and head-and-neck cancers. Few studies analyzed textural features with potentially promising prognostic value that has to be confirmed. The objective of this study is to evaluate the association between metabolic and textural parameters measured at the initial 18FDG-PET/CT, disease-free survival (DFS) and overall survival (OS) in patients with non-metastatic TBNC. Patients and Methods: All consecutive non-metastatic TNBC women who underwent 18FDG-PET/CT at diagnosis between 2012 and 2018 were retrospectively included. Metabolic parameters (SUVmax, SUVmean, SUVpeak, MTV, TLG) in the primary tumor and lymph nodes and textural features (entropy, homogeneity, SRE, LRE, LGZE, HGZE) in the primary tumor were collected. Regression models were used to assess the correlations between PET parameters and histoprognostic factors. Cox regression models were computed to identify association with DFS and OS. Results : One hundred and eleven patients were enrolled. The median follow-up was 53.6 months. Thirty-six patients experienced relapse and 20 died. Homogeneity was associated with no axillary lymph node involvement and lower grade. Entropy was associated with higher grade, lymph node involvement and inflammatory tumors. SRE was only associated with higher grade. TLG and MTV were highly correlated (r =0.98, 95%CI = 0.97-0.99). TLG, MTV and Entropy of the primary tumor were associated with lower DFS (p = 0.008, p = 0.006, and p = 0.025, respectively) and lower OS (p = 0.002, p = 0.001 and p = 0.046, respectively). In the 50 patients with positive PET axillary lymph nodes, all metabolic parameters except SUVmean were correlated with DFS whereas no correlation was seen with OS. Conclusion: Textural associated with metabolic features of baseline 18FDG-PET/CT add prognosis value interesting to identify high risk group of relapse in early TNBC patients.
Citation Format: Clément Bouron, Clara Mathie, Valérie Seegers, Camille Guillerminet, Mario Campone, Olivier Morel, Pascal Jézéquel, Anne Patsouris, Aude Testard. Prognostic value of textural associated with metabolic parameters of baseline 18FDG-PET/CT in early triple-negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS3-19.
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Bringuier M, Carton M, Levy C, Patsouris A, Pasquier D, Debled M, Rigal O, Jacot W, Gonçalves A, Desmoulins I, De La Motte Rouge T, Bachelot T, Ferrero JM, Eymard JC, Dalenc F, Mouret-Reynier MA, Petit T, Chevrot M, Courtinard C, Uwer L, Frenel JS, Baldini C. Abstract PS7-46: Enrollment of older metastatic breast cancer patients in clinical trials. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps7-46] [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: About 40% of breast cancer cases occur in women 65 years old (yo) or older and 20% in women over 75 yo. These numbers are expected to increase in the near future. Ironically, older patients remain underrepresented in clinical trials with no improvement in the past decade, although they may present different efficacy/toxicity profiles compared with younger adults. In this context, real life cohorts may bring valuable insight to identify potential barriers to recruitment of older patients with metastatic breast cancer (MBC) in clinical trials. Methods: We used the national Epidemio-Strategy and Medical Economics (ESME) MBC Data Platform, a multi-center real life database using a retrospective data collection process in 18 French Cancer Centers. Cases selected were adult patients with MBC whose first metastasis was treated between January 1st, 2008 and December 31st, 2016. We selected MBC women over 70 yo at the time of MBC diagnosis, with at least one line of systemic treatment and no other cancer in the 5 years before MBC. The primary objective was to describe factors associated with enrollment in clinical trials in older patients, using a multivariable Cox model. Factors included in this model were age (continuous, and by class), period (2008-2011 vs 2012-2016), phenotype (ER+, HER2+, or ER- HER2-), ECOG Performance Status (PS), treatment, metastatic sites (brain, visceral, nodes/bone only) and number, and volume of hospital activity. No geriatric description could be extracted from the database. Results: There were 5846 patients ≥70yo (median age 77) and 15892 patients < 70 yo. Of the older ones, 245 (4.2%) were enrolled in a clinical trial in first line compared with 1602 (10%) for younger ones. Most of the older patients in this cohort (66%) had ER+ HER2+ disease, half had visceral metastases (< 3 metastatic sites in 82%). Median follow-up of older patients was 46.3 months; 95%CI 44.8-49.0. Cause of death was related to disease in 1155 (33.9%) older patients, and related to another cause or unknown in 2156 (63.3%), data were missing for 2441 patients. Median overall survival (OS) was 34.1 months in the older population, 95%CI 32.9-35.4, and specific overall survival was 70.8 months, 95%CI 66.3-80.0. Significant factors identified in the multivariable analysis for enrollment in 1st line treatment clinical trial ≥70 are shown in table. Volume of activity was not identified as one.
By multivariate analysis, participation of older patients to a clinical trial was associated with an increased OS (HR 0.7; 95% CI 0.6-0.8) but not with a better breast cancer specific survival (HR 0.94; 95%CI 0.68-1.29). Conclusions: In this large real-life database, few older MBC patients were enrolled in a trial compared with younger ones. Factors associated with such participation to clinical research were younger age (< 80 yo), good PS, HER2+ disease, and investigational treatment consisting of chemotherapy or targeted therapy. There was a small improvement in accruing older patients between 2007-2011 and 2012-2016 (2.6% versus 5.5%). Most of these factors raise questions on drug availability and perceived potential benefits by investigators and medical teams. Accrual of older patients with cancer in other disease types should be more encouraged.
VariableOR95%CIAge vs 70-75 75-80 80-85 85+0.74 0.47 0.170.54-1 0.31-0.71 0.06-0.37MBC diagnosis period vs 2008-2011 2012-20161.671.23-2.27Phenotype vs Others HER2+1.761.26-2.45PS vs 0 1 2-40.71 0.150.5-1 0.08-0.26Treatment4.88 5.253.08-7.9 3.48-8.14Chemotherapy vs others4.883.08-7.9Targeted treatment vs others5.253.48-8.14
Citation Format: Michael Bringuier, Matthieu Carton, Christelle Levy, Anne Patsouris, David Pasquier, Marc Debled, Olivier Rigal, William Jacot, Anthony Gonçalves, Isabelle Desmoulins, Thibault De La Motte Rouge, Thomas Bachelot, Jean-Marc Ferrero, Jean-Christophe Eymard, Florence Dalenc, Marie-Ange Mouret-Reynier, Thierry Petit, Michael Chevrot, Coralie Courtinard, Lionel Uwer, Jean-Sebastien Frenel, Capucine Baldini. Enrollment of older metastatic breast cancer patients in clinical trials [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-46.
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Affiliation(s)
| | | | | | - Anne Patsouris
- 3Institut de Cancérologie de l'Ouest - Paul Papin, Angers, France
| | | | | | | | - William Jacot
- 7Institut Régional du Cancer Montpellier / Val d’Aurelle, Montpellier, France
| | | | | | | | | | | | | | | | | | | | | | | | - Lionel Uwer
- 18Institut de Cancérologie de Lorraine, Nancy, France
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Jacot W, Lusque A, Mailliez A, De la Motte Rouge T, Cabel L, Levy C, Patsouris A, Desmoulins I, Uwer L, Leheurteur M, Robain M, Caron O, Bachelot T, Filleron T, Frenel JS, Delaloge S. Abstract PD10-11: Efficacy of Platinum-based first-line chemotherapy among metastatic breast cancer (MBC) patients according to the germline BRCA1/2 mutational status: An analysis of the French ESME MBC database. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd10-11] [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: Platinum-based chemotherapy regimens (PtCT) have been shown to increase treatment efficacy when combined to neoadjuvant standard of care treatment of triple negative breast cancers (TNBC). In the metastatic breast cancer (MBC) setting, preclinical and clinical data suggest that PtCT could be more efficient than non-platinum based ones (non-PtCT) among patients (pts) with germline BRCA1/2 mutations (gBRCAm). However, published data remain controversial on this topic, particularly for MBC. We evaluated the progression-free (PFS) and overall survival (OS) under first-line PtCT and non-PtCT among gBRCAm carriers in ESME, a nationwide real-life MBC database. Methods: ESME MBC database (NCT03275311), is a unique national cohort of all consecutive pts who initiated a first-line treatment for MBC between 2008 and 2016 in one of the 18 French Comprehensive Cancer Centers. Women with HER2- MBC and known hormone receptors (HR) and gBRCA1/2 (before or in the 6 first months of metastatic disease, gBRCAm / wild type / not tested) status, who received a first-line MBC CT were selected. Patients with other germinal mutations were considered as wild type. Primary objectives were OS and PFS under first-line CT (PtCT vs. non-PtCT) in the TNBC gBRCA1/2m population.Secondary objectives were OS and PFS during first-line CT (PtCT vs. non-PtCT) in the TNBC wild-type and “not tested” population, as well as among the HR+/HER2- pts.To avoid guarantee time bias related to oncogenetic testing, analyses were performed at baseline (CT initiation) and different landmark time points (3-month or 6-month after CT initiation). Thus, BRCA status was defined according to oncogenetic testings performed before the landmark time, and patients who progressed or censored before the landmark time were excluded. Results: 10,164 pts (2,794 TNBC; 7,370 HR+/HER2-) were included in this analysis. Pts who received PtCT were significantly younger, affected by a gBRCA1/2m, had a high histological grade and/or TNBC tumor, with more frequent visceral and central nervous system spreading than non PtCT ones. Median follow-up was 51.1 months [95%CI 49.6; 52.6]. All reported results were based on the gBRCA status defined at CT initiation and on multivariable analysis adjusted on age at MBC diagnosis, de novo MBC status, type and number of metastases. In the gBRCA1/2m TNBC population (N=132), PtCT was independently associated with a better PFS compared to non-PtCT (HR=0.56, 95%CI 0.38-0.84, p=0.005), without significant difference in OS (HR=0.79, 95%CI 0.51-1.23, p=0.29).No difference was seen in wild-type BRCA1/2 TNBC pts (N=269) according to the CT regimen, while, in the larger population of untested TNBC (N=2,393), PtCT was associated with worse OS (HR=1.18, 95%CI 1.03-1.34, p=0.016) compared to non-PtCT regimens, without significant difference in PFS (HR=1.07, 95%CI 0.95-1.22, p=0.26). No significant difference was seen regarding PFS nor OS in gBRCA1/2m HR+/HER2- pts (N=124) and in the wild-type BRCA1/2 HR+/HER2- population.However, in the larger population of untested HR+/HER2- pts (N=6,836), PtCT was independently associated with worse OS (HR=2.15, 95%CI 1.79-2.59, p<0.001) and PFS (HR=1.57, 95%CI 1.33-1.86, p<0.001) compared to non-PtCT regimens. Results were similar in landmark analyses at 3-month or 6-month after CT initiation. Conclusions: This large-scale real-life analysis suggests higher efficacy of PtCT in term of PFS in gBRCA1/2m TNBC pts. The small sample size and post-1st line treatments may preclude observing a significant OS difference. PtCT appeared however associated with worse outcomes in untested TNBC and HR+/HER2- pts. These results emphasize the need for BRCA1/2 characterization before considering these regimens in the MBC setting.
Citation Format: William Jacot, Amélie Lusque, Audrey Mailliez, Thibault De la Motte Rouge, Luc Cabel, Christelle Levy, Anne Patsouris, Isabelle Desmoulins, Lionel Uwer, Marianne Leheurteur, Mathieu Robain, Olivier Caron, Thomas Bachelot, Thomas Filleron, Jean-Sébastien Frenel, Suzette Delaloge. Efficacy of Platinum-based first-line chemotherapy among metastatic breast cancer (MBC) patients according to the germline BRCA1/2 mutational status: An analysis of the French ESME MBC database [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD10-11.
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Affiliation(s)
- William Jacot
- 1Institut du Cancer de Montpellier, Montpellier, France
| | - Amélie Lusque
- 2Institut Claudius Regaud – IUCT Oncopole, Toulouse, France
| | | | | | - Luc Cabel
- 5Institut Curie - UMR 144 - CNRS, Paris, France
| | | | - Anne Patsouris
- 7Institut de Cancérologie de l'Ouest, Pays de Loire, Angers, France
| | | | - Lionel Uwer
- 9Institut de Cancérologie de Lorraine - Alexis Vautrin, Vandœuvre-lès-Nancy, France
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Chevalier LM, Billaud A, Fronteau S, Dauvé J, Patsouris A, Verriele V, Morel A. Somatic mRNA Analysis of BRCA1 Splice Variants Provides a Direct Theranostic Impact on PARP Inhibitors. Mol Diagn Ther 2021; 24:233-243. [PMID: 32124385 DOI: 10.1007/s40291-020-00452-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND The identification of pretherapeutic somatic BRCA variants can have considerable clinical impact given that they affect response to the new poly (ADP-ribose) polymerase (PARP)-targeted therapy. One major issue with this type of testing is the identification of splicing variants of uncertain significance (VUS) on degraded somatic messenger RNA. It is therefore important to be able to quickly characterize these splice variants. OBJECTIVE As part of PARP inhibitor targeted therapy, we have investigated a method for the direct confirmation of potential pathogenic somatic splice variants of BRCA1 found in fixed tumor samples. Previously these VUS have commonly only been tested by in silico analysis. METHODS Five BRCA1 variants affecting splicing were characterized from formalin-fixed, paraffin-embedded (FFPE) ovarian carcinoma tissues by next-generation sequencing (NGS). Three patient samples had already been functionally characterized and were used as controls. Total somatic RNA from samples was extracted, reverse-transcribed, and amplified with several primer pairs encompassing the target exon. The polymerase chain reaction (PCR) products were analyzed by capillary gel electrophoresis to assess possible changes in size due to splicing alterations. Finally, we confirmed our results by cloning, followed by Sanger sequencing, and analyzed the expression of the aberrant forms. RESULTS Our molecular approach made it possible to visualize the splicing outcomes of three variants (c.5194-2A>G, c.5434C>G, and c.547+1G>A) already identified and present in databases and/or identified with prediction tools (ClinVar, UMD, ARUP Utah database, and Human Splice Finder splices sites prediction) and to confirm their exon skipping consequences, their expression in tumors, and thus their pathogenicity. The c.4484+5G>A variant was not found in databases and was predicted to have no impact on splicing, but was found to display altered processing in tumor tissue. This variant also had a major detrimental impact on transcriptional expression. CONCLUSION In a break from purely in silico approaches, we propose a simple and rapid pretherapeutic functional analysis of somatic BRCA1 variants potentially involved in splicing alterations. This approach will allow more ovarian cancer patients to benefit from new therapies targeting PARP.
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Affiliation(s)
- Louise-Marie Chevalier
- Université d'Angers, Inserm, CRCINA, 49000, Angers, France.,Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | - Amandine Billaud
- Université d'Angers, Inserm, CRCINA, 49000, Angers, France.,Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | - Sabrina Fronteau
- Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | - Jonathan Dauvé
- Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | - Anne Patsouris
- Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France
| | | | - Alain Morel
- Université d'Angers, Inserm, CRCINA, 49000, Angers, France. .,Institut de Cancérologie de l'Ouest - Paul Papin, 49000, Angers, France.
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Sirieix J, Fraisse J, Mathoulin-Pelissier S, Leheurteur M, Vanlemmens L, Jouannaud C, Diéras V, Lévy C, Ung M, Mouret-Reynier MA, Petit T, Coudert B, Brain E, Pistilli B, Ferrero JM, Goncalves A, Uwer L, Patsouris A, Tredan O, Courtinard C, Gourgou S, Frénel JS. Management and outcome of male metastatic breast cancer in the national multicenter observational research program Epidemiological Strategy and Medical Economics (ESME). Ther Adv Med Oncol 2021; 12:1758835920980548. [PMID: 33488779 PMCID: PMC7768846 DOI: 10.1177/1758835920980548] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Accepted: 11/17/2020] [Indexed: 11/17/2022] Open
Abstract
Background and Aims: Because of its low prevalence, metastatic breast cancer (MBC) in males is managed based on clinical experience with women. Using a real-life database, we aim to provide a comprehensive analysis of male MBC characteristics, management and outcome. Methods: The Epidemiological Strategy and Medical Economics Data Platform collected data for all men and women ⩾18 years with MBC in 18 participating French Comprehensive Cancer Centers from January 2008 to November 2016. Demographic, clinical, and pathological characteristics were retrieved, as was treatment modality. Men were matched 1:1 to women with similar characteristics. Results: Of 16,701 evaluable patients, 149 (0.89%) men were identified. These men were older (median age 69 years) and predominantly had hormone receptor HR+/HER2– disease (78.3%). Median overall survival (OS) was 41.8 months [95% confidence interval (CI: 26.9–49.7)] and similar to women. Median progression-free survival (PFS) with first-line therapy was 9.3 months [95% CI (7.4–11.5)]. In the HR+/HER2– subpopulation, endocrine therapy (ET) alone was the frontline treatment for 43% of patients, including antiestrogens (n = 19), aromatase inhibitors (n = 15) with luteinizing hormone-releasing hormone (LHRH) analogs (n = 3), and various sequential treatments. Median PFS achieved by frontline ET alone was similar in men [9.8 months, 95% CI (6.9–17.4)] and in women [13 months, 95% CI (8.4–30.9)] (p = 0.80). PFS was similar for HR+/HER2– men receiving upfront ET or chemotherapy: 9.8 months [95% CI (6.9–17.4)] versus 9.5 months [95% CI (7.4–11.7)] (p = 0.22), respectively. Conclusion: MBC management in men and women leads to similar outcomes, especially in HR+/HER2– patients for whom ET should also be a cornerstone. Unsolved questions remain and successfully recruiting trials for men are still lacking.
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Affiliation(s)
- Junien Sirieix
- Department of Medical Oncology, ICO Institut de Cancerologie de l'Ouest - René Gauducheau, Saint-Herblain, France
| | - Julien Fraisse
- Biometrics Unit, ICM Regional Cancer Institute of Montpellier, Montpellier, France
| | - Simone Mathoulin-Pelissier
- Bordeaux University, Inserm CIC1401 and Clinical and Epidemiological Research Unit, Institut Bergonie, Bordeaux, France
| | | | | | | | - Véronique Diéras
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Christelle Lévy
- Department of Medical Oncology, Centre Francois Baclesse, Caen, France
| | - Mony Ung
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | | | - Thierry Petit
- Department of Medical Oncology, GINECO & Paul Strauss Cancer Center and University of Strasbourg, Strasbourg, France
| | - Bruno Coudert
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Paris & Saint-Cloud, France
| | - Barbara Pistilli
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institute Paoli-Calmettes, Marseille, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine - Alexis Vautrin, Vandoeuvre-Lès-Nancy, France
| | - Anne Patsouris
- Department of Medical Oncology, ICO Institut de Cancerologie de l'Ouest - Paul Papin, Angers, France
| | - Olivier Tredan
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Sophie Gourgou
- Biometrics Unit, ICM Regional Cancer Institute of Montpellier, Montpellier, France
| | - Jean-Sébastien Frénel
- Department of Medical Oncology, ICO Institut de Cancerologie de l'Ouest - René Gauducheau, Saint-Herblain, France
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Bertho M, Fraisse J, Patsouris A, Cottu P, Arnedos M, Pérol D, Jaffré A, Goncalves A, Lebitasy MP, D’Hondt V, Dalenc F, Ferrero JM, Levy C, Dabakuyo S, Rouzier R, Penault-Llorca F, Uwer L, Eymard JC, Breton M, Chevrot M, Thureau S, Petit T, Simon G, Frénel JS. Real-life prognosis of 5041 bone-only metastatic breast cancer patients in the multicenter national observational ESME program. Ther Adv Med Oncol 2021; 13:1758835920987657. [PMID: 33613700 PMCID: PMC7841864 DOI: 10.1177/1758835920987657] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/17/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Bone-only (BO) metastatic breast cancer (MBC) is considered a more favorable entity than other MBC presentations. However, only few retrospective series and data from selected randomized controlled trials have been reported so far. METHODS Using the French national multicenter ESME (Epidemiological Strategy and Medico Economics) Data Platform, the primary objective of our study was to compare the overall survival (OS) of patients with BO versus non-BO MBC at diagnosis, with adjustment on main prognostic factors using a propensity score. Secondary objectives were to compare first-line progression-free survival (PFS1), describe treatment patterns, and estimate factors associated with OS. RESULTS Out of 20,095 eligible women, 5041 (22.4%) patients had BO disease [hormone-receptor positive (HR+)/human epidermal growth-factor-receptor-2 negative (HER2-), n = 4 102/13,229 (31%); HER2+, n = 644/3909 (16.5%); HR-/HER2-, n = 295/2 957 (10%)]. BO MBC patients had a better adjusted OS compared with non-BO MBC [52.1 months (95% confidence interval (CI) 50.3-54.1) versus 34.7 months (95% CI 34.0-35.6) respectively]. The 5-year OS rate of BO MBC patients was 43.4% (95% CI 41.7-45.2). They also had a better PFS1 [13.1 months (95% CI 12.6-13.8) versus 8.5 months (95% CI 8.3-8.7), respectively]. This observation could be repeated in all subtypes. BO disease was an independent prognostic factor of OS [hazard ratio 0.68 (95% CI 0.65-0.72), p < 0.0001]. Results were concordant in all analyses. CONCLUSION BO MBC patients have better outcomes compared with non-BO MBC, consistently, through all MBC subtypes.
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Affiliation(s)
- Marion Bertho
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest – Paul Papin, Angers, France
| | - Julien Fraisse
- Biometrics Unit, Regional Cancer Institute of Montpellier (ICM), Montpellier, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest – Paul Papin, Angers, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Monica Arnedos
- Department of Medical Oncology, Gustave Roussy Cancer Campus, Villejuif, France
| | - David Pérol
- Biostatistic Unit, Clinical Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - Anne Jaffré
- Department of Medical Information, Institut Bergonié, Bordeaux, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Marie-Paule Lebitasy
- Clinical Research and Innovation Department, Centre Oscar Lambret, Lille, France
| | - Véronique D’Hondt
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Institut Centre Antoine Lacassagne, Nice, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Sandrine Dabakuyo
- National Quality of Life and Cancer Clinical Research Platform, Centre Georges François Leclerc, Dijon, France
| | - Roman Rouzier
- Department of Surgical Oncology, Institut Curie, Saint-Cloud, France
| | | | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès- Nancy, France
| | | | - Mathias Breton
- Department of Medical Information, Centre Eugène Marquis, Rennes, France
| | | | - Sébastien Thureau
- Department of Radiation Oncology, Centre Henri Becquerel, Rouen, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | | | - Jean-Sébastien Frénel
- Department of Medical Oncology, ICO René Gauducheau, Boulevard Jacques Monod, Saint Herblain, Pays de la Loire 44805, France
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Alhenc-Gelas M, Cabel L, Berger F, Delaloge S, Frenel JS, Levy C, Firmin N, Ladoire S, Desmoulins I, Heudel PE, Dalenc F, Loirat D, Dubot C, Vuagnat P, Deluche E, Mokdad-Adi M, Patsouris A, Annic J, Djerroudi L, Lavigne M, Pierga JY, Coppo P, Bidard FC. Characteristics and outcome of breast cancer-related microangiopathic haemolytic anaemia: a multicentre study. Breast Cancer Res 2021; 23:9. [PMID: 33468209 PMCID: PMC7814553 DOI: 10.1186/s13058-021-01386-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 01/01/2021] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Cancer-related microangiopathic haemolytic anaemia (MAHA) is a rare but life-threatening paraneoplastic syndrome. Only single cases or small series have been reported to date. We set up a retrospective multicentre study focusing on breast cancer-related MAHA. METHODS Main inclusion criteria were known diagnosis of breast cancer, presence of schistocytes and either low haptoglobin or cytopenia and absence of any causes of MAHA other than breast cancer, including gemcitabine- or bevacizumab-based treatment. Patient characteristics, treatments and outcome were retrieved from digital medical records. RESULTS Individual data from 54 patients with breast cancer-related MAHA were obtained from 7 centres. Twenty-three (44%) patients had a breast tumour with lobular features, and most primary tumours were low grade (grade I/II, N = 39, 75%). ER+/HER2-, HER2+ and triple-negative phenotypes accounted for N = 33 (69%), N = 7 (15%) and N = 8 (17%) cases, respectively. All patients had stage IV cancer at the time of MAHA diagnosis. Median overall survival (OS) was 28 days (range 0-1035; Q1:10, Q3:186). Independent prognostic factors for early death (≤ 28 days) were PS > 2 (OR = 7.0 [1.6; 31.8]), elevated bilirubin (OR = 6.9 [1.1; 42.6]), haemoglobin < 8.0 g/dL (OR = 3.7 [0.9; 16.7]) and prothrombin time < 50% (OR = 9.1 [1.2; 50.0]). A score to predict early death displayed a sensitivity of 86% (95% CI [0.67; 0.96]), a specificity of 73% (95% CI [0.52; 0.88]) and an area under the curve of 0.90 (95% CI [0.83; 0.97]). CONCLUSIONS Breast cancer-related MAHA appears to be a new feature of invasive lobular breast carcinoma. Prognostic factors and scores may guide clinical decision-making in this serious but not always fatal condition.
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Affiliation(s)
- Marion Alhenc-Gelas
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,UVSQ, Université Paris-Saclay, 35 rue Dailly, Saint Cloud, 92210, France
| | | | - Suzette Delaloge
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Jean-Sebastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, Institut de cancérologie de Montpellier INSERM U1194, Montpellier, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | | | | | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole (IUCT-Oncopole), Toulouse, France
| | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Coraline Dubot
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Perrine Vuagnat
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France
| | - Elise Deluche
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Meriem Mokdad-Adi
- Department of Cancer Medicine, Institut Gustave Roussy, Villejuif, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | - Josselin Annic
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Saint-Herblain, France
| | | | | | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France.,Université de Paris, Paris, France
| | - Paul Coppo
- Reference Center for Thrombotic Microangiopathies (CNR-MAT), AP-HP.SU, INSERM UMRS, 1138, Paris, France.,Sorbonne University, Paris, France
| | - Francois-Clement Bidard
- Department of Medical Oncology, Institut Curie, Paris and Saint Cloud, France. .,UVSQ, Université Paris-Saclay, 35 rue Dailly, Saint Cloud, 92210, France.
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Lacombe V, Patsouris A, Delattre E, Lacout C, Urbanski G. Evolution of plasma vitamin B 12 in patients with solid cancers during curative versus supportive care. Arch Med Sci 2021; 17:1811-1815. [PMID: 34900064 PMCID: PMC8641499 DOI: 10.5114/aoms/140974] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 08/06/2021] [Indexed: 12/02/2022] Open
Abstract
INTRODUCTION The direction of the causal link between solid cancers and elevated plasma vitamin B12 (B12) remains uncertain. METHODS We retrospectively included patients having two B12 measurements with a B12 initially ≥ 1000 ng/l and a solid cancer diagnosed between the measurements. Patients were included in the Curative or Supportive group according to their treatments. RESULTS B12 changes over time differed between groups (p = 0.001): +157.4 ng/l/month in the Supportive care group versus -171.6 ng/l/month in the Curative care group. CONCLUSIONS The decrease of plasma B12 in cases of curative care could suggest that this B12 elevation is secondary to solid cancers.
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Affiliation(s)
- Valentin Lacombe
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - Anne Patsouris
- Medical Oncology, Ouest Cancerology Institute, Angers, France
| | - Estelle Delattre
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
| | - Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, University Hospital, Angers, France
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Bertho M, Patsouris A, Augereau P, Robert M, Frenel JS, Blonz C, Campone M. A pharmacokinetic evaluation of alpelisib for the treatment of HR+, HER2-negative, PIK3CA-mutated advanced or metastatic breast cancer. Expert Opin Drug Metab Toxicol 2020; 17:139-152. [PMID: 33213227 DOI: 10.1080/17425255.2021.1844662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: In most cases, metastatic breast cancer remains an incurable disease. A PIK3CA mutation is detected in 30-40% of all hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) advanced breast cancers. PIK3CA activating mutations have been linked to endocrine resistance. PI3K inhibitors therefore offer promising new therapeutic options for this disease. Areas covered: This review discusses the pharmacologic properties, preclinical development, clinical efficacy, and safety profile of alpelisib, a PI3K inhibitor indicated in HR+/HER2 - PIK3CA-mutated advanced breast cancer, describing current therapeutic indication and open questions. Expert opinion: Following results of the SOLAR-1 trial, alpelisib became the first PI3K inhibitor approved by the U.S. Food and Drug Administration, in combination with fulvestrant, for postmenopausal women and men with HR+/HER2 - PIK3CA-mutated advanced breast cancer following progression on or after an endocrine-based regimen. This trial showed a substantial improvement in progression-free survival. However, given the side effects of alpelisib, the treatment decision should follow a thorough benefit-risk assessment. The BYLieve trial suggests alpelisib-fulvestrant benefit after progression on CDK 4/6 inhibitors. The identification of patients that are likely to benefit the most from PI3K inhibitors is still eagerly sought.
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Affiliation(s)
- Marion Bertho
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - Pays de la Loire , France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - Pays de la Loire , France.,INSERM Unit, Centre de Recherche en Cancérologie et Immunologie Nantes Angers (CRCINA) , France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - Pays de la Loire , France
| | - Marie Robert
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - Pays de la Loire , France
| | - Jean-Sebastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - Pays de la Loire , France.,INSERM Unit, Centre de Recherche en Cancérologie et Immunologie Nantes Angers (CRCINA) , France
| | - Cyriac Blonz
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - Pays de la Loire , France
| | - Mario Campone
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - Pays de la Loire , France.,INSERM Unit, Centre de Recherche en Cancérologie et Immunologie Nantes Angers (CRCINA) , France
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Saleh K, Carton M, Dieras V, Heudel PE, Brain E, D'Hondt V, Mailliez A, Patsouris A, Mouret-Reynier MA, Goncalves A, Ferrero JM, Petit T, Emile G, Uwer L, Debled M, Dalenc F, Jouannaud C, Ladoire S, Leheurteur M, Cottu P, Veron L, Savignoni A, Courtinard C, Robain M, Delaloge S, Deluche E. Impact of body mass index on overall survival in patients with metastatic breast cancer. Breast 2020; 55:16-24. [PMID: 33307392 PMCID: PMC7725947 DOI: 10.1016/j.breast.2020.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 11/21/2020] [Accepted: 11/23/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND High Body mass index (BMI) is a risk factor for breast cancer among postmenopausal women and an adverse prognostic factor in early-stage. Little is known about its impact on clinical outcomes in patients with metastatic breast cancer (MBC). METHODS The National ESME-MBC observational cohort includes all consecutive patients newly diagnosed with MBC between Jan 2008 and Dec 2016 in the 18 French comprehensive cancer centers. RESULTS Of 22 463 patients in ESME-MBC, 12 999 women had BMI data available at MBC diagnosis. Median BMI was 24.9 kg/m2 (range 12.1-66.5); 20% of women were obese and 5% underweight. Obesity was associated with more de novo MBC, while underweight patients had more aggressive cancer features. Median overall survival (OS) of the BMI cohort was 47.4 months (95% CI [46.2-48.5]) (median follow-up: 48.6 months). Underweight was independently associated with a worse OS (median OS 33 months; HR 1.14, 95%CI, 1.02-1.27) and first line progression-free survival (HR, 1.11; 95%CI, 1.01; 1.22), while overweight or obesity had no effect. CONCLUSION Overweight and obesity are not associated with poorer outcomes in women with metastatic disease, while underweight appears as an independent adverse prognostic factor.
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Affiliation(s)
- Khalil Saleh
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Véronique Dieras
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Pierre-Etienne Heudel
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Véronique D'Hondt
- Department of Medical Oncology, Institut Du Cancer de Montpellier, 208 Rue des Apothicaires, 34298, Montpellier, INSERM U1194, University of Montpellier, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest Nantes & Angers, 15 Rue André Boquel, 49055, Angers, France
| | - Marie-Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011, Clermont Ferrand, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189, Nice, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de La Porte de L'Hôpital, 67000, Strasbourg, France
| | - George Emile
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue Du Général Harris, 14000, Caen, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519, Vandœuvre-lès-Nancy, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonie, 229 Cours de L'Argonne, F-33000, Bordeaux, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue Du Général Koenig, 51100, Reims, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, 1 Rue Professeur Marion, 21079, Dijon, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue D'Amiens, 76000, Rouen, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Lucie Veron
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Alexia Savignoni
- Department of Biostatistics, Institut Curie, 26 Rue D'Ulm, 75005, Paris & Saint-Cloud, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Mathieu Robain
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
| | - Elise Deluche
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France; Department of Medical Oncology, CHU de Limoges, 2 Avenue Martin Luther King, Limoges, France
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Lacombe V, Chabrun F, Lacout C, Ghali A, Capitain O, Patsouris A, Lavigne C, Urbanski G. L’élévation persistante de la vitamine B12 plasmatique comme marqueur prédictif de cancer solide. Rev Med Interne 2020. [DOI: 10.1016/j.revmed.2020.10.129] [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: 10/22/2022]
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38
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Deluche E, Antoine A, Bachelot T, Lardy-cleaud A, Dieras V, Brain E, Jacot W, Goncalves A, Dalenc F, Patsouris A, Mathoulin-Pelissier S, Courtinard C, Perol D, Robain M, Delaloge S. Contemporary picture of metastatic breast cancer: Characteristics and outcomes of 22,000 women from the ESME cohort 2008–2016. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30540-2] [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: 11/28/2022]
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Delaloge S, Antoine A, Debled M, Jacot W, Cottu P, Dieras V, Dalenc F, Gonçalves A, Patsouris A, Reynier MM, Mailliez A, Clatot F, Levy C, Ferrero JM, Desmoulins I, Uwer L, Robain M, Bachelot T, Brain E, Perol D. 279MO Divergent evolution of overall survival across metastatic breast cancer (MBC) subtypes in the nationwide ESME real life cohort 2008-2016. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.381] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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de La Motte Rouge T, Bengrine Lefevre L, Mouret-Reynier MA, Asselain B, Lucas B, Gavoille C, Cornila C, Spaeth D, Colomba E, Patsouris A, Fabbro M, Chakiba C, Toussaint P, Simon H, Berton D, Garbay D, Garnier Tixidre C, Coeffic D, Collard O, Lefeuvre-Plesse C. 823P Extended follow-up of a real-world cohort of patients (pts) with BRCA mutation (BRCAm) relapsed epithelial ovarian cancer (EOC) receiving olaparib maintenance therapy: The GINECO RETROLA study. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.962] [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: 11/16/2022] Open
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Pérol D, Carton M, Delaloge S, Mailliez A, Frenel JS, Patsouris A, Levy C, Guiu S, Goncalves A, Mouret-Reynier MA, Desmoulins I, Ferrero JM, De La Motte Rouge T, Leheurteur M, Petit T, Guesmia T, Cabel L, Debled M, Bachelot T, Dalenc F, Uwer L, Jouannaud C, Robain M. Facteurs pronostiques de la survie sans progression chez les patientes atteintes d’un cancer du sein métastatique de type RH+/HER2- avant l’avènement des inhibiteurs CDK dans la cohorte nationale ESME. Rev Epidemiol Sante Publique 2020. [DOI: 10.1016/j.respe.2020.04.015] [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: 11/24/2022] Open
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Patsouris A. Dépistage précoce et thérapeutique appropriée, les clés de la prise en charge. Actualités Pharmaceutiques 2020. [DOI: 10.1016/j.actpha.2020.06.007] [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: 11/27/2022]
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Frasca M, Sabathe C, Delaloge S, Galvin A, Patsouris A, Levy C, Mouret-Reynier MA, Desmoulins I, Vanlemmens L, Bachelot T, Goncalves A, Perotin V, Uwer L, Frenel JS, Ferrero JM, Bouleuc C, Eymard JC, Dieras V, Leheurteur M, Petit T, Dalenc F, Jaffre A, Chevrot M, Courtinard C, Mathoulin-Pelissier S. Palliative care delivery according to age in 12,000 women with metastatic breast cancer: Analysis in the multicentre ESME-MBC cohort 2008-2016. Eur J Cancer 2020; 137:240-249. [PMID: 32805641 DOI: 10.1016/j.ejca.2020.07.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/06/2020] [Indexed: 12/24/2022]
Abstract
INTRODUCTION Patients with metastatic breast cancer (MBC) often require inpatient palliative care (IPC). However, mounting evidence suggests age-related disparities in palliative care delivery. This study aimed to assess the cumulative incidence function (CIF) of IPC delivery, as well as the influence of age. METHODS The national ESME (Epidemio-Strategy-Medical-Economical)-MBC cohort includes consecutive MBC patients treated in 18 French Comprehensive Cancer Centres. ICD-10 palliative care coding was used for IPC identification. RESULTS Our analysis included 12,375 patients, 5093 (41.2%) of whom were aged 65 or over. The median follow-up was 41.5 months (95% confidence interval [CI], 40.5-42.5). The CIF of IPC was 10.3% (95% CI, 10.2-10.4) and 24.8% (95% CI, 24.7-24.8) at 2 and 8 years, respectively. At 2 years, among triple-negative patients, young patients (<65 yo) had a higher CIF of IPC than older patients after adjusting for cancer characteristics, centre and period (65+/<65: β = -0.05; 95% CI, -0.08 to -0.01). Among other tumour sub-types, older patients received short-term IPC more frequently than young patients (65+/<65: β = 0.02; 95% CI, 0.01 to 0.03). At 8 years, outside large centres, IPC was delivered less frequently to older patients adjusted to cancer characteristics and period (65+/<65: β = -0.03; 95% CI, -0.06 to -0.01). CONCLUSION We found a relatively low CIF of IPC and that age influenced IPC delivery. Young triple-negative and older non-triple-negative patients needed more short-term IPCs. Older patients diagnosed outside large centres received less long-term IPC. These findings highlight the need for a wider implementation of IPC facilities and for more age-specific interventions.
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Affiliation(s)
- Matthieu Frasca
- University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; Department of Palliative Medicine, CHU Bordeaux, 33000, Bordeaux, France.
| | - Camille Sabathe
- University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Biostatistic Team, UMR 1219, 33000, Bordeaux, France
| | - Suzette Delaloge
- Department of Medical Oncology, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Angeline Galvin
- University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest - Paul Papin, 49933, Angers, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3, Avenue Du Général Harris, 14076, Caen, France
| | - Marie A Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011, Clermont-Ferrand, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges-Francois Leclerc, 1 Rue Professeur Marion, 21079, Dijon, France
| | - Laurence Vanlemmens
- Department of Medical Oncology, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000, Lille, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008, Lyon, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009, Marseille, France
| | - Virginie Perotin
- Department of Palliative Medicine, Institut Du Cancer de Montpellier, 208 Rue des Apothicaires, 34298, Montpellier, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519 Vandoeuvre-lès-Nancy, France
| | - Jean S Frenel
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest - René Gauducheau, Boulevard Professeur Jacques Monod, 44805, Nantes, France
| | - Jean M Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, 06189, Nice, France
| | - Carole Bouleuc
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm; 75005, Paris & Saint-Cloud, France
| | - Jean C Eymard
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue de Général Koenig, 51100, Reims, France
| | - Véronique Dieras
- Department of Medical Oncology, Centre Eugène Marquis, Avenue de La Bataille Flandres-Dunkerque, 35000, Rennes, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue D'Amiens, 76000, Rouen, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de La Porte de L'Hôpital, 67000, Strasbourg, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059, Toulouse, France
| | - Anne Jaffre
- Department of Medical Information, Institut Bergonie, Comprehensive Cancer Centre, 33000, Bordeaux, France
| | - Michaël Chevrot
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654, Paris, France
| | - Simone Mathoulin-Pelissier
- University of Bordeaux, Inserm, Bordeaux Population Health Research Centre, Epicene Team, UMR 1219, 33000, Bordeaux, France; INSERM CIC1401, Institut Bergonie, Comprehensive Cancer Centre, 33000, Bordeaux, France
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Jézéquel P, Patsouris A, Guette C, Juin PP, Campone M. RE: Immune Checkpoint Profiles in Luminal B Breast Cancer (Alliance). J Natl Cancer Inst 2020; 112:863-864. [DOI: 10.1093/jnci/djaa037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 03/17/2020] [Indexed: 01/17/2023] Open
Affiliation(s)
- Pascal Jézéquel
- Unité de Bioinfomique, Institut de Cancérologie de l’Ouest, Bd Jacques Monod, 44805 Saint Herblain Cedex, France
- CRCINA, INSERM, CNRS, Université de Nantes, Université d’Angers, Institut de Recherche en Santé, Université de Nantes, 8 Quai Moncousu - BP 70721, 44007, Nantes Cedex 1, France
| | - Anne Patsouris
- Oncologie Médicale, Institut de Cancérologie de l’Ouest – Paul Papin, Bd Jacques Monod, 44805 Saint Herblain Cedex, France
| | - Catherine Guette
- CRCINA, INSERM, CNRS, Université de Nantes, Université d’Angers, Institut de Recherche en Santé, Université de Nantes, 8 Quai Moncousu - BP 70721, 44007, Nantes Cedex 1, France
- Institut de Cancérologie de l’Ouest – Paul Papin, 15 Rue André Boquel, 49055 Angers, Cedex 02, France
| | - Philippe P Juin
- CRCINA, INSERM, CNRS, Université de Nantes, Université d’Angers, Institut de Recherche en Santé, Université de Nantes, 8 Quai Moncousu - BP 70721, 44007, Nantes Cedex 1, France
| | - Mario Campone
- CRCINA, INSERM, CNRS, Université de Nantes, Université d’Angers, Institut de Recherche en Santé, Université de Nantes, 8 Quai Moncousu - BP 70721, 44007, Nantes Cedex 1, France
- Oncologie Médicale, Institut de Cancérologie de l’Ouest - René Gauducheau, Bd Jacques Monod, 44805, Saint Herblain Cedex, France
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Frank S, Carton M, Dubot C, Campone M, Pistilli B, Dalenc F, Mailliez A, Levy C, D'Hondt V, Debled M, Vermeulin T, Coudert B, Perrin C, Gonçalves A, Uwer L, Ferrero JM, Eymard JC, Petit T, Mouret-Reynier MA, Patsouris A, Guesmia T, Bachelot T, Robain M, Cottu P. Impact of age at diagnosis of metastatic breast cancer on overall survival in the real-life ESME metastatic breast cancer cohort. Breast 2020; 52:50-57. [PMID: 32380440 PMCID: PMC7375638 DOI: 10.1016/j.breast.2020.04.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Revised: 04/17/2020] [Accepted: 04/21/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Young age is a poor prognostic factor in early stage breast cancer (BC) but its value is less established in metastatic BC (MBC). We evaluated the impact of age at MBC diagnosis on overall survival (OS) across three age groups (<40, 40 to 60 and > 60 years(y)). METHODS ESME MBC database is a national cohort, collecting retrospective data from 18 participating French cancer centers between January 01, 2008 and December 31, 2014. RESULTS Among 14 403 women included, 1077 (7.5%), 6436 (44.7%) and 6890 (47.8%) pts were <40, 40-60 and > 60 y respectively. Pts <40 had significantly more aggressive presentations than other age groups: more frequent HER2+ (25.7 vs 15.3% in >60y) and triple negative subtypes (27.4 vs 14.6% in >60y), and more frequent visceral involvement (36.3 vs 29.8% in >60y). At a median follow-up of 48 months, median OS differed across age groups: 38.8, 38.4 and 35.6 months for pts <40, 40-60 and > 60y, respectively (p < 0.0001). Compared to pts <40y, older pts had a statistically significant higher risk of death (all causes of death included), although of limited clinical value (HR = 1.1, IC 95%:1.01-1.20). There was a significant trend for better OS in pts <40y with HER2+ and luminal diseases. A possible explanation is a greater use of anti-Her2 therapies as first-line treatments: 86.6, 81.9 and 74.9% for pts <40, 40-60 and > 60y, respectively (p < 0.0001). CONCLUSION Although young age seems associated with more aggressive presentations at diagnosis of MBC, it has no deleterious effect on OS in this large series.
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Affiliation(s)
- Sophie Frank
- Institut Curie, Paris-Saint Cloud, 26, Rue d'Ulm, 75005, Paris, France.
| | - Matthieu Carton
- Institut Curie, Paris-Saint Cloud, 26, Rue d'Ulm, 75005, Paris, France.
| | - Coraline Dubot
- Institut Curie, Paris-Saint Cloud, 26, Rue d'Ulm, 75005, Paris, France.
| | - Mario Campone
- Institut de Cancérologie de l'Ouest, site René Gauducheau, Site Hospitalier Nord, Boulevard Jacques Monod, 44800, Saint-Herblain, France.
| | - Barbara Pistilli
- Gustave Roussy, 39, Rue Camille Desmoulins, 94800, Villejuif, France.
| | - Florence Dalenc
- Institut Claudius Régaud, 1, Av Irène Joliot Curie, 31059, Toulouse, France.
| | - Audrey Mailliez
- Centre Oscar Lambret, 3, Rue Frédéric Combemale, 59000, Lille, France.
| | - Christelle Levy
- Centre François Baclesse, 3, Avenue du Général Harris, 14000, Caen, France.
| | - Véronique D'Hondt
- Institut du Cancer de Montpellier, 208, Av. Apothicaires, 34298, Montpellier, France.
| | - Marc Debled
- Institut Bergonié, 229, Cours de l'Argonne, 33000, Bordeaux, France.
| | | | - Bruno Coudert
- Centre Georges-François Leclerc, 1, Rue du Professeur Marion, 21079, Dijon, France.
| | - Christophe Perrin
- Centre Eugène Marquis, Avenue de la Bataille Flandre Dunkerque, 35042, Rennes, France.
| | - Anthony Gonçalves
- Institut Paoli-Calmettes, 232, BD Ste Marguerite, 13009, Marseille, France.
| | - Lionel Uwer
- Institut de Cancérologie de Lorraine, 6, Avenue Bourgogne, 54519, Vandoeuvre les Nancy, France.
| | - Jean-Marc Ferrero
- Centre Antoine Lacassagne, 33, Avenue de Valombrose, 06189, Nice, France.
| | | | - Thierry Petit
- Centre Paul Strauss, 3, Rue de la Porte de l'Hôpital, 67065, Strasbourg, France.
| | | | - Anne Patsouris
- Institut de Cancérologie de l'Ouest, site Paul Papin, 15, Rue André Boquel, 49055, Angers, France.
| | - Tahar Guesmia
- R&D Unicancer, 67 avenue Fontainebleau 94270 Le Kremlin Bicêtre, France.
| | | | - Mathieu Robain
- R&D Unicancer, 67 avenue Fontainebleau 94270 Le Kremlin Bicêtre, France.
| | - Paul Cottu
- Institut Curie, Paris-Saint Cloud, 26, Rue d'Ulm, 75005, Paris, France.
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Deluche E, Antoine A, Bachelot T, Lardy-Cleaud A, Dieras V, Brain E, Debled M, Jacot W, Mouret-Reynier MA, Goncalves A, Dalenc F, Patsouris A, Ferrero JM, Levy C, Lorgis V, Vanlemmens L, Lefeuvre-Plesse C, Mathoulin-Pelissier S, Petit T, Uwer L, Jouannaud C, Leheurteur M, Lacroix-Triki M, Courtinard C, Perol D, Robain M, Delaloge S. Contemporary outcomes of metastatic breast cancer among 22,000 women from the multicentre ESME cohort 2008-2016. Eur J Cancer 2020; 129:60-70. [PMID: 32135312 DOI: 10.1016/j.ejca.2020.01.016] [Citation(s) in RCA: 86] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/12/2020] [Accepted: 01/13/2020] [Indexed: 12/26/2022]
Abstract
AIM Real-world data inform the outcome comparisons and help the development of new therapeutic strategies. To this end, we aimed to describe the full characteristics and outcomes in the Epidemiological Strategy and Medical Economics (ESME) cohort, a large national contemporary observational database of patients with metastatic breast cancer (MBC). METHODS Women aged ≥18 years with newly diagnosed MBC and who initiated MBC treatment between January 2008 and December 2016 in one of the 18 French Comprehensive Cancer Centers (N = 22,109) were included. We assessed the full patients' characteristics, first-line treatments, overall survival (OS) and first-line progression-free survival, as well as updated prognostic factors in the whole cohort and among the 3 major subtypes: hormone receptor positive and HER2-negative (HR+/HER2-, n = 13,656), HER2-positive (HER2+, n = 4017) and triple-negative (n = 2963) tumours. RESULTS The median OS of the whole cohort was 39.5 months (95% confidence interval [CI], 38.7-40.3). Five-year OS was 33.8%. OS differed significantly between the 3 subtypes (p < 0.0001) with a median OS of 43.3 (95% CI, 42.5-44.5) in HR+/HER2-; 50.1 (95% CI, 47.6-53.1) in HER2+; and 14.8 months (95% CI, 14.1-15.5) in triple-negative subgroups, respectively. Beyond performance status, the following variables had a constant significant negative prognostic impact on OS in the whole cohort and among subtypes: older age at diagnosis of metastases (except for the triple-negative subtype), metastasis-free interval between 6 and 24 months, presence of visceral metastases and number of metastatic sites ≥ 3. CONCLUSIONS The ESME program represents a unique large-scale real-life cohort on MBC. This study highlights important situations of high medical need within MBC patients. DATABASE REGISTRATION: clinicaltrials.gov Identifier NCT032753.
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Affiliation(s)
- Elise Deluche
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France; Department of Medical Oncology, CHU de Limoges, France
| | - Alison Antoine
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Audrey Lardy-Cleaud
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Veronique Dieras
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, Rennes, 35000, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, 26 Rue D'Ulm, Paris & Saint-Cloud, 75005, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, 229 Cours de L'Argonne, Bordeaux, 33000, France
| | - William Jacot
- Department of Medical Oncology, Institut Du Cancer de Montpellier, 208 Rue des Apothicaires, Montpellier, 34298, France
| | - Marie Ange Mouret-Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, Clermont Ferrand, 63011, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, Marseille, 13009, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, Toulouse, 31059, France
| | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancérologie de L'Ouest Nantes & Angers, 15 Rue André Boquel, Angers, 49055, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 33 Avenue de Valambrose, Nice, 06189, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue Du Général Harris, Caen, 14000, France
| | - Veronique Lorgis
- Department of Medical Oncology, Institut de Cancérologie de Bourgogne, Dijon, 21079, France
| | - Laurence Vanlemmens
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, Lille, 59000, France
| | - Claudia Lefeuvre-Plesse
- Medical Oncology Department, Centre Eugéne Marquis, Avenue de La Bataille Flandres-Dunkerque, Rennes, 35000, France
| | | | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de La Porte de L'Hôpital, Strasbourg, 67000, France
| | - Lionel Uwer
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, Vandœuvre-lès-Nancy, 54519, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue Du Général Koenig, Reims, 51100, France
| | - Marianne Leheurteur
- Department of Medical Oncology, Centre Henri Becquerel, Rue D'Amiens, Rouen, 76000, France
| | - Magali Lacroix-Triki
- Department of BioPathology, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, Paris, 75654, France
| | - David Perol
- Department of Biostatistics, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, Lyon, 69008, France
| | - Mathieu Robain
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, Paris, 75654, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, 94800, France.
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Patsouris A, Lasla H, Jézéquel P, Juin P, Boissard A, Henry C, Campone M, Guette C. Abstract P4-06-11: High immune response identified as a good prognostic factor by proteomic SWATH-MS approach in 157 ER+/HER2- early breast cancer. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-06-11] [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: Estrogen positive/HER2 negative (ER+/HER2-) early (e) breast carcinoma (BC) is an heterogeneous entity, on the prognostic and predictive plan. Several prognostic multigene tests have been developed to identify patients in whom chemotherapy could be safely avoided. Proteomic is a complementary approach as variations in mRNA expression only account for ≈40% of the tumor-encoded protein range and it is taking into account, as other OMICs the tumoral microenvironment Sequential Windowed Acquisition of All Theoretical fragment (SWATH-MS) proteomic approach let an accurate and reproducible label-free quantification of large proteome. To our knowledge, no study has been conducted in a large cohort of luminal BC by SWATH-MS. The aim of this study was to establish a proteomic cartography of ER+/HER2- eBC and identify prognostic biomarkers. Methods: Frozen primary tumors were collected from 157 ER+/HER2- eBC treated in the ICO cancer center between 2006 and 2009. Patients were included if they fulfilled the following criteria: 1) ductal carcinoma; 2) unilateral; 3) first occurrence; 4) have received adjuvant chemotherapy. Clinicopathologic characteristics as outcomes were collected. Each sample was analyzed using SWATH-MS acquisition method as previously described (Aebersold et al, 2012). Peak extraction of the SWATH data was performed using either the Spectronaut software (ver 8.0, Biognosys, Switzerland). Peptide identification results were filtered with a q-value of < 1%. We performed clustering analysis (fuzzy clustering method) based on the 15% of most variant proteins. Functional annotation of clusters based on GO biological process terms enrichment (GOEA) was performed by means of ToppGene and GORILLA web tools. Results: The median of follow-up was 8.34 years. Respectively 32, 4 and 7 patients presented a metastatic, locoregional and controlateral recurrence. 684 among 4555 proteins represented the 15% of most variants proteins.Two ER+/HER2- eBC clusters were identified (C1 [23%] and C2 [77%]) by means of fuzzy clustering and GOEA. Two significant clinicopathological differences were observed between the two subgroups: more unifocal tumors in C1 (P = 0.0415) and mostly a clear better outcome in term of Disease Free Survival (DFS), Distant DFS (DDFS) and Overall survival (OS) in patients belonging to C2 (cf table 1). Functional annotation found that C1 was characterized by mRNA processing and protein synthesis (GO:0006396: RNA processing; GO:0008380: RNA splicing; GO:0016071: mRNA metabolic process; GO:0022613: ribonucleoprotein complex biogenesis), and C2 by a high immune response (GO:0002757: immune response-activating signal transduction; GO:0050778: positive regulation of immune response; GO:0002253: activation of immune response; GO:0050776: regulation of immune response). Differential protein expression according to the C1-C2 clusters will be presented at the meeting. Conclusion: Proteomic cartography by SWATH-MS can clearly distinguish two ER+/HER2- eBC subgroups with clear different prognosis with a better outcome for C2 patients compared to C1 patients. High immune response observed in C2 could underlie this difference with results that must be confirmed on external cohort. Nevertheless this approach could be considered as a complementary approach, helpful for clinical decision for administration of adjuvant treatment.
All (n=157)Cluster 1 (n = 36)Cluster 2 (n = 121)PDisease-free survival72%55.5%77.6%0.0016Distant disease-free survival79.6%66.6%83.4%0.0063Overall survival81%61%87%0.0009Specific overall survival86%69%91%0.0012
Citation Format: Anne Patsouris, Hamza Lasla, Pascal Jézéquel, Philippe Juin, Alice Boissard, Cécile Henry, Mario Campone, Catherine Guette. High immune response identified as a good prognostic factor by proteomic SWATH-MS approach in 157 ER+/HER2- early breast cancer [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-06-11.
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Affiliation(s)
- Anne Patsouris
- 1ICO Cancer Center-Unité INSERM 1232, Equipe 12 CRCINA, Angers, France
| | | | | | | | | | | | - Mario Campone
- 5ICO Cancer Center-Unité INSERM 1232, Equipe 8 CRCINA, Nantes, France
| | - Catherine Guette
- 1ICO Cancer Center-Unité INSERM 1232, Equipe 12 CRCINA, Angers, France
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Bertho M, Fraisse J, Patsouris A, Cottu P, Delaloge S, Pérol D, Jaffré A, Goncalves A, Lebitasy MP, D'Hondt V, Dalenc F, Ferrero JM, Levy C, Arveux P, Rouzier R, Penault-Llorca F, Uwer L, Eymard JC, Breton M, Chevrot M, Leheurteur M, Velten M, Simon G, Frenel JS. Abstract P2-19-01: Impact of bone-only metastatic breast cancer on outcome in a real-life setting: A comprehensive analysis of 5,041 women from the ESME database. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-19-01] [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: Bone-only (BO) metastatic breast cancer (MBC), defined as bone as unique site of metastasis at MBC diagnosis, is thought to carry a better prognosis among MBC. However, only small retrospective series and data from selected randomized controlled trials have been reported so far. Based on a national database, we aimed at providing a large comprehensive analysis of BO MBC, and at evaluating its impact on clinical outcome.
Methods: The ESME MBC platform (NCT03275311) is a French multicenter retrospective real-life database using a clinical trial-like methodology to collect data from 18 French Comprehensive Cancer Centers. It includes data from each newly diagnosed MBC patient having initiated at least one treatment between 2008 and 2016. BO cases occurring in women were retrieved and compared to the overall non-BO population, regarding treatment effects and survival.
Results: Of the 22,463 women selected in the database, 5,041 (22.4%) patients with BO disease were identified. Most (N=4,102, 81.4%) had HR+/HER2- disease while 644 (12.8%) and 295 (5.9%) patients had HER2+ or HR-/HER2- disease, respectively. Compared to non-BO MBC, BO MBC patients were older in the global cohort and in HR-/HER2- patients (mean age 61.0y versus 59.5y, and 59.3y vs 56.4y, all p<0.0001, respectively), and tumor histology was more frequently a lobular carcinoma in the global cohort, in HR+/HER2- and in HR-/HER2- patients (18.6% vs 10.8%, 20.6% vs 15.2%, 13.8% vs 3.2%, all p<0.0001, respectively). In addition, metastatic disease occurred de novo more frequently in BO MBC patients (37.9% versus 29.2%) (p<0.0001), and a statistically significant difference was also observed within each tumor subtype group. The management of bone disease included bisphosphonates or denosumab, radiotherapy, and invasive bone metastasis procedures in 3,913 (77.6%), 2,929 (58.1%), and 1,154 (22.9%) patients, respectively. Median follow up was 52.4 months (95% CI [50.8-54.2]) in BO population and 50.9 months (95% CI [49.7-51.8]) in non-BO population. BO MBC patients had improved median progression-free survival (PFS) 1, regarding first-line treatment, and overall survival (OS) compared to non-BO MBC, globally and within each tumor subtype group (Table). Indeed, 5-year OS rates reached up to 43%, 54% and 16% in HR+/HER2-, HER2+ and HR-/HER2- BO MBC groups, respectively. This suggests that a substantial number of these patients could be considered as long survivors. In the BO MBC cohort, de novo BO MBC patients had a higher 5-year OS rate than relapsed BO MBC patients. BO disease was an independent prognostic factor of OS (hazard ratio 0.68 (95% CI [0.65-0.72]), p<0.0001) together with age, tumor subtype, grade, adjuvant treatment and metastatic-free interval.
Conclusion: This large comprehensive study is the largest cohort of BO MBC to date. BO MBC has a distinct presentation from non-BO MBC and carry a better prognosis compared to non-BO MBC. A significant proportion of BO MBC patients have a very long survival and may benefit from aggressive local therapy, as stereotactic radiotherapy. Dedicated studies are warranted to tailor the management of these patients.
Funding: This work was supported by UNICANCER. The ESME MBC database is supported by an industrial consortium (Roche, Pfizer, AstraZeneca, MSD, Eisai and Daiichi Sankyo). Data collection, analyses and publications are totally managed by R&D UNICANCER independently of the industrial consortium.
TableBOBOBOBOnon-BOnon-BOnon-BOnon-BON (%)median OS monthsmedian PFS1 months5-year OS rate %N (%)median OS monthsmedian PFS1 months5-year OS rate %(95% CI)(95% CI)(95% CI)(95% CI)(95% CI)(95% CI)Overall population5,041 (100%)52.1 (50.3-54.1) 13.1 (12.6-13.8) 43.41 (41.66-45.15)15,054 (100%)34.7 (34.0-35.6) 8.5 (8.3-8.7) 30.55 (29.62-31.48)HR+/HER-4,102 (81.4%)52.6 (50.5-54.8)13.6 (13.0-14.3)43.52 (41.56-45.46)9,127 (60.6%) 39.0 (37.8-40.1)9.6 (9.3-9.9)32.69 (31.47-33.93)HER2+644 (12.8%)66.4 (59.8-71.9) 14.9 (12.9-17.3) 54.49 (49.54-59.16)3,265 (21.7%) 46.5 (44.2-48.9)10.6 (10.1-11.3)39.88 (37.77-41.98)HR-/HER2-295 (5.9%)20.8 (18.3-27.4) 5.6 (4.9-7.5)16.21 (11.21-22.02)2,662 (17.7%) 14.3 (13.6-15.1)4.8 (4.6-5.0)10.89 (9.4-12.5)De novo MBC patients1,909 (37.9%)58.6 (55.4-62.1)17.9 (17.0-18.9)48.24 (45.28-51.14)4,399 (29.2%) ---Relapsed MBC patients3,132 (62.1%)48.3 (46.5-50.5)10.7 (10.2-11.2)40.51 (38.34-42.67)10,655 (70.8%)---
Citation Format: Marion Bertho, Julien Fraisse, Anne Patsouris, Paul Cottu, Suzette Delaloge, David Pérol, Anne Jaffré, Anthony Goncalves, Marie-Paule Lebitasy, Véronique D'Hondt, Florence Dalenc, Jean-Marc Ferrero, Christelle Levy, Patrick Arveux, Roman Rouzier, Frédérique Penault-Llorca, Lionel Uwer, Jean-Christophe Eymard, Mathias Breton, Michaël Chevrot, Marianne Leheurteur, Michel Velten, Gaëtane Simon, Jean-Sébastien Frenel. Impact of bone-only metastatic breast cancer on outcome in a real-life setting: A comprehensive analysis of 5,041 women from the ESME database [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-19-01.
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Affiliation(s)
- Marion Bertho
- 1Medical Oncology, ICO Institut de Cancerologie de l’Ouest – Paul Papin, Angers, France
| | - Julien Fraisse
- 2Biometrics Unit, Regional Cancer Institute of Montpellier (ICM), Montpellier, France
| | - Anne Patsouris
- 1Medical Oncology, ICO Institut de Cancerologie de l’Ouest – Paul Papin, Angers, France
| | - Paul Cottu
- 3Department of Medical Oncology, Institut Curie, Paris, France
| | - Suzette Delaloge
- 4Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - David Pérol
- 5Biostatistic Unit, Clinical Research and Innovation Department, Centre Léon Bérard, Lyon, France
| | - Anne Jaffré
- 6Department of Medical Information, Institut Bergonié, Bordeaux, France
| | - Anthony Goncalves
- 7Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | | | - Véronique D'Hondt
- 9Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - Florence Dalenc
- 10Department of Oncology, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Jean-Marc Ferrero
- 11Department of Oncology, Institut Centre Antoine Lacassagne, Nice, France
| | - Christelle Levy
- 12Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Patrick Arveux
- 13Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Roman Rouzier
- 14Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | | | - Lionel Uwer
- 16Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandœuvre-lès-Nancy, France
| | | | - Mathias Breton
- 18Medical Information Department, Centre Eugène Marquis, Rennes, France
| | | | | | - Michel Velten
- 21Clinical Research and Epidemiology Department, Centre Paul Strauss, Strasbourg, France
| | | | - Jean-Sébastien Frenel
- 22Medical Oncology, ICO Institut de Cancerologie de l’Ouest – René Gauducheau, Saint-Herblain, France
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Saleh K, Carton M, Dieras V, Heudel PE, Brain E, Firmin N, Mailliez A, Patsouris A, Mouret Reynier M, Gonçalves A, Ferrero JM, Petit T, Levy C, Uwer L, Cottu P, Veron L, Deluche E, Savignoni A, Robain M, Delaloge S. Prognostic impact of body mass index (BMI) on overall survival in patients with metastatic breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz242.062] [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: 11/13/2022] Open
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Patsouris A, Augereau P, Frenel JS, Robert M, Gourmelon C, Bourbouloux E, Berton-Rigaud D, Chevalier LM, Campone M. Benefits versus risk profile of buparlisib for the treatment of breast cancer. Expert Opin Drug Saf 2019; 18:553-562. [PMID: 31159599 DOI: 10.1080/14740338.2019.1623877] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Introduction: Activation of phosphoinositide 3-kinase (PI3K)/AKT/mammalian target of rapamycin (mTOR) pathways occurs in 70% of breast cancer, including PIK3CA activating mutations, PTEN loss and AKT mutation. It is associated with poor prognosis and resistance to anti-HER2 and endocrine therapy. PI3K inhibitors are promising anticancer targets that can reverse resistance to these therapies. Buparlisib (BKM-120) is an orally active pan-PI3K inhibitor evaluated in different solid tumors as monotherapy or in combination. Areas covered: This article reviews preclinical data, clinical studies that have evaluated the efficacy and safety profiles of buparlisib as a monotherapy or in combination with targeted therapy (including endocrine and anti-HER2 therapy) or cytotoxics. The authors cover completed and ongoing studies to evaluate the benefit vs risk profile of buparlisib. Expert opinion: Targeting PI3K showed efficacy in BC. Buparlisib, a pan PI3K inhibitor, presents manageable but not negligible toxicity with an activity/toxicity ratio in favor of the use of emerging second generation, α-selective PI3K inhibitors for ongoing and future trials.
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Affiliation(s)
- Anne Patsouris
- a Unité INSERM 1232, Equipe 12, CRCINA , ICO Nantes-Angers , Nantes , France
| | - Paule Augereau
- b Departement of medical oncology , ICO Nantes-Angers , Nantes , France
| | | | - Marie Robert
- b Departement of medical oncology , ICO Nantes-Angers , Nantes , France
| | - Carole Gourmelon
- b Departement of medical oncology , ICO Nantes-Angers , Nantes , France
| | | | | | | | - Mario Campone
- d Unité INSERM 1232, Equipe 8 CRCINA , ICO Nantes-Angers , Nantes , France
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