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Gougis P, Grandal B, Jochum F, Bihan K, Coussy F, Barraud S, Asselain B, Dumas E, Sebbag C, Hotton J, Spaggiari E, Pierga JY, Savarino R, Laas E, Spano JP, Reyal F, Hamy AS. Treatments During Pregnancy Targeting ERBB2 and Outcomes of Pregnant Individuals and Newborns. JAMA Netw Open 2023; 6:e2339934. [PMID: 37883083 PMCID: PMC10603505 DOI: 10.1001/jamanetworkopen.2023.39934] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Accepted: 09/15/2023] [Indexed: 10/27/2023] Open
Abstract
Importance Targeted therapies directed against ERBB2 are the cornerstone of medical treatment for ERBB2-positive breast cancers but are contraindicated during pregnancy. Objectives To describe the association of exposure to anti-ERBB2 agents during pregnancy with pregnancy and fetal or newborn outcomes, and to compare the risk and types of adverse outcomes reported more frequently in this context than after exposure to other anticancer agents. Design, Setting, and Participants For this case-control study, All reports with a pregnancy-related condition and an antineoplastic agent (Anatomical Therapeutic Chemical classification group L01) registered in the World Health Organization international pharmacovigilance database VigiBase up to June 26, 2022, were extracted. All reports with a pregnancy, an antineoplastic treatment during pregnancy, and a cancer were retained. Reports with anticancer agents prescribed for nononcologic purposes were not included. Exposure The exposure group was defined as reports that mention anti-ERBB2 agents compared with exposure to other anticancer agents. Main Outcome and Measures The main outcome was the reporting odds ratio (ROR) for maternofetal complications in the group exposed to anti-ERBB2 agents compared with other anticancer agents, as determined using a disproportionality analysis. Results A total of 3558 reports (anti-ERBB2 agents, 328; other anticancer agents, 3230) were included in the analysis. In the group exposed to anti-ERBB2 agents, most reports were from the US (159 [48.5%]), the mean (SD) age of participants was 30.8 (10.4) years, and 209 patients (97.7%) were treated for breast cancers. The molecules most frequently involved in cases with anti-ERBB2 agents were trastuzumab (n = 302), pertuzumab (n = 55), trastuzumab-emtansine (n = 20), and lapatinib (n = 18). The outcomes overreported in these cases included oligohydramnios (ROR, 17.68 [95% CI, 12.26-25.52]; P < .001), congenital respiratory tract disorders (ROR, 9.98 [95% CI, 2.88-34.67]; P < .001), and neonatal kidney failure (ROR, 9.15 [95% CI, 4.62-18.12]; P < .001). Sensitivity and multivariable analyses found similar results. Toxic effects were also significantly overreported for trastuzumab-emtansine (cardiovascular malformation: ROR, 4.46 [95% CI, 1.02-19.52]) and lapatinib (intrauterine growth restriction: ROR, 7.68 [95% CI, 3.01-19.59]). Conclusions and Relevance In this case-control study of 328 individuals exposed to anti-ERBB2 agents during pregnancy, exposure was associated with a severe specific adverse pregnancy and fetal or newborn outcomes compared with exposure to other anticancer treatments.
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Affiliation(s)
- Paul Gougis
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Medical Oncology, Pitié-Salpêtrière Hospital, Paris, France, Assistance Publique–Hôpitaux de Paris, Paris, France
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Assistance Publique–Hôpitaux de Paris, Clinical Investigation Center (CIC-1901), Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
| | - Beatriz Grandal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
| | - Floriane Jochum
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Gynecology, Strasbourg University Hospital, Strasbourg, France
| | - Kevin Bihan
- Sorbonne Université, Institut National de la Santé et de la Recherche Médicale, Assistance Publique–Hôpitaux de Paris, Clinical Investigation Center (CIC-1901), Department of Pharmacology, Pitié-Salpêtrière Hospital, Paris, France
| | - Florence Coussy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Solenn Barraud
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
| | - Bernard Asselain
- Department of Statistics, Association de Recherche sur les Cancers dont Gynécologiques–Groupe d’Investigateurs National des Etudes des Cancers Ovariens et du sein (ARCAGY-GINECO), Paris, France
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
| | - Clara Sebbag
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Judicael Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Emmanuel Spaggiari
- Department of Obstetrics and Maternal-Fetal Medicine, Assistance Publique–Hôpitaux de Paris, Necker Enfants-Malades Hospital, Paris, France
| | - Jean-Yves Pierga
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Raphaëlle Savarino
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
| | - Enora Laas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Jean-Philippe Spano
- Department of Medical Oncology, Pitié-Salpêtrière Hospital, Paris, France, Assistance Publique–Hôpitaux de Paris, Paris, France
- Institut National de la Santé et de la Recherche Médicale, UMRS 1136, Paris, France
| | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Surgical Oncology, Institut Godinot, Reims, France
- Department of Breast, Gynecological and Reconstructive Surgery, Institut Curie, Université Paris Cité, Paris, France
| | - Anne-Sophie Hamy
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Institut National de la Santé et de la Recherche Médicale, U932 Immunity and Cancer, Institut Curie, Université Paris Cité, Paris, France
- Department of Medical Oncology, Institut Curie, Université Paris Cité, Paris, France
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Najid S, Seban RD, Champion L, De Moura A, Sebbag C, Salaün H, Cabel L, Bonneau C. Clinical Utility of Pre-Therapeutic [18F]FDG PET/CT Imaging for Predicting Outcomes in Breast Cancer. J Clin Med 2023; 12:5487. [PMID: 37685551 PMCID: PMC10488013 DOI: 10.3390/jcm12175487] [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: 06/26/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/10/2023] Open
Abstract
BACKGROUND [18F]FDG PET/CT is used for staging and could also provide information associated with clinical outcomes. The objective of this study was to determine the clinical utility of biomarkers measured using [18F]FDG PET/CT to predict the absence of pathological complete response (no-pCR) and recurrence. METHODS In this retrospective study, we included patients with non-special-type breast carcinoma who underwent [18F]FDG PET/CT before neoadjuvant chemotherapy between 2011 and 2019. Clinicopathological data were collected. Tumor SUVmax and total metabolic tumor volume (TMTV) were measured from PET images. The association between biomarkers and no-pCR was studied using logistic regression. The cut-off value was determined using the area under the ROC Curve. To predict 3-year recurrence-free survival (RFS), we used a multivariable Cox model, and the cut-off value was determined using time-dependent ROC and predictiveness curves. RESULTS Two hundred and eighty-six patients were included in the analysis. One hundred and twelve patients had a pCR (39.2%). The pCR rate was significantly higher in patients with a high nuclear grade (p < 0.01), HER2+ and TNBC subtypes (p < 0.01), high Ki67 (p < 0.01), and low TMTV (p < 0.01). A high TMTV value (>9.0 cm3) was significantly associated with no-pCR in the whole cohort (OR = 2.4, 95% CI: 1.3-4.2, p < 0.01). After a median follow-up of 4.5 years, 65 patients experienced recurrence and 39 patients died. High TMTV (>13.5 cm3) was associated with shorter RFS (HR = 4.0, 95% CI: 1.9-8.4, p < 0.01). CONCLUSION High TMTV in pre-therapeutic imaging is associated with no-pCR and recurrence. It can help in identifying high-risk patients and be considered as an intensified or alternative adjuvant therapy for closely monitoring patients.
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Affiliation(s)
- Sophia Najid
- Institut Curie, Inserm U900, 92210 Saint-Cloud, France
| | - Romain-David Seban
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France;
| | - Laurence Champion
- Department of Nuclear Medicine, Institut Curie, 92210 Saint-Cloud, France;
| | - Alexandre De Moura
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005 Paris, France; (A.D.M.); (C.S.); (H.S.); (L.C.)
- UVSQ, Paris Saclay University, 92210 Saint-Cloud, France
| | - Clara Sebbag
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005 Paris, France; (A.D.M.); (C.S.); (H.S.); (L.C.)
- UVSQ, Paris Saclay University, 92210 Saint-Cloud, France
| | - Hélène Salaün
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005 Paris, France; (A.D.M.); (C.S.); (H.S.); (L.C.)
- UVSQ, Paris Saclay University, 92210 Saint-Cloud, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, PSL Research University, 75005 Paris, France; (A.D.M.); (C.S.); (H.S.); (L.C.)
- UVSQ, Paris Saclay University, 92210 Saint-Cloud, France
| | - Claire Bonneau
- Department of Surgery, Institut Curie, 92210 Saint-Cloud, France
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Sebbag C, Rousset-Jablonski C, Coussy F, Ray-Coquard I, Garin C, Evrevin C, Cessot M, Labrosse J, Laot L, Darrigues L, Bobrie A, Sénéchal-Davin C, Espié M, Giacchetti S, Plu-Bureau G, Maitrot-Mantelet L, Gompel A, Santulli P, Asselain B, Hotton J, Coutant C, Guerin J, Decanter C, Mailliez A, Brain E, Dumas E, Sablone L, Seintinelles RN, Reyal F, Hamy AS. Contraception in breast cancer survivors from the FEERIC case-control study (performed on behalf of the Seintinelles research network). Breast 2022; 67:62-70. [PMID: 36630821 PMCID: PMC9982267 DOI: 10.1016/j.breast.2022.12.033] [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: 10/21/2022] [Revised: 12/22/2022] [Accepted: 12/27/2022] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To compare the prevalence of contraception in breast cancer (BC) patients at risk of unintentional pregnancy (i.e. not currently pregnant or trying to get pregnant) and matched controls. STUDY DESIGN The FEERIC study (Fertility, Pregnancy, Contraception after BC in France) is a prospective, multicenter case-control study, including localized BC patients aged 18-43 years, matched for age and parity to cancer-free volunteer controls in a 1:2 ratio. Data were collected through online questionnaires completed on the Seintinelles research platform. RESULTS In a population of 1278 women at risk of unintentional pregnancy, the prevalence of contraception at study inclusion did not differ significantly between cases (340/431, 78.9%) and controls (666/847, 78.6%, p = 0.97). Contrarily, the contraceptive methods used were significantly different, with a higher proportion of copper IUD use in BC survivors (59.5% versus 25.0% in controls p < 0.001). For patients at risk of unintentional pregnancy, receiving information about chemotherapy-induced ovary damage at BC diagnosis (OR = 2.47 95%CI [ 1.39-4.37] and anti-HER2 treatment (OR = 2.46, 95% CI [ 1.14-6.16]) were significantly associated with the use of a contraception in multivariate analysis. CONCLUSION In this large French study, BC survivors had a prevalence of contraception use similar to that for matched controls, though almost one in five women at risk of unintentional pregnancy did not use contraception. Dedicated consultations at cancer care centers could further improve access to information and contraception counseling.
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Affiliation(s)
- Clara Sebbag
- Department of Medical Oncology, Institut Curie, Paris, France,Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France,Université Paris Cité, Paris, France
| | - Christine Rousset-Jablonski
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France,Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Isabelle Ray-Coquard
- INSERM U1290 RESearch on HealthcAre PErformance (RESHAPE), University Claude Bernard Lyon 1, Lyon, France,Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Clémentine Garin
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France
| | - Clémence Evrevin
- Department of Medical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Marion Cessot
- Department of Surgical Oncology, Centre Léon Bérard, Lyon, France
| | - Julie Labrosse
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Lucie Laot
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Lauren Darrigues
- Department of Surgical Oncology, Institut Curie, Paris, France,Université Paris Cité, Paris, France
| | - Angélique Bobrie
- Department of Medical Oncology, Institut du cancer de Montpellier, Montpellier, France
| | | | - Marc Espié
- Sénolopole, Hôpital Saint Louis, AP-HP, Paris, France; University Paris, Paris France
| | - Sylvie Giacchetti
- Sénolopole, Hôpital Saint Louis, AP-HP, Paris, France; University Paris, Paris France
| | - Geneviève Plu-Bureau
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | | | - Anne Gompel
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | - Pietro Santulli
- Department of Gynecology, Hôpital Cochin, Paris, France; University Paris, Paris France
| | | | - Judicaël Hotton
- Department of Surgical Oncology, Institut Godinot, Reims, France
| | - Charles Coutant
- Department of Surgical Oncology, Centre Georges-François Leclerc - Unicancer, Dijon, France,Clinical Research Department, Centre Georges-François Leclerc - Unicancer, Dijon, France
| | - Julien Guerin
- Data Factory, Data Office, Institut Curie, 25 rue d’Ulm, 75005 Paris, France
| | | | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar Lambert, Lille, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Elise Dumas
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France
| | - Laura Sablone
- Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France
| | | | - Fabien Reyal
- Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France,Department of Surgical Oncology, Institut Curie, Paris, France,Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France,Université Paris Cité, Paris, France
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Institut Curie, Paris, France; Residual Tumor & Response to Treatment Laboratory, RT2Lab, Translational Research Department, INSERM, U932 Immunity and Cancer, University Paris, Paris, France; Department of Surgical Oncology, Institut Curie, Paris, France; Seintinelles Research Network, 40 Rue Rémy Dumoncel, 75014, Paris, France; Université Paris Cité, Paris, France.
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Mangiardi-Veltin M, Sebbag C, Rousset-Jablonski C, Ray-Coquard I, Berkach C, Laot L, Wang Y, Abdennebi I, Labrosse J, Sautter C, Toussaint A, Sablone L, Laas E, Khallouch S, Coussy F, Santulli P, Chapron C, Bobrie A, Jacot W, Sella N, Dumas E, Sénéchal-Davin C, Espie M, Giacchetti S, Maitrot L, Plu-Bureau G, Coutant C, Guerin J, Asselain B, Fumoleau P, Rodrigues M, Decanter C, Mailliez A, Delrieu L, Lemoine A, Jouannaud C, Houdre D, Reyal F, Hamy AS. Pregnancy, fertility concerns, and fertility preservation procedures in French breast cancer survivors in the FEERIC national study (on behalf of the Seintinelles research network). Reprod Biomed Online 2022; 44:1031-1044. [DOI: 10.1016/j.rbmo.2021.12.019] [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] [Received: 06/10/2021] [Revised: 12/06/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
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Cristall K, Bidard FC, Pierga JY, Rauh MJ, Popova T, Sebbag C, Lantz O, Stern MH, Mueller CR. A DNA methylation-based liquid biopsy for triple-negative breast cancer. NPJ Precis Oncol 2021; 5:53. [PMID: 34135468 PMCID: PMC8209161 DOI: 10.1038/s41698-021-00198-9] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
Here, we present a next-generation sequencing (NGS) methylation-based blood test called methylation DETEction of Circulating Tumour DNA (mDETECT) designed for the optimal detection and monitoring of metastatic triple-negative breast cancer (TNBC). Based on a highly multiplexed targeted sequencing approach, this assay incorporates features that offer superior performance and included 53 amplicons from 47 regions. Analysis of a previously characterised cohort of women with metastatic TNBC with limited quantities of plasma (<2 ml) produced an AUC of 0.92 for detection of a tumour with a sensitivity of 76% for a specificity of 100%. mDETECTTNBC was quantitative and showed superior performance to an NGS TP53 mutation-based test carried out on the same patients and to the conventional CA15-3 biomarker. mDETECT also functioned well in serum samples from metastatic TNBC patients where it produced an AUC of 0.97 for detection of a tumour with a sensitivity of 93% for a specificity of 100%. An assay for BRCA1 promoter methylation was also incorporated into the mDETECT assay and functioned well but its clinical significance is currently unclear. Clonal Hematopoiesis of Indeterminate Potential was investigated as a source of background in control subjects but was not seen to be significant, though a link to adiposity may be relevant. The mDETECTTNBC assay is a liquid biopsy able to quantitatively detect all TNBC cancers and has the potential to improve the management of patients with this disease.
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Affiliation(s)
- Katrina Cristall
- Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada.,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Francois-Clement Bidard
- Circulating Tumor Biomarkers Laboratory, SiRIC, Translational Research Department, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Paris, France
| | - Jean-Yves Pierga
- Circulating Tumor Biomarkers Laboratory, SiRIC, Translational Research Department, Institut Curie, Paris, France.,Department of Medical Oncology, Institut Curie, Paris, France.,Université Paris Descartes, Paris, France
| | - Michael J Rauh
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada
| | - Tatiana Popova
- INSERM U830 Cancer, Heterogeneity, Instability and Plasticity (CHIP), Institut Curie, Paris, France
| | - Clara Sebbag
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Olivier Lantz
- Circulating Tumor Biomarkers Laboratory, SiRIC, Translational Research Department, Institut Curie, Paris, France.,INSERM CIC BT 1428, Institut Curie, Paris, France.,INSERM U932, Institut Curie, Paris, France
| | - Marc-Henri Stern
- INSERM U830 Cancer, Heterogeneity, Instability and Plasticity (CHIP), Institut Curie, Paris, France
| | - Christopher R Mueller
- Queen's Cancer Research Institute, Queen's University, Kingston, ON, Canada. .,Department of Pathology and Molecular Medicine, Queen's University, Kingston, ON, Canada. .,Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada.
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Grandal B, Evrevin C, Daoud E, Dumas E, Sella N, Sebbag C, Rozette S, Jardin I, Laot L, Coussy F, Saule C, Stoppa-Lyonnet D, Franck S, Sénéchal C, Laas E, Lae M, De Croze D, Reyal F, Hamy AS. Abstract PS13-10: Impact of BRCA mutation status on immune infiltration, chemosensitivity, and prognosis of breast cancer patients treated with neoadjuvant chemotherapy. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps13-10] [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
Context: The majority of BRCA mutation carriers diagnosed with breast cancer (BC) are treated with chemotherapy. The effectiveness of standard neoadjuvant chemotherapy (NAC) in BRCA associated BC compared to noncarriers has been poorly explored. Objectives: To assess whether the BRCA mutation status modifies the immune infiltration, chemosensitivity, and prognosis of breast cancer. Methods: We retrospectively identified in our institutional database all consecutive patients with BRCA germline mutation status available treated with NAC between 2002 and 2012. Microbiopsy specimens and paired surgical samples were evaluated for pre-NAC and post-NAC immune infiltration (stromal TILs, str TILs; intratumoral TILs, IT TILs). Response to chemotherapy was assessed by pathological complete response (pCR) rates. Association of clinical and pathological factors with pCR, overall survival (OS), and relapse free survival (RFS) was assessed by univariate and multivariate analyses. Results: Overall, 267 patients were included in this study (46 BRCA carriers and 221 BRCA noncarriers). The median age at BC diagnosis was 40 years old, and most of the patients (n=227, 85%) were premenopausal. Patients repartition by subtype was as follows: luminal (n=90, 33.7%), TNBC (n=110, 41.2%), HER2-positive (n=67, 25.1%). BRCA mutation carriers were likely to have familial history of BC (73.9% vs. 52.3%, p = 0.012), and be diagnosed with TNBC (58.7% vs 37.6%; p = 0.006), than noncarriers. No pattern was significantly different between BRCA mutation subgroups regarding age, body mass index, histology, tumor size, grade or Ki67. TIL levels were available in 192 patients. Neither pre-NAC stromal TIL levels nor IT TILs were significantly different by BRCA status in the whole population, nor in each BC subtype. PCR rates were significantly higher in BRCA mutation carriers (p= 0.035), and this association remained statistically significant only in the luminal BC subtype (p=0.006) after stratification by BC subtype (Pinteraction= 0.056). After multivariate analysis, only BC subtype and pre-NAC str TILs were independent predictors of pCR. Post-NAC stromal and intra-tumoral TIL levels were significantly higher luminal subtype (p=0.009 and p=0.019, respectively). After a median follow-up of 90 months, RFS and OS were not different between BRCA carriers and noncarriers, neither in the whole population nor after stratification by BC subtype. Discussion: In our study, BRCA status was associated with an enhanced response to standard NAC, particularly in luminal BC patients, in addition to higher post-NAC TIL levels. Whether patients with luminal BC and BRCA mutation derive benefit from second line immunotherapy after NAC completion remains to determine.
Citation Format: Beatriz Grandal, Clémence Evrevin, Eric Daoud, Elise Dumas, Nadir Sella, Clara Sebbag, Sonia Rozette, Isabelle Jardin, Lucie Laot, Florence Coussy, Claire Saule, Dominique Stoppa-Lyonnet, Sophie Franck, Claire Sénéchal, Enora Laas, Marick Lae, Diane De Croze, Fabien Reyal, Anne-Sophie Hamy. Impact of BRCA mutation status on immune infiltration, chemosensitivity, and prognosis of breast cancer patients treated with neoadjuvant chemotherapy [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 PS13-10.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Marick Lae
- 3Centre René Huguenin - Institut Curie, St Cloud, France
| | - Diane De Croze
- 4Centre René Huguenin - Institut Curie, St Cloud, France
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Labrosse J, Lam T, Sebbag C, Benque M, Abdennebi I, Merckelbagh H, Osdoit M, Priour M, Guerin J, Balezeau T, Grandal B, Coussy F, Bobrie A, Ferrer L, Laas E, Feron JG, Reyal F, Hamy AS. Text Mining in Electronic Medical Records Enables Quick and Efficient Identification of Pregnancy Cases Occurring After Breast Cancer. JCO Clin Cancer Inform 2020; 3:1-12. [PMID: 31626565 DOI: 10.1200/cci.19.00031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
PURPOSE To apply text mining (TM) technology on electronic medical records (EMRs) of patients with breast cancer (BC) to retrieve the occurrence of a pregnancy after BC diagnosis and compare its performance to manual curation. MATERIALS AND METHODS The training cohort (Cohort A) comprised 344 patients with BC age ≤ 40 years old treated at Institut Curie between 2005 and 2007. Manual curation consisted in manually reviewing each EMR to retrieve pregnancies. TM consisted of first applying a keyword filter ("accouch*" or "enceinte," French terms for "deliver*" and "pregnant," respectively) to select a subset of EMRs, and, second, checking manually EMRs to confirm the pregnancy. Then, we applied our TM algorithm on an independent cohort of patients with BC treated between 2008 and 2012 (Cohort B). RESULTS In Cohort A, 36 pregnancies were identified among 344 patients (10.5%; 2,829 person-years of EMR). Thirty were identified by manual review versus 35 by TM. TM resulted in a lower percentage of manual checking (26.7% v 100%, respectively) and substantial time gains (time to identify a pregnancy: 13 minutes for TM v 244 minutes for manual curation, respectively). Presence of any of the two TM filters showed excellent sensitivity (97%) and negative predictive value (100%). In Cohort B, 67 pregnancies were identified among 1,226 patients (5.5%; 7,349 person-years of EMR). Similarly, for Cohort B, TM spared 904 (73.7%) EMRs from manual review and quickly generated a cohort of 67 pregnancies after BC. Incidence rate of pregnancy after BC was 0.01 pregnancy per person-year of EMR in both cohorts. CONCLUSION TM is highly efficient to quickly identify rare events and is a promising tool to improve rapidity, efficiency, and costs of medical research.
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Affiliation(s)
| | - Thanh Lam
- Geneva University Hospitals, Geneva, Switzerland
| | | | | | | | | | | | | | | | | | | | | | | | - Loïc Ferrer
- Institut Curie, U900, Hôpital René Huguenin, Saint-Cloud, France
| | | | | | - Fabien Reyal
- Paris 5 Research University, INSERM U932, Institut Curie, Paris, France
| | - Anne-Sophie Hamy
- Paris 5 Research University, INSERM U932, Institut Curie, Paris, France
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