1
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Aggarwal R, Heller G, Hillman DW, Xiao H, Picus J, Taplin ME, Dorff T, Appleman L, Weckstein D, Patnaik A, Bryce A, Shevrin D, Mohler J, Anderson D, Rao A, Tagawa S, Tan A, Halabi S, Dooley K, O'Brien P, Chen R, Ryan CJ, Eggener SE, Morris MJ. PRESTO: A Phase III, Open-Label Study of Intensification of Androgen Blockade in Patients With High-Risk Biochemically Relapsed Castration-Sensitive Prostate Cancer (AFT-19). J Clin Oncol 2024; 42:1114-1123. [PMID: 38261983 DOI: 10.1200/jco.23.01157] [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] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/01/2023] [Accepted: 11/08/2023] [Indexed: 01/25/2024] Open
Abstract
PURPOSE Patients with biochemically recurrent prostate cancer (BRPC) after radical prostatectomy and a short PSA doubling time are at risk for distant metastases. Apalutamide, an androgen receptor antagonist, and abiraterone acetate plus prednisone (AAP) prolong survival in the metastatic setting. We evaluated whether intensification of androgen-deprivation therapy (ADT) improves outcomes in BRPC. PATIENTS AND METHODS PRESTO is a randomized phase III, open-label trial in patients with BRPC and PSA doubling time ≤9 months (ClinicalTrials.gov identifier: NCT03009981). Patients were randomly assigned 1:1:1 to receive a finite 52-week treatment course with ADT control, ADT + apalutamide, or ADT + apalutamide + AAP. The primary end point was PSA progression-free survival (PSA-PFS), defined as serum PSA >0.2 ng/mL after treatment completion. RESULTS Five hundred three patients were enrolled. The median PSA was 1.8 ng/mL (IQR, 1.0-3.6). At the first planned interim analysis, both experimental arms significantly prolonged PSA-PFS compared with the control arm (median, 24.9 months for ADT + apalutamide v 20.3 months for ADT; hazard ratio [HR], 0.52 [95% CI, 0.35 to 0.77]; P = .00047; median, 26.0 months for ADT + apalutamide + AAP v 20.0 months for ADT; HR, 0.48 [95% CI, 0.32 to 0.71]; P = .00008). Median time to testosterone recovery did not differ across treatment arms. The most common grade ≥3 adverse event was hypertension (7.5%, 7.4%, and 18% in ADT, ADT + apalutamide, and ADT + apalutamide + AAP arms, respectively). CONCLUSION Intensified AR blockade for a finite duration prolongs PSA-PFS with a manageable safety profile, without adversely affecting time to testosterone recovery. The addition of apalutamide to ADT should be considered in patients with high-risk BRPC.
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Affiliation(s)
| | - Glenn Heller
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Han Xiao
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | | | | | | | | | - Arpit Rao
- Baylor College of Medicine, Houston, TX
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2
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Leon-Ferre RA, Carter JM, Zahrieh D, Sinnwell JP, Salgado R, Suman VJ, Hillman DW, Boughey JC, Kalari KR, Couch FJ, Ingle JN, Balkenhol M, Ciompi F, van der Laak J, Goetz MP. Automated mitotic spindle hotspot counts are highly associated with clinical outcomes in systemically untreated early-stage triple-negative breast cancer. NPJ Breast Cancer 2024; 10:25. [PMID: 38553444 PMCID: PMC10980681 DOI: 10.1038/s41523-024-00629-3] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/08/2024] [Indexed: 04/02/2024] Open
Abstract
Operable triple-negative breast cancer (TNBC) has a higher risk of recurrence and death compared to other subtypes. Tumor size and nodal status are the primary clinical factors used to guide systemic treatment, while biomarkers of proliferation have not demonstrated value. Recent studies suggest that subsets of TNBC have a favorable prognosis, even without systemic therapy. We evaluated the association of fully automated mitotic spindle hotspot (AMSH) counts with recurrence-free (RFS) and overall survival (OS) in two separate cohorts of patients with early-stage TNBC who did not receive systemic therapy. AMSH counts were obtained from areas with the highest mitotic density in digitized whole slide images processed with a convolutional neural network trained to detect mitoses. In 140 patients from the Mayo Clinic TNBC cohort, AMSH counts were significantly associated with RFS and OS in a multivariable model controlling for nodal status, tumor size, and tumor-infiltrating lymphocytes (TILs) (p < 0.0001). For every 10-point increase in AMSH counts, there was a 16% increase in the risk of an RFS event (HR 1.16, 95% CI 1.08-1.25), and a 7% increase in the risk of death (HR 1.07, 95% CI 1.00-1.14). We corroborated these findings in a separate cohort of systemically untreated TNBC patients from Radboud UMC in the Netherlands. Our findings suggest that AMSH counts offer valuable prognostic information in patients with early-stage TNBC who did not receive systemic therapy, independent of tumor size, nodal status, and TILs. If further validated, AMSH counts could help inform future systemic therapy de-escalation strategies.
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Affiliation(s)
| | | | | | | | - Roberto Salgado
- GZA-ZNA-Hospitals, Antwerp, Belgium
- Peter Mac Callum Cancer Centre, Melbourne, Australia
| | | | | | | | | | | | | | | | | | - Jeroen van der Laak
- Radboud University Medical Center, Nijmegen, Netherlands
- Center for Medical Image Science and Visualization, Linköping University, Linköping, Sweden
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3
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Rediti M, Fernandez-Martinez A, Venet D, Rothé F, Hoadley KA, Parker JS, Singh B, Campbell JD, Ballman KV, Hillman DW, Winer EP, El-Abed S, Piccart M, Di Cosimo S, Symmans WF, Krop IE, Salgado R, Loi S, Pusztai L, Perou CM, Carey LA, Sotiriou C. Immunological and clinicopathological features predict HER2-positive breast cancer prognosis in the neoadjuvant NeoALTTO and CALGB 40601 randomized trials. Nat Commun 2023; 14:7053. [PMID: 37923752 PMCID: PMC10624889 DOI: 10.1038/s41467-023-42635-2] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 10/16/2023] [Indexed: 11/06/2023] Open
Abstract
The identification of prognostic markers in patients receiving neoadjuvant therapy is crucial for treatment optimization in HER2-positive breast cancer, with the immune microenvironment being a key factor. Here, we investigate the complexity of B and T cell receptor (BCR and TCR) repertoires in the context of two phase III trials, NeoALTTO and CALGB 40601, evaluating neoadjuvant paclitaxel with trastuzumab and/or lapatinib in women with HER2-positive breast cancer. BCR features, particularly the number of reads and clones, evenness and Gini index, are heterogeneous according to hormone receptor status and PAM50 subtypes. Moreover, BCR measures describing clonal expansion, namely evenness and Gini index, are independent prognostic factors. We present a model developed in NeoALTTO and validated in CALGB 40601 that can predict event-free survival (EFS) by integrating hormone receptor and clinical nodal status, breast pathological complete response (pCR), stromal tumor-infiltrating lymphocyte levels (%) and BCR repertoire evenness. A prognostic score derived from the model and including those variables, HER2-EveNT, allows the identification of patients with 5-year EFS > 90%, and, in those not achieving pCR, of a subgroup of immune-enriched tumors with an excellent outcome despite residual disease.
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Affiliation(s)
- Mattia Rediti
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - David Venet
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Françoise Rothé
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Katherine A Hoadley
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Joel S Parker
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | | | - Jordan D Campbell
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Karla V Ballman
- Alliance Statistics and Data Management Center, Weill Cornell Medicine, New York, NY, USA
| | - David W Hillman
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN, USA
| | - Eric P Winer
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | | | - Martine Piccart
- Medical Oncology Department, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Serena Di Cosimo
- Integrated biology platform unit, Department of Applied Research and Technological Development, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - William Fraser Symmans
- Department of Pathology, University of Texas, MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Ian E Krop
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA Ziekenhuizen, Antwerp, Belgium
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sherene Loi
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lajos Pusztai
- Breast Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Lisa A Carey
- Division of Hematology-Oncology, Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (H.U.B), Université Libre de Bruxelles (ULB), Brussels, Belgium.
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4
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Morris MJ, Heller G, Hillman DW, Bobek O, Ryan C, Antonarakis ES, Bryce AH, Hahn O, Beltran H, Armstrong AJ, Schwartz L, Lewis LD, Beumer JH, Langevin B, McGary EC, Mehan PT, Goldkorn A, Roth BJ, Xiao H, Watt C, Taplin ME, Halabi S, Small EJ. Randomized Phase III Study of Enzalutamide Compared With Enzalutamide Plus Abiraterone for Metastatic Castration-Resistant Prostate Cancer (Alliance A031201 Trial). J Clin Oncol 2023; 41:3352-3362. [PMID: 36996380 PMCID: PMC10414728 DOI: 10.1200/jco.22.02394] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/01/2023] [Accepted: 02/09/2023] [Indexed: 04/01/2023] Open
Abstract
PURPOSE Enzalutamide and abiraterone both target androgen receptor signaling but via different mechanisms. The mechanism of action of one drug may counteract the resistance pathways of the other. We sought to determine whether the addition of abiraterone acetate and prednisone (AAP) to enzalutamide prolongs overall survival (OS) in patients with metastatic castration-resistant prostate cancer (mCRPC) in the first-line setting. PATIENTS AND METHODS Men with untreated mCRPC were randomly assigned (1:1) to receive first-line enzalutamide with or without AAP. The primary end point was OS. Toxicity, prostate-specific antigen declines, pharmacokinetics, and radiographic progression-free survival (rPFS) were also examined. Data were analyzed using an intent-to-treat approach. The Kaplan-Meier estimate and the stratified log-rank statistic were used to compare OS between treatments. RESULTS In total, 1,311 patients were randomly assigned: 657 to enzalutamide and 654 to enzalutamide plus AAP. OS was not statistically different between the two arms (median, 32.7 [95% CI, 30.5 to 35.4] months for enzalutamide v 34.2 [95% CI, 31.4 to 37.3] months for enzalutamide and AAP; hazard ratio [HR], 0.89; one-sided P = .03; boundary nominal significance level = .02). rPFS was longer in the combination arm (median rPFS, 21.3 [95% CI, 19.4 to 22.9] months for enzalutamide v 24.3 [95% CI, 22.3 to 26.7] months for enzalutamide and AAP; HR, 0.86; two-sided P = .02). However, pharmacokinetic clearance of abiraterone was 2.2- to 2.9-fold higher when administered with enzalutamide, compared with clearance values for abiraterone alone. CONCLUSION The addition of AAP to enzalutamide for first-line treatment of mCRPC was not associated with a statistically significant benefit in OS. Drug-drug interactions between the two agents resulting in increased abiraterone clearance may partly account for this result, although these interactions did not prevent the combination regimen from having more nonhematologic toxicity.
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Affiliation(s)
- Michael J. Morris
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Glenn Heller
- Alliance Statistics and Data Management Center, Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - David W. Hillman
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Olivia Bobek
- Alliance Statistics and Data Management Center, Mayo Clinic, Rochester, MN
| | - Charles Ryan
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Emmanuel S. Antonarakis
- Division of Hematology, Oncology, and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
| | - Alan H. Bryce
- Division of Hematology and Medical Oncology, Mayo Clinic, Phoenix, AZ
| | - Olwen Hahn
- University of Chicago Medical Center, Chicago, IL
| | - Himisha Beltran
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, MA
| | - Andrew J. Armstrong
- Duke Cancer Institute Center for Prostate and Urologic Cancers, Division of Medical Oncology, Department of Medicine, Duke University, Durham, NC
| | - Lawrence Schwartz
- Department of Radiology, Columbia University Irving Medical Center, New York, NY
| | - Lionel D. Lewis
- Norris Cotton Cancer Center, The Geisel School of Medicine at Dartmouth and The Dartmouth-Hitchcock Medical Center, Lebanon, NH
| | | | - Brooke Langevin
- Center for Translational Medicine, University of Maryland School of Pharmacy, Baltimore, MD
| | - Eric C. McGary
- Division of Medical Oncology, Kaiser Permanente (SCAL) and Kaiser Permanente School of Medicine, Cadillac, CA
| | | | - Amir Goldkorn
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Bruce J. Roth
- Washington University School of Medicine, St Louis, MO
| | - Han Xiao
- Genitourinary Oncology Service, Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Mary-Ellen Taplin
- Department of Medical Oncology, Dana-Farber/Partners Cancer Care, Boston, MA
| | - Susan Halabi
- Alliance Statistics and Data Management Center, and Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - Eric J. Small
- UCSF Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, CA
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5
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Carter JM, Chumsri S, Hinerfeld DA, Ma Y, Wang X, Zahrieh D, Hillman DW, Tenner KS, Kachergus JM, Brauer HA, Warren SE, Henderson D, Shi J, Liu Y, Joensuu H, Lindman H, Leon-Ferre RA, Boughey JC, Liu MC, Ingle JN, Kalari KR, Couch FJ, Knutson KL, Goetz MP, Perez EA, Thompson EA. Distinct spatial immune microlandscapes are independently associated with outcomes in triple-negative breast cancer. Nat Commun 2023; 14:2215. [PMID: 37072398 PMCID: PMC10113250 DOI: 10.1038/s41467-023-37806-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Accepted: 03/30/2023] [Indexed: 04/20/2023] Open
Abstract
The utility of spatial immunobiomarker quantitation in prognostication and therapeutic prediction is actively being investigated in triple-negative breast cancer (TNBC). Here, with high-plex quantitative digital spatial profiling, we map and quantitate intraepithelial and adjacent stromal tumor immune protein microenvironments in systemic treatment-naïve (female only) TNBC to assess the spatial context in immunobiomarker-based prediction of outcome. Immune protein profiles of CD45-rich and CD68-rich stromal microenvironments differ significantly. While they typically mirror adjacent, intraepithelial microenvironments, this is not uniformly true. In two TNBC cohorts, intraepithelial CD40 or HLA-DR enrichment associates with better outcomes, independently of stromal immune protein profiles or stromal TILs and other established prognostic variables. In contrast, intraepithelial or stromal microenvironment enrichment with IDO1 associates with improved survival irrespective of its spatial location. Antigen-presenting and T-cell activation states are inferred from eigenprotein scores. Such scores within the intraepithelial compartment interact with PD-L1 and IDO1 in ways that suggest prognostic and/or therapeutic potential. This characterization of the intrinsic spatial immunobiology of treatment-naïve TNBC highlights the importance of spatial microenvironments for biomarker quantitation to resolve intrinsic prognostic and predictive immune features and ultimately inform therapeutic strategies for clinically actionable immune biomarkers.
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Affiliation(s)
- Jodi M Carter
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Canada
| | - Saranya Chumsri
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
| | | | - Yaohua Ma
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Xue Wang
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - David Zahrieh
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - David W Hillman
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Kathleen S Tenner
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Ji Shi
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Yi Liu
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Henrik Lindman
- Department of Oncology, University of Uppsala, Uppsala, Sweden
| | - Roberto A Leon-Ferre
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | | | | | - James N Ingle
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Krishna R Kalari
- Department of Health Science Research, Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Fergus J Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Keith L Knutson
- Department of Immunology, Mayo Clinic, Jacksonville, FL, USA
| | - Matthew P Goetz
- Department of Oncology, Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
| | - Edith A Perez
- Department of Medicine, Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL, USA
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6
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Choo R, Hillman DW, Mitchell C, Daniels T, Vargas C, Rwigema JC, Corbin K, Keole S, Vora S, Merrell K, Stish B, Pisansky T, Davis BJ, Amundson A, Wong W. Late Toxicity of Moderately Hypofractionated Intensity-Modulated Proton Therapy Treating the Prostate and Pelvic Lymph Nodes for High-Risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2023; 115:1085-1094. [PMID: 36427645 DOI: 10.1016/j.ijrobp.2022.11.027] [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] [Received: 08/19/2022] [Revised: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 11/23/2022]
Abstract
PURPOSE To evaluate late gastrointestinal (GI) and genitourinary (GU) toxicity of moderately hypofractionated intensity modulated proton therapy (IMPT) targeting the prostate and pelvic lymph nodes. METHODS AND MATERIALS A target accrual of 56 patients with high-risk or unfavorable intermediate risk prostate cancer were enrolled into a prospective study (ClinicalTrials.gov: NCT02874014) of moderately hypofractionated IMPT. IMPT with pencil beam scanning was used to deliver 6750 and 4500 cGy relative biological effectiveness in 25 daily fractions simultaneously to the prostate and pelvic lymph nodes, respectively. All received androgen deprivation therapy. Late GI and GU toxicity was prospectively assessed using Common Terminology Criteria for Adverse Events version 4.0, at baseline, weekly during radiation therapy, 3-month postradiation therapy, and then every 6 months. Actuarial rates of late GI and GU toxicity were estimated using Kaplan-Meier method. RESULTS Median age was 75.5 years. Fifty-four patients were available for late toxicity evaluation. Median follow-up was 43.9 months (range, 16-66). The actuarial rate of late grade ≥2 GI toxicity at both 2 and 3 years was 7.4% (95% confidence interval [CI], 0.2%-14.2%). The actuarial rate of late grade 3 GI toxicity at both 2 and 3 years was 1.9% (95% CI, 0%-5.4%). One patient experienced grade 3 GI toxicity with proctitis. The actuarial rate of late grade ≥2 GU toxicity was 20.5% (95% CI, 8.9%-30.6%) at 2 years, and 29.2 % (95% CI, 15.5%-40.7%) at 3 years. None had grade 3 GU toxicity. The presence of baseline GU symptoms was associated with a higher likelihood of experiencing late grade 2 GU toxicity. CONCLUSIONS A moderately hypofractionated IMPT targeting the prostate and regional pelvic lymph nodes was generally well tolerated. Patients with pre-existing GU symptoms had a higher rate of late grade 2 GU toxicity. A phase 3 study is needed to assess any therapeutic gain of IMPT, in comparison with photon-based radiation therapy.
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Affiliation(s)
- Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
| | - David W Hillman
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Cecilia Mitchell
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | - Thomas Daniels
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, Arizona
| | - Carlos Vargas
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
| | - Jean Claude Rwigema
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
| | - Kimberly Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Sameer Keole
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
| | - Sujay Vora
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Bradley Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Thomas Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - Adam Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota
| | - William Wong
- Department of Radiation Oncology, New York University Langone Hospital, Brooklyn, New York
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7
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Lewis AR, Sosa C, Bobek O, Hillman DW, Costello BA, Quevedo F, Pagliaro LC, Weinshilboum RM, Cairns J, Wang L, Kalari KR, Kohli M, Tan W, Giridhar K. Association of whole blood mRNA expression and overall survival (OS) in metastatic castrate resistant prostate cancer (mCRPC). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.201] [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: 03/15/2023] Open
Abstract
201 Background: Previous studies have evaluated peripheral whole blood mRNA to identify prognostic biomarkers in metastatic prostate cancer, with no consistent genes of prognostic significance between studies and sample collection done at various points of therapy. We aim to identify the prognostic value of 20 previously identified genes in patients mCRPC from a prospective clinical trial. Methods: Between June 2013 and August 2015, whole blood was prospectively collected in PAXgene RNA tubes from 92 men with mCRPC (NCT01953640). Gene expression from samples with RIN > 4.0 were quantified using a customized NanoString CodeSet of 20 candidate genes (C1QA, MCM2, STOM, GABARAPL2, R10K3, HMBS, TFDP1, CDKN1A, ITGAL, TMCC2, TERF2IP, MMP9, SNCA, TIMP1, SLC4A1, SELENBP1, TMEM66, SEMA4D, PROS1, CD22). The raw data from the nCounter Analysis system were normalized to the positive controls and log2 transformed. Univariable Cox proportional hazards models were performed on each target gene sufficiently above negative control (5 times the maximum value of the negative control) to evaluate associations with overall survival (OS). For each gene we considered a linear, quadratic, or categorical model with quantile cutpoints. Categorical models with cutpoints at the 25th percentile for the genes CD22, GABARAPL2, R10K3, and STOM were used as there was a nonlinear relationship between gene expression and death hazard. The remaining genes were modeled with a linear model. Findings were considered statistically significant based on p-values adjusted using the Holm-Bonferroni correction. Results: 18/20 genes were identified and passed quality control (QC) measures, which excluded C1QA and MCM2. 72/92 men had an evaluable pretreatment specimen that passed QC. The median age was 72 years. The study cohort was evenly balanced in terms of Gleason score ( < = 7 v. > 7) and 60% had high volume disease. The median follow-up time was 5.73 years (IQR: 5.39, 6.49) and 58 patients had died. Of the 18 genes evaluated, STOM (Stomatin) [hazard ratio (HR) 3.00, adjusted p = 0.007] and GABARAPL2 (GABA Type A Receptor Associated Protein Like 2) [HR 2.62, adjusted p = 0.033] were significantly associated with overall survival in univariate analysis. In multivariate analysis, after adjusting for volume of metastatic disease and Gleason score, STOM [HR 2.89, adjusted p = 0.014] was significantly associated with overall survival. Conclusions: Elevated whole blood mRNA expression of STOM is adversely associated with OS in mCRPC. Further studies investigating elucidating the molecular significance of STOM in mCRPC are planned. Clinical trial information: NCT01953640 .
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8
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Aggarwal RR, Heller G, Hillman DW, Xiao H, Picus J, Taplin ME, Dorff TB, Appleman LJ, Weckstein DJ, Patnaik A, Bryce AH, Shevrin DH, Mohler J, Anderson DM, Rao A, Tagawa ST, Tan A, Eggener SE, Ryan CJ, Morris MJ. Baseline characteristics associated with PSA progression-free survival in patients (pts) with high-risk biochemically relapsed prostate cancer: Results from the phase 3 PRESTO study (AFT-19). J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.208] [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: 03/16/2023] Open
Abstract
208 Background: In the Phase 3 PRESTO study, intensified androgen deprivation therapy (ADT) with apalutamide (APA) with or without abiraterone acetate plus prednisone (AAP), administered for a finite treatment period of 52 weeks, prolonged prostate-specific antigen progression-free survival (PSA PFS) in pts with high-risk biochemically relapsed prostate cancer (BRPC). We evaluated baseline factors associated with PSA PFS in this study. Methods: PRESTO is a randomized phase 3, open-label trial in pts with BRPC following radical prostatectomy (RP) and PSA doubling time (PSADT) ≤ 9 months (mo), without distant metastases on conventional imaging (NCT03009981). Pts were randomized 1:1:1 to receive a finite 52-week treatment course with ADT, ADT + APA, or ADT + APA + AAP, stratified by PSADT (< 3 vs 3–9 mo), with post-treatment follow-up. Baseline factors associated with PSA PFS including Gleason sum at RP (6-7, 8, ≥ 9) were analyzed in a post hoc fashion. Results: 504 pts were randomized to ADT alone (N = 167), ADT + APA (N = 168) or ADT + APA + AAP (N = 169). Baseline patient characteristics including Gleason sum at diagnosis, serum PSA and PSADT at study entry, time interval from radical prostatectomy, and receipt of prior radiation (none, adjuvant, salvage) were well balanced across the three treatment arms. At the first planned interim analysis, both experimental arms significantly prolonged PSA PFS compared to the control arm (median 24.9 mo for ADT + APA vs 20.3 mo for ADT, HR = 0.52 (95% CI: 0.35–0.77); median 26.0 mo for ADT + APA + AAP vs 20.0 mo for ADT, HR = 0.48 (95% CI: 0.32–0.71)). Across the study cohort, Gleason sum ≥ 9 at diagnosis was associated with shorter PSA PFS (median 21.9 mo for Gleason ≥ 9 vs. 31.1 mo for Gleason 8 vs. 25.2 mo for Gleason 6-7, log-rank p-value = 0.0409). In addition, within each treatment arm, a shorter observed median PSA PFS was detected for patients with Gleason ≥ 9 prostate cancer. Serum PSA and PSADT at study entry, time from prior radical prostatectomy, and prior radiation were not associated with PSA PFS in the overall study cohort or in individual study arms. Conclusions: Gleason sum ≥ 9 prostate cancer at diagnosis was associated with shorter time to PSA progression following subsequent intensified ADT administered for a finite treatment interval in BRPC. Follow-up is ongoing to integrate genomic profiling of primary prostate cancer tissue with these results and validate with longer term endpoints including metastasis-free survival. Clinical trial information: NCT03009981 .
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Affiliation(s)
- Rahul Raj Aggarwal
- University of California San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - Glenn Heller
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Han Xiao
- Memorial Sloan Kettering Cancer Center at Basking Ridge New Jersey, Basking Ridge, NJ
| | | | | | | | | | | | | | | | | | | | | | - Arpit Rao
- Baylor College of Medicine, Houston, TX
| | - Scott T. Tagawa
- Weill Cornell Medical College of Cornell University, New York, NY
| | - Alan Tan
- Rush University Medical Center, Chicago, IL
| | - Scott E. Eggener
- Center for Data Intensive Science at the University of Chicago, Chicago, IL
| | - Charles J. Ryan
- Division of Hematology, Oncology and Transplantation, Department of Medicine, University of Minnesota, Minneapolis, MN
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9
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Sicotte H, Kalari KR, Qin S, Dehm SM, Bhargava V, Gormley M, Tan W, Sinnwell JP, Hillman DW, Li Y, Vedell PT, Carlson RE, Bryce AH, Jimenez RE, Weinshilboum RM, Kohli M, Wang L. Molecular Profile Changes in Patients with Castrate-Resistant Prostate Cancer Pre- and Post-Abiraterone/Prednisone Treatment. Mol Cancer Res 2022; 20:1739-1750. [PMID: 36135372 PMCID: PMC9716248 DOI: 10.1158/1541-7786.mcr-22-0099] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 07/05/2022] [Accepted: 09/02/2022] [Indexed: 01/15/2023]
Abstract
We identified resistance mechanisms to abiraterone acetate/prednisone (AA/P) in patients with metastatic castration-resistant prostate cancer (mCRPC) in the Prostate Cancer Medically Optimized Genome-Enhanced Therapy (PROMOTE) study. We analyzed whole-exome sequencing (WES) and RNA-sequencing data from 83 patients with metastatic biopsies before (V1) and after 12 weeks of AA/P treatment (V2). Resistance was determined by time to treatment change (TTTC). At V2, 18 and 11 of 58 patients had either short-term (median 3.6 months; range 1.4-4.5) or long-term (median 29 months; range 23.5-41.7) responses, respectively. Nonresponders had low expression of TGFBR3 and increased activation of the Wnt pathway, cell cycle, upregulation of AR variants, both pre- and posttreatment, with further deletion of AR inhibitor CDK11B posttreatment. Deletion of androgen processing genes, HSD17B11, CYP19A1 were observed in nonresponders posttreatment. Genes involved in cell cycle, DNA repair, Wnt-signaling, and Aurora kinase pathways were differentially expressed between the responder and non-responder at V2. Activation of Wnt signaling in nonresponder and deactivation of MYC or its target genes in responders was detected via SCN loss, somatic mutations, and transcriptomics. Upregulation of genes in the AURKA pathway are consistent with the activation of MYC regulated genes in nonresponders. Several genes in the AKT1 axis had increased mutation rate in nonresponders. We also found evidence of resistance via PDCD1 overexpression in responders. IMPLICATIONS Finally, we identified candidates drugs to reverse AA/P resistance: topoisomerase inhibitors and drugs targeting the cell cycle via the MYC/AURKA/AURKB/TOP2A and/or PI3K_AKT_MTOR pathways.
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Affiliation(s)
- Hugues Sicotte
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Krishna R. Kalari
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Sisi Qin
- Department of Pathology, The University of Chicago., Chicago, Illinois
| | - Scott M. Dehm
- Masonic Cancer Center and Departments of Laboratory Medicine and Pathology and Urology, University of Minnesota, Minneapolis, Minnesota
| | - Vipul Bhargava
- Janssen Research and Development, Spring House, Pennsylvania
| | - Michael Gormley
- Janssen Research and Development, Spring House, Pennsylvania
| | - Winston Tan
- Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Jason P. Sinnwell
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - David W. Hillman
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Ying Li
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Peter T. Vedell
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Rachel E. Carlson
- Division of Biomedical Statistics and Informatics, Department of Quantitative Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | - Alan H. Bryce
- Division of Hematology & Medical Oncology, Mayo Clinic, Rochester, Minnesota
| | | | - Richard M. Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Manish Kohli
- Department of Internal Medicine, University of Utah and Huntsman Cancer Institute, Salt Lake City, Utah
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
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Wong WW, Hillman DW, Daniels TB, Vargas CE, Rwigema JC, Corbin KS, Keole SR, Merrell KW, Stish BJ, Pisansky TM, Davis BJ, Mitchell CM, Choo R. A Phase II prospective study of hypofractionated proton therapy of prostate and pelvic lymph nodes: Acute effects on patient-reported quality of life. Prostate 2022; 82:1338-1345. [PMID: 35789497 DOI: 10.1002/pros.24408] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2022] [Revised: 06/13/2022] [Accepted: 06/22/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND The objective of this study was to report acute changes in patient-reported quality of life (PRQOL) using the 26-item Expanded Prostate Index Composite (EPIC-26) questionnaire in a prospective study using hypofractionated intensity-modulated proton beam therapy (H-IMPT) targeting the prostate and the pelvic lymph nodes for high-risk or unfavorable intermediate-risk prostate cancer. METHODS Fifty-five patients were enrolled. H-IMPT consisted of 45 GyE to the pelvic lymph nodes and 67.5 GyE to the prostate and seminal vesicles in 25 fractions. PRQOL was assessed with the urinary incontinence (UI), urinary irritative/obstructive symptoms (UO), and bowel function (BF) domains of EPIC-26 questionnaire. Mean changes in domain scores were analyzed from pretreatment to the end of treatment and 3 months posttreatment. A clinically meaningful change (or minimum important change) was defined as a score change > 50% of the baseline standard deviation. RESULTS The mean scores of UO, UI, and BF at baseline were 84.6, 91.1, and 95.3, respectively. At the end of treatment, there were statistically significant and clinically meaningful declines in UO and BF scores (-13.5 and -2.3, respectively), while the decline in UI score was statistically significant but not clinically meaningful (-13.7). A clinically meaningful decline in UO, UI, and BF scores occurred in 53.5%, 22.7%, and 73.2% of the patients, respectively. At 3 months posttreatment, all three mean scores showed an improvement, with fewer patients having a clinically meaningful decline in UO, UI, and BF scores (18.4%, 20.5%, and 45.0%, respectively). There was no significant reduction in the mean UO and UI scores compared to baseline, although the mean BF score remained lower than baseline and the difference was clinically meaningful. CONCLUSIONS UO, UI, and BF scores of PRQOL declined at the end of H-IMPT. UO and UI scores showed improvement at 3 months posttreatment and were similar to the baseline scores. However, BF score remained lower at 3 months posttreatment with a clinically meaningful decline.
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Affiliation(s)
- William W Wong
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - David W Hillman
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas B Daniels
- Department of Radiation Oncology, New York University, New York, New York, USA
| | - Carlos E Vargas
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | | | - Kimberly S Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona, USA
| | - Kenneth W Merrell
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Bradley J Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Thomas M Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Cecilia M Mitchell
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota, USA
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Chumsri S, Norton N, Bruggeman S, Hillman DW, Ernst B, Ruddy KJ, Northfelt DW, Advani PP, Sideras K, Moreno-Aspitia A, Goetz MP, Knutson KL. Phase II trial to evaluate immune-related biomarkers for pathological response in stage II-III HER2-positive breast cancer receiving neoadjuvant chemotherapy with subsequent randomization to multi-epitope HER2 vaccine versus placebo in patients with residual disease post-neoadjuvant chemotherapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.tps610] [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: 11/20/2022] Open
Abstract
TPS610 Background: Several studies demonstrated worsening disease-free survival in patients who failed to achieve complete pathological response after neoadjuvant chemotherapy (NAC), particularly in HER2-positive (HER2+) breast cancer. Despite the recent approval of trastuzumab emtansine (T-DM1) in patients with residual disease after NAC approximately 12% of patients still develop recurrent and metastatic disease. TPIV100 is a multi-epitope vaccine that includes a pool of 4 degenerate HER2-derived HLA-DR epitopes, which activate CD4 helper T cells, admixed with GM-CSF. In our previous phase I trial this vaccine was shown to be safe in combination with trastuzumab in stage II-III HER2+ breast cancer after completion of standard of care chemotherapy. Furthermore, this vaccine also generated robust long-lasting T-cell immune responses and antibody immunity against HER2. Methods: This trial is a multi-center, randomized, placebo-controlled, phase II trial of TPIV100 in combination with T-DM1 in stage II-III HER2+ breast cancer patients with residual disease after NAC. This trial is currently opened through the ACCRU consortium. Eligible patients include those with stage II-III HER2+ with residual disease, in the breast and/or lymph nodes, after trastuzumab ± pertuzumab-based NAC, with ECOG PS ≤ 2 and adequate organ function. Patients with baseline left ventricular ejection fraction < 50%, history of trastuzumab-related cardiac toxicity, myocardial infarction or stroke < 6 months, history of congestive heart failure, autoimmune disease, immunocompromised patients with known HIV or those on chronic steroid, hypersensitivity to GM-CSF, and other active malignancy < 3 years are excluded. TPIV100 or placebo, in combination with GM-CSF, will be given concurrently with T-DM1. To ensure that TPIV100 in combination with T-DM1 is safe, there is a run-in phase with 20 patients treated with the combination. If there is no significant dose-limiting toxicity observed in the run-in phase, the trial will be expanded to the randomized phase II portion, which will include 240 patients. Eligible patients will be randomized in a 2:1 fashion with ER/PR as a stratification factor. The primary endpoint is invasive disease-free survival, and the secondary endpoint includes immunogenicity of TPIV100 as assessed by IFN-g ELIspot analysis. Correlative studies include assessment of helper T-cell response distribution (including Th1, Th2, Th17, Tfh), HER2-specific antibody immunity, and HLA genotype. Currently, 20 patients in the run-in phase have been enrolled. Enrollment to the randomized phase II portion is expected to begin in March 2022. Clinical trial information: NCT04197687.
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12
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Sideras K, Hillman DW, Giridhar K, Ginos BF, Tenglin RC, Liu H, Chen B, Tan W, Gross GG, Mowat RB, Dueck AC, Perez EA, Moreno-Aspitia A. Randomized Phase II Study of Two Doses of Pixantrone in Patients with Metastatic Breast Cancer (NCCTG N1031, Alliance). Oncologist 2022; 27:oyab065. [PMID: 35445723 PMCID: PMC9074972 DOI: 10.1093/oncolo/oyab065] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 09/28/2021] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Anthracycline use in metastatic breast cancer (MBC) is hindered by cumulative exposure limits and risk of cardiotoxicity. Pixantrone, a novel aza-anthracenedione with structural similarities to mitoxantrone and anthracyclines, is theorized to exhibit less cardiotoxicity, mainly due to lack of iron binding. We conducted a randomized phase II study to evaluate the efficacy and safety of 2 dosing schedules of pixantrone in patients with refractory HER2-negative MBC. METHODS Intravenous pixantrone was administered at 180 mg/m2 every 3 weeks (group A) versus 85 mg/m2 on days 1, 8, and 15 of a 28-day cycle (group B). Primary endpoint was objective response rate (ORR) and secondary endpoints included progression-free survival (PFS), median 6-month PFS, overall survival (OS), safety, quality of life, and serial assessment of circulating tumor cells. A 20% ORR was targeted as sufficient for further testing of pixantrone in this patient population. RESULTS Forty-five patients were evaluable, with 2 confirmed partial responses in group A and 1 in group B. The trial was terminated due to insufficient activity. Overall median PFS and OS were 2.8 (95% confidence interval [CI]: 2.0-4.1) and 16.8 (95% CI: 8.9-21.6) months, respectively. Notable overall grade 3-4 adverse events were the following: neutrophil count decrease (62%), fatigue (16%), and decrease in ejection fraction (EF) (4%). CONCLUSION Pixantrone has insufficient activity in the second- and third-line MBC setting. It appears, however, to have limited cardiotoxicity. (ClinicalTrials.gov ID: NCT01086605).
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Rex B Mowat
- Toledo Community Hospital Oncology Program, Toledo, OH, USA
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13
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Leon-Ferre RA, Carter JM, Zahrieh DM, Hillman DW, Chumsri S, Ma Y, Kachergus JM, Wang X, Boughey JC, Liu MC, Ingle JN, Kalari KR, Villasboas Bisneto JC, Couch FJ, Thompson EA, Goetz MP. Abstract P1-04-01: Digital spatial profiling of immune-related proteins in luminal androgen receptor (LAR) vs non-LAR triple-negative breast cancer (TNBC). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-04-01] [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: The importance of the antitumor immune response in TNBC is well established. TNBC with higher TILs are less likely to recur and more responsive to systemic therapy. Likewise, PD-L1+ TNBC are more likely to benefit from chemoimmunotherapy. However, TNBC is highly heterogeneous. Of the TNBC molecular subtypes, LAR TNBC is less sensitive to systemic therapy, has lower TILs and lower rates of PD-L1 positivity. The role of other immune related proteins in LAR TNBC is not well established. Here, we evaluated differentially expressed (DE) immune related proteins in the stromal and intratumoral compartments of LAR vs non-LAR TNBC tumors. Methods: We used the Nanostring GeoMX DSP platform to quantitate 58 proteins within spatially distinct intraepithelial, cytokeratin (CK)-positive tumor segments and adjacent CK-negative/nuclei-positive stromal segments in 248 TNBC tumors included in a tissue microarray generated from a cohort of pts with centrally confirmed TNBC who underwent breast surgery without prior neoadjuvant therapy. A subset (n=111) underwent bulk tumor RNA sequencing and were classified as LAR or non-LAR TNBC. DE proteins were identified using a negative binomial generalized linear model (SNR>2, p<0.05). A targeted set of DE proteins was dichotomized at the 80th percentile. Results: Of 111 TNBC tumors, 17 (15%) were LAR and 94 (85%) non-LAR. Compared to non-LAR TNBC, pts with LAR TNBC were older (age ≥50: 82% vs 52%, p<0.01), with tumors that were more often of apocrine histology (35% vs 0%, p <0.01), grade 1-2 (24% vs 1%, p<0.01), and had lower Ki67 (Ki67 ≤15: 24% vs 11%, p=0.06). Most tumors were T1-2 (94% vs 93%, p=0.82) and N0 (53% vs 62%, p=0.09), respectively. As expected, expression of most immune-related proteins was higher in the stromal vs the intratumoral compartment for both LAR and non-LAR TNBC. When focusing on the stromal compartment, expression of multiple immune related proteins was significantly lower in LAR compared to non-LAR TNBC, including the pan-leukocyte marker CD45 (log-2 fold change [log2FC]: 0.552, p=0.05), the macrophage marker CD14 (log2FC: 0.834, p=0.06), CD44 (lof2FC: 0.637, p=0.07), and the immune checkpoint proteins IDO1 (log2FC: 0.914, p=0.04), VISTA (log2FC: 0.471, p=0.07), ICOS (log2FC: 0.444, p=0.08), and STING (log2FC: 0.544, p=0.09). Proteins with expression levels too low for comparisons included PD-L1, LAG3, FOXP3 and BCL-2. When focusing on the intratumoral compartment, expression of most immune-related proteins was very low in both LAR and non-LAR TNBC. Like in the stromal compartment, CD45 expression was lower in LAR TNBC (log2FC: 0.78, p=0.02). Expression of the immune checkpoint B7-H3 was lower in LAR TNBC (log2FC: 0.737, p=0.02), while expression of the T cell marker CD127 was higher (log2FC: -0.528, p=0.34). With regards to relevant non-immune markers, expression of Ki67 was lower in LAR TNBC (log2FC: 0.5498, p=0.05), consistent with the clinical assay. Conclusion: In this ultra high-plex spatial analysis, we provide first insights into the differential expression at the protein level of several targetable immune checkpoint molecules in LAR vs non-LAR TNBC. The lower expression of several immune related proteins in LAR TNBC is consistent with the hypothesis that LAR TNBC exhibits a “cold” immune microenvironment compared to other TNBC subtypes, potentially rendering itself less susceptible to immunotherapy-based strategies. These data support the need to consider TNBC molecular subtypes in future evaluations of immune-based therapeutic approaches. Funding: This work was supported by NIH grant P50CA116201 to RLF, JMC, KRK, FJC, DZ, JNI, and MPG; BCRF grant 19-161 to EAT and NCATS grant CTSA KL2 TR002379 to RLF. The contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIH
Citation Format: Roberto A Leon-Ferre, Jodi M. Carter, David M. Zahrieh, David W. Hillman, Saranya Chumsri, Yaohua Ma, Jennifer M. Kachergus, Xue Wang, Judy C. Boughey, Minetta C. Liu, James N. Ingle, Krishna R. Kalari, Jose C. Villasboas Bisneto, Fergus J. Couch, E. Aubrey Thompson, Matthew P. Goetz. Digital spatial profiling of immune-related proteins in luminal androgen receptor (LAR) vs non-LAR triple-negative breast cancer (TNBC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-04-01.
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Choo R, Hillman DW, Daniels T, Vargas C, Rwigema JC, Corbin K, Keole S, Vora S, Merrell K, Stish B, Pisansky T, Davis B, Amundson A, Wong W. Proton Therapy of Prostate and Pelvic Lymph Nodes for High Risk Prostate Cancer: Acute Toxicity. Int J Part Ther 2021; 8:41-50. [PMID: 34722810 PMCID: PMC8489485 DOI: 10.14338/ijpt-20-00094.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 12/10/2020] [Accepted: 03/02/2021] [Indexed: 11/21/2022] Open
Abstract
Purpose To assess acute gastrointestinal (GI) and genitourinary (GU) toxicities of intensity-modulated proton therapy (IMPT) targeting the prostate/seminal vesicles and pelvic lymph nodes for prostate cancer. Materials and Methods A prospective study (ClinicalTrials.gov: NCT02874014), evaluating moderately hypofractionated IMPT for high-risk or unfavorable intermediate-risk prostate cancer, accrued a target sample size of 56 patients. The prostate/seminal vesicles and pelvic lymph nodes were treated simultaneously with 6750 and 4500 centigray radiobiologic equivalent (cGyRBE), respectively, in 25 daily fractions. All received androgen-deprivation therapy. Acute GI and GU toxicities were prospectively assessed from 7 GI and 9 GU categories of the Common Terminology Criteria for Adverse Events (version 4), at baseline, weekly during radiotherapy, and 3-month after radiotherapy. Fisher exact tests were used for comparisons of categorical data. Results Median age was 75 years. Median follow-up was 25 months. Fifty-five patients were available for acute toxicity assessment. Sixty-two percent and 2%, respectively, experienced acute grade 1 and 2 GI toxicity. Grade 2 GI toxicity was proctitis. Sixty-five percent and 35%, respectively, had acute grade 1 and 2 GU toxicity. The 3 most frequent grade 2 GU toxicities were urinary frequency, urgency, and obstructive symptoms. None had acute grade ≥ 3 GI or GU toxicity. The presence of baseline GI and GU symptoms was associated with a greater likelihood of experiencing acute GI and GU toxicity, respectively. Of 45 patients with baseline GU symptoms, 44% experienced acute grade 2 GU toxicity, compared with only 10% among 10 with no baseline GU symptoms (P = 0.07). Although acute grade 1 and 2 GI and GU toxicities were common during radiotherapy, most resolved at 3 months after radiotherapy. Conclusion A moderately hypofractionated IMPT targeting the prostate/seminal vesicles and regional pelvic lymph nodes was well tolerated with no acute grade ≥ 3 GI or GU toxicity. Patients with baseline GU symptoms had a higher rate of acute grade 2 GU toxicity.
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Affiliation(s)
- Richard Choo
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - David W Hillman
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Thomas Daniels
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Carlos Vargas
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | | | - Kimberly Corbin
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Sameer Keole
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Sujay Vora
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Kenneth Merrell
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
| | - Bradley Stish
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Thomas Pisansky
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Brian Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - Adam Amundson
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN, USA
| | - William Wong
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, USA
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15
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Leon-Ferre RA, Carter JM, Hillman DW, Tenner KS, Zahrieh D, Liu MC, Ingle JN, Kalari KR, Visscher DW, Boughey JC, Couch F, Goetz MP. Long-term outcomes of patients with node-negative (N0), triple-negative breast cancer (TNBC) who did not receive adjuvant chemotherapy according to stromal TILs (sTILs). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.548] [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: 11/20/2022] Open
Abstract
548 Background: sTILs are a well-established prognostic and predictive biomarker in patients with operable TNBC receiving pre or postoperative systemic therapy. We1 and others2,3 have also shown that sTILs are prognostic in patients who did not receive adjuvant chemotherapy. Here, we detail the outcomes of systemically untreated patients with N0 TNBC according to sTIL score. We focused on the N0 subset as a group of patients who may be candidates for future prospective therapy de-escalation trials. Methods: From a clinically annotated cohort of 605 patients with centrally confirmed TNBC (ER/PR < 1% and HER2 negative) with long-term outcomes data, we identified 182 patients treated with locoregional therapy only (breast surgery +/- radiation therapy and no chemotherapy). The clinicopathological characteristics of this cohort have previously been published1. In this analysis, we report the 5- and 10-year invasive disease-free survival (iDFS) and overall survival (OS) rates of patients with N0 TNBC according to sTIL levels. IDFS and OS were defined as per the STEEP classification and estimated using the Kaplan–Meier method. Comparisons of the survival distributions between groups were assessed by the log-rank test. sTILs were assessed as a continuous parameter according to the International TIL Working Group guidelines. For comparisons of outcomes between groups, tumors were classified as lymphocyte-predominant TNBC (defined as containing ≥50% sTILs) vs non-lymphocyte-predominant ( < 50% sTILs). Results: Of 182 systemically untreated patients, 149 (82%) were N0 and most (78%) were post-menopausal. T stage distribution was T1: 68%, T2: 28%, T3/4: 4%. Among N0 patients, 31 (21%) had lymphocyte-predominant TNBC, and in this group the 5-year iDFS and OS were 89% (95% CI 76-100) and 96% (95% CI 89-100), while the 10-year iDFS and OS were 89% (95% CI 76-100) and 87% (95% CI 73-100), respectively. In contrast, outcomes for patients with non-lymphocyte predominant TNBC were significantly worse. For this group, 5-year iDFS and OS were 62% (95% CI 53-73) and 78% (95% CI 71-86) while the 10-year iDFS and OS were 45% (95% CI 36-58) and 66% (95% CI 68-76), respectively ( log-rank p = 0.02 for iDFS and log-rank p = 0.03 for OS). Conclusions: sTIL quantification identifies a subset of patients with early-stage N0 TNBC with an exceedingly good prognosis, even in the absence of adjuvant chemotherapy. These data provide support for the evaluation of sTILs as part of prospective investigation of systemic therapy de-escalation strategies in N0 TNBC. References:1Leon-Ferre et al, Breast Cancer Res Treat (2018) 167:89-99 2Park et al, Ann Oncol (2019) 12:1941-1949 3De Jong et al, ESMO 2020
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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Moreno-Aspitia A, Holmes EM, Jackisch C, de Azambuja E, Boyle F, Hillman DW, Korde L, Fumagalli D, Izquierdo MA, McCullough AE, Wolff AC, Pritchard KI, Untch M, Guillaume S, Ewer MS, Shao Z, Sim SH, Aziz Z, Demetriou G, Mehta AO, Andersson M, Toi M, Lang I, Xu B, Smith IE, Barrios CH, Baselga J, Gelber RD, Piccart-Gebhart M. Updated results from the international phase III ALTTO trial (BIG 2-06/Alliance N063D). Eur J Cancer 2021; 148:287-296. [PMID: 33765513 DOI: 10.1016/j.ejca.2021.01.053] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/14/2021] [Accepted: 01/24/2021] [Indexed: 01/03/2023]
Abstract
AIM To present the pre-specified analyses of >5-years follow-up of the Phase III ALTTO trial. PATIENTS AND METHODS 8381 patients with stage I-III HER2 positive breast cancer randomised to chemotherapy plus 1-year of trastuzumab (T), oral lapatinib (L; no longer evaluated), trastuzumab followed by lapatinib (T→L), and lapatinib + trastuzumab (L+T). The primary endpoint was disease-free survival (DFS). A secondary analysis examined DFS treatment effects by hormone receptor status, nodal status and chemotherapy timing; time to recurrence; overall survival (OS) and safety (overall and cardiac). RESULTS At a median follow-up of 6.9 years, 705 DFS events for L+T versus T were observed. Hazard Ratio (HR) for DFS was 0.86 (95% CI, 0.74-1.00) for L+T versus T and 0.93 (95% CI, 0.81-1.08) for T→L versus T. The 6-year DFS were 85%, 84%, and 82% for L+T, T→L, and T, respectively. HR for OS was 0.86 (95% CI, 0.70-1.06) for L+T versus T and 0.88 (95% CI, 0.71-1.08) for T→L versus T. The 6-year OS were 93%, 92%, and 91% for L+T, T→L, and T, respectively. Subset analyses showed a numerically better HR for DFS in favour of L+T versus T for the hormone-receptor-negative [HR 0.80 (95% CI, 0.64-1.00; 6-yr DFS% = 84% versus 80%)] and the sequential chemotherapy [HR 0.83 (95% CI, 0.69-1.00; 6-yr DFS% = 83% versus79%)] subgroups. CONCLUSION T+L did not significantly improve DFS and OS over T alone, both with chemotherapy, and, therefore, cannot be recommended for adjuvant treatment of early-stage HER2-positive breast cancer. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT00490139.
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Affiliation(s)
| | - Eileen M Holmes
- Dundee Epidemiology and Statistics Unit, University of Dundee, Dundee, UK
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - Evandro de Azambuja
- Institute Jules Bordet and l' Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Sydney, Australia
| | - David W Hillman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Larissa Korde
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Ann E McCullough
- Division of Anatomic Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Sébastien Guillaume
- Institute Jules Bordet and l' Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Michael S Ewer
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Zhimin Shao
- Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Sung Hoon Sim
- Center for Breast Cancer, National Cancer Centre, Gyeonggi-do, South Korea
| | - Zeba Aziz
- Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Ajay O Mehta
- Central India Cancer Research Institute, Nagpur, Maharashtra, India
| | | | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | - Binghe Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Ian E Smith
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Oncoclínicas, Porto Alegre, Brazil
| | - Jose Baselga
- Oncology Research and Development, Astra-Zeneca, Cambridge, UK
| | - Richard D Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health and Frontier Science Technology Research Foundation, Boston, MA, USA
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Chumsri S, Carter JM, Ma Y, Hinerfeld D, Brauer HA, Warren S, Nielsen TO, Asleh K, Joensuu H, Perez EA, Leon-Ferre RA, Hillman DW, Boughey JC, Liu MC, Ingle JN, Kalari KR, Couch FJ, Knutson KL, Goetz MP, Thompson EA. Abstract PS6-02: Spatially defined immune-related proteins and outcome in triple negative breast cancer in the FinXX trial and Mayo Clinic cohort. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps6-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Growing data established the pivotal role of preexisting immune response in triple negative breast cancer (TNBC). Conventionally, preexisting immune response can be evaluated by quantifying tumor infiltrating lymphocytes mainly in the stroma or gene expression analysis from the whole tumor section. Due to technical challenges with these conventional methods, limited data regarding specific subtypes and spatial distribution of these immune infiltrates are currently available. Methods: NanoString IO360 gene expression analysis and Digital Spatial Profiling (DSP) were used. DSP was used to quantify 29 immune-related proteins in stromal and tumor-enriched segments from 44 TNBC samples from the FinXX trial (NCT00114816) and 335 samples from the Mayo Clinic (MC) cohort of centrally reviewed TNBC (Leon-Ferre BCRT 2018). In FinXX trial, 22 patients with recurrence and 22 patients without recurrence were included. In MC cohort, 217/335 patients received adjuvant chemotherapy while 118 patients had surgery only without adjuvant chemotherapy. Regions were segmented based on pancytokeratin staining. The general linear model was used for statistical analysis of differential expression with recurrence free survival (RFS) as a categorical variable (recur yes or no). Kaplan-Meier (KM) estimates and Cox regression models were also used for analysis. Results: In the FinXX trial, there were 12 out of 29 proteins in tumor epithelial segments (intraepithelial) which were significantly expressed at higher levels among patients who were free of recurrence. These proteins include Beta-2 microglobulin, CD11c, CD20, CD40, CD56, CD8, Granzyme B, HLA-DR, ICOS, PD-L1, PD-L2, and TGFB1. In contrast, merely 5 out of 29 proteins in stromal segments were significantly differentially expressed in these 2 groups of patients. Granzyme B, IDO1, PD-L1, and PD-L2 in stroma were significantly higher and SMA was significantly lower in patients without recurrence. Using Cox regression models, intraepithelial CD56, CD40, and HLA-DR were significantly associated with outcome. When comparing between highest and lowest intraepithelial protein expression by tertile, intraepithelial CD56 (HR 0.12, 95%CI 0.03-0.39, p < 0.001), CD40 (HR 0.13, 95%CI 0.04-0.46, p = 0.002), and HLA-DR (HR 0.24, 95%CI 0.06-0.89, p = 0.032) were significantly associated with improved outcome. However, expression of these same proteins in stroma was not associated with outcome. Using KM estimates, intraepithelial CD56 (p < 0.0001), CD40 (p = 0.0006), and HLA-DR (p = 0.013) were also significantly associated with improved outcome. Nonetheless, RNA expression of these proteins by IO360 from whole tumor sections were not significantly associated with outcome (CD56 p = 0.27, CD40 p = 0.21, HLA-DR p = 0.48). Similar findings with DSP were observed in MC TNBC cohort. Comparing between the highest and lowest quartiles, there were significantly fewer patients who developed recurrence with high protein expression of intraepithelial CD56 (p < 0.001), CD40 (p = 0.002), and HLA-DR (p = 0.006). Conclusions: Using an in-depth analysis with spatially defined context, we identify that there were numerically more intraepithelial immune-related proteins associated with outcome compared to proteins in stroma. Specifically, intraepithelial CD56, CD40, and HLA-DR were significantly associated with improved outcome in both FinXX and MC TNBC cohorts. However, neither expression of these proteins in stroma nor RNA expression from whole tumor were associated with outcome. Our study highlights the impact of spatial biology and the importance of evaluating each potential biomarker in a spatially defined manner. Support: W81XWH-15-1-0292, BCRF 19-161, P50CA116201-9, P50CA015083
Citation Format: Saranya Chumsri, Jodi M. Carter, Yaohua Ma, Douglas Hinerfeld, Heather Ann Brauer, Sarah Warren, Torsten O. Nielsen, Karama Asleh, Heikki Joensuu, Edith A. Perez, Roberto A. Leon-Ferre, David W. Hillman, Judy C. Boughey, Minetta C. Liu, James N. Ingle, Krishna R. Kalari, Fergus J. Couch, Keith L. Knutson, Matthew P. Goetz, E. A. Thompson. Spatially defined immune-related proteins and outcome in triple negative breast cancer in the FinXX trial and Mayo Clinic cohort [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 PS6-02.
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Affiliation(s)
| | | | | | | | | | | | | | - Karama Asleh
- 4University of British Columbia, Vancouver, BC, Canada
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Carter JM, Chumsri S, Hillman DW, Zahrieh DM, Ma Y, Wang X, Kachergus JM, Boughey JC, Liu MC, Kalari KR, Villasboas JC, Ferre RAL, Couch FJ, Goetz MP, Thompson EA. Abstract PS16-01: Intra-epithelial tumor immune landscapes are associated with clinical outcomes in early-stage triple-negative breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps16-01] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Stromal tumor-infiltrating lymphocytes (sTILs) have established prognostic and predictive significance in triple-negative breast cancer (TNBC). However, the roles of other immune cells in TNBC are less well-established. We performed high-plex quantitative spatial profiling in a cohort of early-stage TNBC to 1) apply spatial context to tumoral immune landscapes and 2) identify immune proteins associated with clinical outcomes, independently of TILs and other established prognostic clinicopathologic variables, in patients (pts) treated with or without adjuvant chemotherapy (CTX). Methods: The Mayo TNBC cohort comprises pts with centrally-verified, CTX-naive tumors resected from 1985-2012. Using a cohort-based TMA, with Nanostring GeoMX DSP, we quantitated 58 proteins within spatially-distinct intra-epithelial, cytokeratin-positive tumor segments and adjacent cytokeratin-negative/nuclei-positive stromal segments. Differentially-expressed (DE) proteins were identified using a negative binomial generalized linear model (SNR>2, p< 0.05) and a target DE protein set was dichotomized (80th percentile). After adjusting for prognostic clinicopathologic variables, proteins associated with recurrence-free survival (RFS, defined as time from surgery to either local, regional, and distant recurrence, or death by any cause) were identified by performing variable selection using the Akaike Information Criterion (AIC) obtained from fitting all possible Cox proportional hazards regression models (performed separately for intra-epithelial/stromal segments, and in groups +/- adjuvant CTX. Results: From the TNBC TMA, DSP data (N=250 tumors) included 169 pts who received adjuvant CTX+ and 81 who did not (CTX-). Overall, 85/250 developed recurrent disease. In the CTX+ group, intra-epithelial tumor segments from pts without recurrent disease were enriched in 10 immune proteins, including CD8, markers involved in antigen presentation/dendritic cells (CD11c, CD40, HLA-DR) or NK cells (CD56) (FC: 1.4-2.1, p<0.05); CD14 was increased in stroma (FC: 1.5, p<0.05). In contrast, in the CTX- group, both the intra-epithelial tumor and stromal segments from pts without recurrences were enriched in immune proteins (N= 12 and 15 respectively; FC 1.6-5.5, p< 0.05) most markedly CD40, IDO1 and HLA-DR (FC: 3.2-5.5, p< 0.05). Overall, CD3, CD4, CD27, CD44, and ICOS among others were enriched only in the CTX- group; CD14 and CD56 were enriched only in the CTX+ group. Based on these spatial data, biologic function and DSP data from another set of TNBC (FinXX trial), CD11c, CD14, CD27, CD40, CD56, and IDO1 were selected for RFS analysis. After applying our model selection criterion and adjusting for pt age at surgery, tumor size, lymph node status, and sTILs, intra-epithelial CD56 was independently associated with improved RFS in the CTX+ group (HR: 0.31[0.12, 0.81]). In the CTX- group, intra-epithelial CD11c was independently associated with improved RFS (0.10 [0.01, 0.81]). Conclusion: In this early-stage TNBC cohort, spatially-distinct tumor immune landscapes were associated with RFS but differed according to receipt of CTX after surgical resection. In the patients who received CTX, the intra-epithelial compartment, rather than stromal compartment, was immune-enriched in pts without recurrences. Among a targeted protein set, intra-epithelial CD56 remained associated with improved outcomes, independent of sTILs and other clinicopathologic features. In the CTX- group, spatial landscapes were more balanced, and intra-epithelial CD11c was independently associated with improved outcomes. These data provide insight into the spatial context of intrinsic immune landscapes in TNBC, and identify candidate prognostic immune biomarkers which may inform therapeutic strategies.
Citation Format: Jodi M Carter, Saranya Chumsri, David W Hillman, David M Zahrieh, Yaohua Ma, Xue Wang, Jennifer M Kachergus, Judy C Boughey, Minetta C Liu, Krishna R Kalari, JC Villasboas, Roberto A Leon Ferre, Fergus J Couch, Matthew P Goetz, E. Aubrey Thompson. Intra-epithelial tumor immune landscapes are associated with clinical outcomes in early-stage triple-negative breast cancer [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 PS16-01.
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Fernandez-Martinez A, Krop IE, Hillman DW, Polley MY, Parker JS, Huebner L, Hoadley KA, Shepherd J, Tolaney S, Henry NL, Dang C, Harris L, Berry D, Hahn O, Hudis C, Winer E, Partridge A, Perou CM, Carey LA. Survival, Pathologic Response, and Genomics in CALGB 40601 (Alliance), a Neoadjuvant Phase III Trial of Paclitaxel-Trastuzumab With or Without Lapatinib in HER2-Positive Breast Cancer. J Clin Oncol 2020; 38:4184-4193. [PMID: 33095682 DOI: 10.1200/jco.20.01276] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
PURPOSE CALGB 40601 assessed whether dual versus single human epidermal growth factor receptor 2 (HER2) -targeting drugs added to neoadjuvant chemotherapy increased pathologic complete response (pCR). Here, we report relapse-free survival (RFS), overall survival (OS), and gene expression signatures that predict pCR and survival. PATIENTS AND METHODS Three hundred five women with untreated stage II and III HER2-positive breast cancer were randomly assigned to receive weekly paclitaxel combined with trastuzumab plus lapatinib (THL), trastuzumab (TH), or lapatinib (TL). The primary end point was pCR, and secondary end points included RFS, OS, and gene expression analyses. mRNA sequencing was performed on 264 pretreatment samples. RESULTS One hundred eighteen patients were randomly allocated to THL, 120 to TH, and 67 to TL. At more than 7 years of follow-up, THL had significantly better RFS and OS than did TH (RFS hazard ratio, 0.32; 95% CI, 0.14 to 0.71; P = .005; OS hazard ratio, 0.34; 95% CI, 0.12 to 0.94; P = .037), with no difference between TH and TL. Of 688 previously described gene expression signatures, significant associations were found in 215 with pCR, 45 with RFS, and only 22 with both pCR and RFS (3.2%). Specifically, eight immune signatures were significantly correlated with a higher pCR rate and better RFS. Among patients with residual disease, the immunoglobulin G signature was an independent, good prognostic factor, whereas the HER2-enriched signature, which was associated with a higher pCR rate, showed a significantly shorter RFS. CONCLUSION In CALGB 40601, dual HER2-targeting resulted in significant RFS and OS benefits. Integration of intrinsic subtype and immune signatures allowed for the prediction of pCR and RFS, both overall and within the residual disease group. These approaches may provide means for rational escalation and de-escalation treatment strategies in HER2-positive breast cancer.
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Affiliation(s)
- Aranzazu Fernandez-Martinez
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Ian E Krop
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - David W Hillman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Mei-Yin Polley
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Joel S Parker
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Lucas Huebner
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Katherine A Hoadley
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Jonathan Shepherd
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Sara Tolaney
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - N Lynn Henry
- University of Michigan Rogel Cancer Center, Ann Arbor, MI
| | - Chau Dang
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Lyndsay Harris
- National Cancer Institute, Cancer Diagnostics Program, Bethesda, MD
| | - Donald Berry
- Division of Biostatistics, MD Anderson Cancer Center, Houston, TX
| | - Olwen Hahn
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | | | - Eric Winer
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - Ann Partridge
- Department of Medical Oncology, Dana-Farber/Partners CancerCare, Boston, MA
| | - Charles M Perou
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Department of Genetics, University of North Carolina, Chapel Hill, NC
| | - Lisa A Carey
- Lineberger Comprehensive Center, University of North Carolina, Chapel Hill, NC.,Division of Hematology-Oncology, University of North Carolina, Chapel Hill, NC
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Eastham JA, Heller G, Halabi S, Monk JP, Beltran H, Gleave M, Evans CP, Clinton SK, Szmulewitz RZ, Coleman J, Hillman DW, Watt CR, George S, Sanda MG, Hahn OM, Taplin ME, Parsons JK, Mohler JL, Small EJ, Morris MJ. Cancer and Leukemia Group B 90203 (Alliance): Radical Prostatectomy With or Without Neoadjuvant Chemohormonal Therapy in Localized, High-Risk Prostate Cancer. J Clin Oncol 2020; 38:3042-3050. [PMID: 32706639 DOI: 10.1200/jco.20.00315] [Citation(s) in RCA: 51] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
PURPOSE Radical prostatectomy (RP) alone is often inadequate in curing men with clinically localized, high-risk prostate cancer (PC). We hypothesized that chemohormonal therapy (CHT) with androgen-deprivation therapy plus docetaxel before RP would improve biochemical progression-free survival (BPFS) over RP alone. PATIENTS AND METHODS Men with clinically localized, high-risk PC were assigned to RP alone or neoadjuvant CHT with androgen deprivation plus docetaxel (75 mg/m2 body surface area every 3 weeks for 6 cycles) and RP. The primary end point was 3-year BPFS. Biochemical failure was defined as a serum prostate-specific antigen level > 0.2 ng/mL that increased on 2 consecutive occasions that were at least 3 months apart. Secondary end points included 5-year BPFS, overall BPFS, local recurrence, metastasis-free survival (MFS), PC-specific mortality, and overall survival (OS). RESULTS In total, 788 men were randomly assigned. Median follow-up time was 6.1 years. The overall rates of grade 3 and 4 adverse events during chemotherapy were 26% and 19%, respectively. No difference was seen in 3-year BPFS between neoadjuvant CHT plus RP and RP alone (0.89 v 0.84, respectively; 95% CI for the difference, -0.01 to 0.11; P = .11). Neoadjuvant CHT was associated with improved overall BPFS (hazard ratio [HR], 0.69; 95% CI, 0.48 to 0.99), improved MFS (HR, 0.70; 95% CI, 0.51 to 0.95), and improved OS (HR, 0.61; 95% CI, 0.40 to 0.94) compared with RP alone. CONCLUSION The primary study end point, 3-year BPFS, was not met. Although some improvement was seen in secondary end points, any potential benefit must be weighed against toxicity. Our data do not support the routine use of neoadjuvant CHT and RP in patients with clinically localized, high-risk PC at this time.
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Affiliation(s)
| | - Glenn Heller
- Memorial Sloan Kettering Cancer Center, New York, NY
| | - Susan Halabi
- Department of Biostatistics and Bioinformatics, Duke University, Durham, NC
| | - J Paul Monk
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital, Columbus, OH
| | | | - Martin Gleave
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Steven K Clinton
- The Ohio State University Comprehensive Cancer Center, The James Cancer Hospital, Columbus, OH
| | | | | | - David W Hillman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | - Colleen R Watt
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | - Saby George
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | - Olwen M Hahn
- Alliance Protocol Operations Office, University of Chicago, Chicago, IL
| | | | | | | | - Eric J Small
- University of California, San Francisco, Medical Center-Mount Zion, San Francisco, CA
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Liu MC, Hillman DW, Frith AE, Lyss AP, Weckstein DJ, Moreno-Aspitia A, Le-Lindqwister N, Isaacs C, Wender DB, Lewis DA, Cole JT, Jaslowski AJ, Rowland KM, Openshaw TH, Friday BEB, Fleming GF, Asmus E, Rogak LJ, Basch EM, Dueck AC. Randomized phase III trial of eribulin (E) versus standard weekly paclitaxel (P) as first- or second-line therapy for locally recurrent or metastatic breast cancer (MBC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1016] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1016 Background: The ph III EMBRACE trial of E vs physician’s choice of tx led to FDA approval of E as ≥3rd-line tx for MBC pts with prior exposure to anthracyclines/taxanes. The ph III BOLD 301 trial of E vs capecitabine in advanced BC treated with anthracyclines/taxanes showed a nonsignificant trend to improved median OS for all pts; pre-planned analysis by HER2 status revealed a nominally significant benefit for HER2- pts. Methods: RU011201I is an investigator initiated ph III trial with 1:1 randomization to E (1.4 mg/m2 D1,8 q21days) vs P (90 mg/m2 D1,8,15 q28days) within strata defined by (neo)adjuvant taxanes (yes/no), HR status (+/-), and line of tx (1st/2nd). Pts had measurable or non-measurable disease by RECIST v1.1; new or progressive mets; peripheral neuropathy (PN) gr<2; ≤1 prior chemotx regimens for advanced or MBC. Asymptomatic brain mets with stable MRIs for >3 mos were allowed. (Neo)adjuvant taxanes were allowed if >12 mos between tx completion and disease recurrence. Radiographic studies occur q12wks. Survival data are collected q12wks after the Off-Tx Visit. Pts reported side effects weekly; post-baseline symptomatic AE rates worse than baseline were compared between arms using Fisher’s exact tests. We report clinical outcomes and the primary objective related to PRO-CTCAE use. Results: 201 pts enrolled 3/2014 - 5/2018 with 33.8 mos median f/u; 3 are on tx as of 2/20/20 (1E, 2P). Pt characteristics were the same between E vs P: median age 62 yrs (range 27-85); 42% prior taxane; 78% ER+; 70% starting 1st line tx. Baseline lesion distribution was similar except for lung mets (37E, 53P). No difference was seen between E vs P in PFS (5.7 vs 5.9 mos; P=0.72), OS (18.1 vs 16.4 mos; P=0.75), TTF (5.3 vs 4.9 mos; P=0.82), DOR (10.8 vs 12.3 mos; P=0.84), or number of metastatic events (55 vs 54). 37E and 36P pts required ≥1 dose reduction. Hematologic toxicities ≥ gr 3 were higher with E (40 vs 22%). PN events were similar: 56 vs 58 total, 4 vs 7 motor, 52 vs 51 sensory. Median duration of PN and median time to 1st PN event were 74 vs 140 and 56 vs 41 days. Worsened numbness/tingling severity and other pt-reported AE rates were similar, but worsened numbness/tingling interference (63% vs 78%, P=0.04) and vomiting frequency (35% vs 57%, P=0.005) were lower with E. Conclusions: Clinical outcomes were equivalent with E vs P as 1st/2nd line tx for HER2- advanced BC. The nature and severity of PN were similar between arms, but time of onset, duration, and interference with daily living favor E. E may be a suitable treatment option in this setting. Clinical trial information: NCT02037529 .
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Affiliation(s)
| | | | | | | | | | | | | | - Claudine Isaacs
- Georgetown Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC
| | | | | | - John T. Cole
- Louisiana State University Health Sciences Center, New Orleans, LA
| | | | | | | | | | | | | | | | - Ethan M. Basch
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
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Chumsri S, Carter JM, Ma Y, Hinerfeld D, Brauer HA, Warren S, Nielsen TO, Asleh K, Joensuu H, Perez EA, Leon-Ferre RA, Hillman DW, Boughey JC, Liu MC, Ingle JN, Kalari KR, Couch F, Knutson KL, Goetz MP, Thompson EA. Role of intratumoral NK cells in triple-negative breast cancer in the FinXX trial and Mayo Clinic cohort. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.510] [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: 11/20/2022] Open
Abstract
510 Background: Several studies have established the critical role of preexisting immune response in triple negative breast cancer (TNBC). Most studies evaluated the tumor infiltrating lymphocytes in stroma. However, limited data are available with regards to the importance of specific subtypes and spatial distribution of these immune infiltrates. Methods: NanoString IO360 gene expression analysis and Digital Spatial Profiling (DSP) were used. DSP was used to quantify 39 immune-related proteins in stromal and tumor-enriched segments from 44 TNBC samples from the FinXX trial (NCT00114816) and 335 samples from the Mayo Clinic (MC) cohort of centrally reviewed TNBC (Leon-Ferre BCRT 2018). In FinXX trial, 22 patients with recurrence and 22 patients without recurrence were included. In MC cohort, 217/335 patients received adjuvant chemotherapy while 118 patients had surgery only without adjuvant chemotherapy. Regions were segmented based on pancytokeratin staining. The general linear model was used for statistical analysis of differential expression with recurrence free survival (RFS) as a categorical variable (recur yes or no). Kaplan-Meier estimates and Cox regression models were also used for analysis. Results: In the FinXX trial, using global gene expression analysis with IO360, there was no signature significantly associated with RFS. However, using DSP, high protein expression of CD56 in the tumor-enriched segments was associated with significant improvement in RFS (HR 0.26, 95%CI 0.09-0.78, p 0.01). Nevertheless, CD56 expression in the stroma (HR 0.66, 95%CI 0.29-1.53, p 0.33) and all segments (HR 0.53, 95%CI 0.23-1.25, p 0.14) was not significantly associated with improved outcome. We further validated these findings in the MC TNBC cohort where intratumoral CD56 expression was associated with a significant improvement in RFS (HR 0.23, p 0.002) but not stromal CD56 (p 0.79). Interestingly, when evaluating the MC TNBC cohort according to receipt of chemotherapy, intratumoral CD56 was associated with improved outcome only in patients who received chemotherapy (p 0.02 vs. 0.07). In both cohorts, higher expressions of intratumoral PD-L1, HLA-DR, and CD8 were associated with improved outcome. Conclusions: Using an in-depth analysis with spatially defined context, we identify that intratumoral CD56-positive NK cells are associated with improved outcome in TNBC. Our study highlights the potential role of NK cells in TNBC and future implications for biomarkers and therapeutic targets.Support: W81XWH-15-1-0292, P50CA116201-9, P50CA015083. Clinical trial information: NCT00114816 .
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Affiliation(s)
| | | | | | | | | | | | - Torsten O Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Karama Asleh
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Heikki Joensuu
- Helsinki University Hospital Comprehensive Cancer Center, Helsinki, Finland
| | | | | | | | | | | | | | | | - Fergus Couch
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
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23
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Costello BA, Ho TH, Perez Burbano G, Hillman DW, Quevedo F, Pitot HC, Pagliaro LC, Bryce AH, Tan W, Joseph RW, Leibovich BC, Castle EP, Dronca RS, Kohli M. Phase II efficacy trial of pazopanib in nonclear cell metastatic renal cell cancer (mRCC): PINCR. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.6_suppl.696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
696 Background: A number of treatments for metastatic renal cell carcinoma (RCC) have been FDA approved since December, 2005. Trials evaluating these agents excluded non-clear cell histologies and therefore the efficacy of these treatments remains unclear in patients (pts) with metastatic non-clear cell RCC (mncRCC). Methods: This is a single arm Phase II study designed to determine the efficacy of pazopanib in mncRCC. Treatment was pazopanib 800 mg by mouth daily until progression or intolerability of treatment. Dose reductions were allowed for toxicity with dose level -1 being 600 mg daily and dose level -2, 400 mg daily. Cycles were every 28 days. Main eligibility criteria included: (1) age ³ 18 years old; (2) histologic confirmation of ncRCC; (3) ECOG Performance Status (PS) 0, 1, or 2; (4) up to one prior treatment for mncRCC (5) measurable or non-measurable metastatic disease per RECIST criteria. The primary endpoint was overall survival rate at 12 months. Secondary endpoints were best tumor response rates after two cycles, PFS, OS and toxicity. Results: 38 pts were enrolled between May 16, 2013 and February 1, 2018. 35 pts were evaluable for primary endpoint. Median age 63 years old and 22/35 (62.9%) were male. Most common histology was papillary RCC, 14/35 (40%), and most common number of metastatic sites was 1. 29/35 (82.9%) had prior nephrectomy and 30/35 (85.7%) had no prior systemic therapy. Median number of cycles was 5. 12-month OS was 65.7% (90% CI, 50.5-78.9%). Best response in first 2 cycles: PR 11%, SD 60%, PD 9%, not evaluated 20%. Median PFS was 7.5 months (90% CI, 5.0-11.0); median OS 18.9 months (90% CI, 13.0-NE). Grade 3 / 4 AEs seen in 25 pts with hypertension, transaminitis and abdominal pain being most common (seen in >10%). Conclusions: There are limited data about the efficacy of available therapies for mncRCC. This study shows that pazopanib has similar efficacy compared to historical data in clinical trials using other TKIs in mncRCC. The safety profile of pazopanib in pts with mncRCC was found to be similar to that found in prior clinical trials studying pazopanib. Our findings warrant further investigation into the utility of pazopanib in metastatic ncRCC. Clinical trial information: NCT01767636.
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24
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Norton N, Youssef B, Hillman DW, Nassar A, Geiger XJ, Necela BM, Liu H, Ruddy KJ, Polley MYC, Ingle JN, Couch FJ, Perez EA, Liu MC, Carter JM, Leon-Ferre RA, Boughey JC, Somers EB, Kalari KR, Visscher DW, Goetz MP, Knutson KL. Folate receptor alpha expression associates with improved disease-free survival in triple negative breast cancer patients. NPJ Breast Cancer 2020; 6:4. [PMID: 32047850 PMCID: PMC7000381 DOI: 10.1038/s41523-020-0147-1] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [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: 10/07/2019] [Accepted: 01/14/2020] [Indexed: 12/11/2022] Open
Abstract
Triple negative breast cancer (TNBC) comprises 15-20% of all invasive breast cancer and is associated with a poor prognosis. As therapy options are limited for this subtype, there is a significant need to identify new targeted approaches for TNBC patient management. The expression of the folate receptor alpha (FRα) is significantly increased in patients with TNBC and is therefore a potential biomarker and therapeutic target. We optimized and validated a FRα immunohistochemistry method, specific to TNBC, to measure FRα expression in a centrally confirmed cohort of 384 patients with TNBC in order to determine if expression of the protein is associated with invasive disease-free survival (IDFS) and overall survival (OS). The FRα IHC demonstrated exceptional performance characteristics with low intra- and interassay variability as well as minimal lot-to-lot variation. FRα expression, which varied widely from sample to sample, was detected in 274 (71%) of the TNBC lesions. In a multivariable model adjusted for baseline characteristics, FRα expression was associated with improved IDFS (HR = 0.63, p = 0.01) but not with OS. The results demonstrate the potential of targeting the FRα in the majority of TNBC patients and suggest that variable expression may point to a need to stratify on FRα expression in clinical studies.
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Affiliation(s)
- Nadine Norton
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224 USA
| | | | - David W. Hillman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905 USA
| | - Aziza Nassar
- Department of Pathology, Mayo Clinic, Jacksonville, FL 32224 USA
| | | | - Brian M. Necela
- Department of Cancer Biology, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Heshan Liu
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905 USA
| | | | - Mei-Yin C. Polley
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905 USA
| | - James N. Ingle
- Department of Oncology, Mayo Clinic, Rochester, MN 55905 USA
| | - Fergus J. Couch
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905 USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA
| | - Edith A. Perez
- Division of Hematology and Oncology, Mayo Clinic, Jacksonville, FL 32224 USA
| | - Minetta C. Liu
- Department of Oncology, Mayo Clinic, Rochester, MN 55905 USA
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA
| | - Jodi M. Carter
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA
| | | | | | | | - Krishna R. Kalari
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905 USA
| | - Daniel W. Visscher
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905 USA
| | - Matthew P. Goetz
- Department of Oncology, Mayo Clinic, Rochester, MN 55905 USA
- Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN 55905 USA
| | - Keith L. Knutson
- Department of Immunology, Mayo Clinic, Jacksonville, FL 32246 USA
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25
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Assel MJ, Ulmert HD, Karnes RJ, Boorjian SA, Hillman DW, Vickers AJ, Klee GG, Lilja H. Kallikrein markers performance in pretreatment blood to predict early prostate cancer recurrence and metastasis after radical prostatectomy among very high-risk men. Prostate 2020; 80:51-56. [PMID: 31603253 PMCID: PMC6944058 DOI: 10.1002/pros.23916] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/26/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND To assess whether a prespecified statistical model based on the four kallikrein markers measured in blood-total, free, and intact prostate-specific antigen (PSA), together with human kallikrein-related peptidase 2 (hK2)-or any individual marker measured in pretreatment serum were associated with biochemical recurrence-free (BCR) or metastasis-free survival after radical prostatectomy (RP) in a subgroup of men with very high-risk disease. METHODS We identified 106 men treated at Mayo Clinic from 2004 to 2008 with pathological Gleason grade group 4 to 5 or seminal vesicle invasion at RP. Univariable and multivariable Cox models were used to test the association between standard predictors (Kattan nomogram and GPSM [Gleason, PSA, seminal vesicle and margin status] score), kallikrein panel, and individual kallikrein markers with the outcomes. RESULTS BCR and metastasis occurred in 67 and 30 patients, respectively. The median follow-up for patients who did not develop a BCR was 10.3 years (interquartile range = 8.2-11.8). In this high-risk group, neither Kattan risk, GPSM score, or the kallikrein panel model was associated with either outcome. However, after adjusting for Kattan risk and GPSM score, separately, preoperative intact PSA was associated with both outcomes while hK2 was associated with metastasis-free survival. CONCLUSIONS Conventional risk prediction tools were poor discriminators for risk of adverse outcomes after RP (Kattan risk and GPSM risk) in patients with very high-risk disease. Further studies are needed to define the role of individual kallikrein marker forms in the blood to predict adverse prostate cancer outcomes after RP in this high-risk setting.
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Affiliation(s)
- Melissa J. Assel
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Hans David Ulmert
- Molecular Pharmacology Program, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Department of Molecular and Medical Pharmacology, David Geffen School of Medicine at University of California, Los Angeles, CA, USA
- Department of Translational Medicine, Lund University, Malmö, Sweden
| | | | | | - David W. Hillman
- Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Andrew J. Vickers
- Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - George G. Klee
- Mayo Clinic College of Medicine & Science, Mayo Clinic, Rochester, MN, USA
| | - Hans Lilja
- Departments of Laboratory Medicine, Surgery, and Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Department of Translational Medicine, Lund University, Malmö, Sweden
- Corresponding author: Hans Lilja, MD, PhD, 1275 York Ave, BOX 213, New York, NY 10065, (P) 212-639-6982, (F) 646-422-2379,
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26
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Morris MJ, Heller G, Bryce AH, Armstrong AJ, Beltran H, Hahn OM, McGary EC, Mehan PT, Goldkorn A, Roth BJ, Xiao H, Watt C, Hillman DW, Taplin ME, Ryan CJ, Halabi S, Small EJ. Alliance A031201: A phase III trial of enzalutamide (ENZ) versus enzalutamide, abiraterone, and prednisone (ENZ/AAP) for metastatic castration resistant prostate cancer (mCRPC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5008] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5008 Background: Androgen receptor (AR) signaling is an important growth mechanism in mCRPC, providing the rationale for treatment with AR axis inhibitors such as ENZ and AAP. Targeting AR with anti-androgens such as ENZ can result in compensatory autocrine and paracrine androgenic stimulation. Therefore, using ENZ with the androgen biosynthesis inhibitor AAP to dampen these resistance mechanisms could improve clinical outcomes relative to ENZ alone. Methods: Men with progressive mCRPC by Prostate Cancer Working Group 2 criteria were eligible. Prior treatment with taxanes for mCRPC and any prior treatment with ENZ or AAP was exclusionary. Patients (pts) were randomized 1:1 to ENZ or ENZ/AAP at standard FDA-approved doses. Randomization was stratified by prior chemotherapy and Halabi prognostic three risk groups. Castrating therapy was maintained. The primary endpoint was overall survival (OS) defined as the date of randomization from date of death or last follow-up. The log-rank test had 90% power to detect a hazard ratio for OS of 0.77 with a one-sided type I error rate of 0.025. Secondary endpoints included radiographic progression free survival (rPFS) and on-treatment PSA declines. Exploratory endpoints included imaging changes, and changes in serum biomarkers such as androgens, angiokines, and circulating microRNA and RNA. The primary analysis was based on the stratified log-rank test adjusting on the stratification factors. Results: Between January 2014 and August 2016, 1311 men were randomized: 657 to ENZ and 654 to ENZ/AAP. Groups were well balanced between arms, including stratification variables. 15.6% of pts were high risk, 35.3% intermediate, and 48.1% low. Median OS was 33.6 mo (95% CI 30.5-36.4) and 32.7 mo (29.9-35.4) respectively, two-sided p = 0.53. Fifty percent PSA decline rate was 80% vs. 76.5%. Grade 3-5 adverse events (AE) (all attributions) were 55.6% and 68.8% respectively. Treatment discontinuation due to AEs occurred in 5% and 12%, pt withdrawal in 5% and 13%, and progression or death in 57% and 48% of pts respectively. Conclusions: Addition of abiraterone acetate to enzalutamide did not prolong survival in men with mCRPC. The combination resulted in more AEs than enzalutamide alone. Support: U10CA180821, U10CA180882, U24CA196171; https://acknowledgments.alliancefound.org . Clinical trial information: NCT01949337.
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Affiliation(s)
| | - Glenn Heller
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | | | - Amir Goldkorn
- Division of Medical Oncology, Department of Medicine, Keck School of Medicine and Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA
| | - Bruce J. Roth
- Washington University School of Medicine, St. Louis, MO
| | - Han Xiao
- Memorial Sloan Kettering Cancer Center, Basking Ridge, NJ
| | | | | | - Mary-Ellen Taplin
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Eric Jay Small
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
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27
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Eastham JA, Heller G, Halabi S, Monk P, Clinton SK, Szmulewitz RZ, Coleman J, Gleave M, Evans CP, Hillman DW, Beltran H, Taplin ME, Hahn OM, Parsons JK, Small EJ, Mohler J, Morris MJ. CALGB 90203 (Alliance): Radical prostatectomy (RP) with or without neoadjuvant chemohormonal therapy (CHT) in men with clinically localized, high-risk prostate cancer (CLHRPC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.5079] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5079 Background: Neoadjuvant CHT followed by RP did not increase 3-year biochemical progression free-survival (bPFS) compared to RP alone in men with CLHRPC. However, there is evidence that bPFS and overall survival over time was improved. In the current analysis we assessed whether CHT followed by RP improved pathological specimen features compared to RP alone. Methods: CALGB 90203 (Alliance) is a Phase III study which randomly assigned, in a 1:1 fashion, men with CLHRPC [biopsy Gleason Grade Group (GGG) 4 or 5 or Kattan pre-op nomogram bPFS < 60%] to RP alone or RP plus neoadjuvant CHT [androgen deprivation plus docetaxel (75 mg/m2 every 3 weeks for 6 cycles)]. We conducted an exploratory analysis comparing histologic findings, determined at the treating center, in the RP specimens of men receiving CHT plus RP and men treated with RP alone. We used the Chi-square test, with P-values adjusted by the Holm method for multiple comparisons. Results: A total of 788 men (median age, 62; range: 32-83 years) were randomized, with 738 ultimately undergoing RP. There was no difference in pathologic GGG (Table). Men treated with neoadjuvant CHT had a lower pathologic T-stage and lower likelihood of having seminal vesicle invasion (SVI), positive pelvic lymph nodes, or positive surgical margins (SM) (Table). Conclusions: Most pathologic features in the RP specimen were improved in men receiving neoadjuvant CHT compared to RP alone. The relationship between pathologic changes and the development of metastasis and survival require further analysis. RP pathologic outcomes. Summary statistics are calculated for the number of patients with non-missing data for each characteristic. Clinical trial information: NCT00430183. [Table: see text]
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Affiliation(s)
| | - Glenn Heller
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | | | | | | | - Martin Gleave
- Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | | | | | | | - Mary-Ellen Taplin
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Eric Jay Small
- UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, CA
| | - James Mohler
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
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28
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Wang L, Dehm SM, Hillman DW, Sicotte H, Tan W, Gormley M, Bhargava V, Jimenez R, Xie F, Yin P, Qin S, Quevedo F, Costello BA, Pitot HC, Ho T, Bryce AH, Ye Z, Li Y, Eiken P, Vedell PT, Barman P, McMenomy BP, Atwell TD, Carlson RE, Ellingson M, Eckloff BW, Qin R, Ou F, Hart SN, Huang H, Jen J, Wieben ED, Kalari KR, Weinshilboum RM, Wang L, Kohli M. A prospective genome-wide study of prostate cancer metastases reveals association of wnt pathway activation and increased cell cycle proliferation with primary resistance to abiraterone acetate-prednisone. Ann Oncol 2019; 29:352-360. [PMID: 29069303 DOI: 10.1093/annonc/mdx689] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background Genomic aberrations have been identified in metastatic castration-resistant prostate cancer (mCRPC), but molecular predictors of resistance to abiraterone acetate/prednisone (AA/P) treatment are not known. Patients and methods In a prospective clinical trial, mCRPC patients underwent whole-exome sequencing (n = 82) and RNA sequencing (n = 75) of metastatic biopsies before initiating AA/P with the objective of identifying genomic alterations associated with resistance to AA/P. Primary resistance was determined at 12 weeks of treatment using criteria for progression that included serum prostate-specific antigen measurement, bone and computerized tomography imaging and symptom assessments. Acquired resistance was determined using the end point of time to treatment change (TTTC), defined as time from enrollment until change in treatment from progressive disease. Associations of genomic and transcriptomic alterations with primary resistance were determined using logistic regression, Fisher's exact test, single and multivariate analyses. Cox regression models were utilized for determining association of genomic and transcriptomic alterations with TTTC. Results At 12 weeks, 32 patients in the cohort had progressed (nonresponders). Median study follow-up was 32.1 months by which time 58 patients had switched treatments due to progression. Median TTTC was 10.1 months (interquartile range: 4.4-24.1). Genes in the Wnt/β-catenin pathway were more frequently mutated and negative regulators of Wnt/β-catenin signaling were more frequently deleted or displayed reduced mRNA expression in nonresponders. Additionally, mRNA expression of cell cycle regulatory genes was increased in nonresponders. In multivariate models, increased cell cycle proliferation scores (≥ 50) were associated with shorter TTTC (hazard ratio = 2.11, 95% confidence interval: 1.17-3.80; P = 0.01). Conclusions Wnt/β-catenin pathway activation and increased cell cycle progression scores can serve as molecular markers for predicting resistance to AA/P therapy.
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Affiliation(s)
- L Wang
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA; Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, USA
| | - S M Dehm
- Masonic Cancer Center, University of Minnesota, Minneapolis, USA; Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, USA; Department of Urology, University of Minnesota, Minneapolis, USA
| | - D W Hillman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - H Sicotte
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - W Tan
- Department of Medicine, Mayo Clinic, Jacksonville, USA
| | - M Gormley
- Janssen Research and Development, Spring House, Philadelphia, USA
| | - V Bhargava
- Janssen Research and Development, Spring House, Philadelphia, USA
| | - R Jimenez
- Department of Pathology and Lab Medicine, Mayo Clinic, Rochester, USA
| | - F Xie
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - P Yin
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - S Qin
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - F Quevedo
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - B A Costello
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - H C Pitot
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - T Ho
- Department of Medicine, Mayo Clinic, Scottsdale, USA
| | - A H Bryce
- Department of Medicine, Mayo Clinic, Scottsdale, USA
| | - Z Ye
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, USA
| | - Y Li
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - P Eiken
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - P T Vedell
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - P Barman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - B P McMenomy
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - T D Atwell
- Department of Radiology, Mayo Clinic, Rochester, USA
| | - R E Carlson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - M Ellingson
- Medical Genetics, Mayo Clinic, Rochester, USA
| | - B W Eckloff
- Medical Genome Facility, Mayo Clinic, Rochester, USA
| | - R Qin
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - F Ou
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - S N Hart
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - H Huang
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, USA
| | - J Jen
- Medical Genome Facility, Mayo Clinic, Rochester, USA; Division of Experimental Pathology and Laboratory Medicine, Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, USA; Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, USA
| | - E D Wieben
- Medical Genome Facility, Mayo Clinic, Rochester, USA
| | - K R Kalari
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, USA
| | - R M Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA
| | - L Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, USA.
| | - M Kohli
- Department of Oncology, Mayo Clinic, Rochester, USA.
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Giridhar KV, Sanhueza C, Hillman DW, Alkhateeb H, Carlson R, Tan W, Costello BA, Quevedo F, Pagliaro L, Kohli M. Serum chromogranin-A-based prognosis in metastatic castration-resistant prostate cancer. Prostate Cancer Prostatic Dis 2018; 21:431-437. [PMID: 29858590 PMCID: PMC6126956 DOI: 10.1038/s41391-018-0046-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 02/15/2018] [Accepted: 02/20/2018] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To determine the prognostic value of serum chromogranin-A (CGA) in a two-cohort study of men with metastatic castrate resistant prostate cancer (mCRPC) and to compare with circulating tumor cells (CTCs)-based prognosis. PATIENTS AND METHODS A two-cohort-based evaluation for serum CGA for prognostication in CRPC stage was performed using a screening cohort of 256 men with mCRPC and an independent validation cohort of 92 men with mCRPC. In both cohorts, men receiving proton pump inhibitors and those with non-castrate levels of testosterone (>50 ng/dl) were excluded. Serum CGA was measured in a homogeneous automated immunofluorescent assay using time-resolved amplified cryptate emission. In the validation cohort, CTC enumeration was also performed using the FDA-cleared CELLSEARCH® CTC test. Cox proportional hazard regression models were used for prognostic association of serum CGA and CTC counts with overall survival. RESULTS In the screening cohort, 200 men were eligible for analysis. The median serum CGA was 100.3 ng/mL (interquartile range: 67-161.3) and 34/200 were above the reference range. In the subset of men with Gleason scores ≥ 8, elevated CGA was associated with shorter overall survival [hazard ratio (HR) 2.19, p = 0.017]. In the validation cohort for 71 men eligible for analysis, the median serum CGA was 90 ng/mL (interquartile range: 55-156) and 31/71 patients had an elevated CGA. 51% of patients had a Gleason score ≥ 8 and 66/71 patients had CTCs enumerated with 26/66 with a CTC count ≥ 5 per 7.5 ml blood sample (unfavorable). Both elevated serum CGA (HR: 1.91, p = 0.043) and unfavorable CTC counts (HR: 2.97, p = 0.0012) were adversely associated with overall survival and patients with ≥ 5 CTCs and elevated serum CGA had the shortest overall survival (HR: 3.76, p = 0.008). CONCLUSION Elevated serum CGA was negatively associated with OS in men with mCRPC. Serum CGA represents a prognostic biomarker that may complement CTC enumeration.
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Affiliation(s)
| | - Cristobal Sanhueza
- Department of Oncology, Mayo Clinic, Rochester, MN, USA
- Department of Oncology, Clínica Santa María, Santiago, Chile
| | - David W Hillman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | - Rachel Carlson
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Winston Tan
- Department of Medicine, Mayo Clinic, Jacksonville, FL, USA
| | | | | | | | - Manish Kohli
- Department of Oncology, Mayo Clinic, Rochester, MN, USA.
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30
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Kohli M, Li J, Du M, Hillman DW, Dehm SM, Tan W, Carlson R, Campion MB, Wang L, Wang L, Zhang H, Zhang P, Kilari D, Huang CC, Wang L. Prognostic association of plasma cell-free DNA-based androgen receptor amplification and circulating tumor cells in pre-chemotherapy metastatic castration-resistant prostate cancer patients. Prostate Cancer Prostatic Dis 2018; 21:411-418. [PMID: 29858592 PMCID: PMC6126974 DOI: 10.1038/s41391-018-0043-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [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: 12/13/2017] [Revised: 02/07/2018] [Accepted: 02/16/2018] [Indexed: 02/08/2023]
Abstract
Background The prognostic significance of plasma cell-free DNA (cfDNA) androgen receptor amplification (ARamp) in metastatic castration resistant prostate cancer (mCRPC) compared with circulating tumor cell (CTC) counts is not known. Methods As part of correlative aims of a prospective study in mCRPC, concurrent and serial collections of plasma and CTCs were performed. Specimen collections were performed at baseline after progression on androgen deprivation therapy and then 12 weeks later. QuantStudio3D digital PCR system (dPCR) was used to determine plasma cfDNA AR copy number variations and Cell search assay for enumerating CTC counts. Association of baseline cfDNA ARamp status/CTC counts with overall survival (OS) (primary goal) was evaluated using Kaplan–Meier method and log-rank test (p ≤ 0.05 for significance) and Receiver Operator Curves (ROC) for ARamp status and CTCs ≥ 5. A multivariate analysis was performed using Cox regression models that included ARamp, CTC counts and other clinical factors. Results ARamp was detected in 19/70 patients at baseline. At the time of analysis, 28/70 patients had died (median follow-up 806 days (IQR: 535–966)). ARamp was associated with poor OS (2 year OS of 35% in ARamp vs. 71% in non-ARamp; log-rank p-value= <0.0001). Baseline CTC count ≥ 5 (vs < 5) was also associated with poor survival (2 year OS of 44% vs 74%; log-rank p=0.001). ROC analysis demonstrated area under the curve (AUC) of 0.66 for ARamp- and 0.68 for CTC counts-based prognosis (p=0.84 for difference). The best two variables included for multivariable analysis were ARamp and CTC ≥ 5, however the two factor model was not significantly better than using ARamp alone for predicting survival (HR=5.25; p=0.0002). Conclusions CTCs and plasma cfDNA ARamp were observed to have equal prognostic value in mCRPC. Larger cohorts that incorporate molecular and clinical factors are needed to further refine prognosis in CRPC.
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Affiliation(s)
- Manish Kohli
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, MN, USA.
| | - Jian Li
- Department of Internal Medicine, People's Hospital of Zhengzhou University, Henan Provincial People's Hospital, Zhengzhou, Henan, China.,Department of Pathology and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Meijun Du
- Department of Pathology and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - David W Hillman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Scott M Dehm
- Department of Laboratory Medicine and Pathology, Masonic Cancer Center, University of Minnesota, Minneapolis, MN, USA.,Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Winston Tan
- Division of Hematology-Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Rachel Carlson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Michael B Campion
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Liguo Wang
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, MN, USA
| | - Huijuan Zhang
- Department of Pathology and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA.,Physical Examination Center, Zhengzhou Seventh People Hospital, Zhengzhou, Henan, China
| | - Peng Zhang
- Department of Pathology and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Deepak Kilari
- Department of Medicine, Medical College of Wisconsin and Milwaukee VA Medical Center, Milwaukee, WI, USA
| | - Chiang-Ching Huang
- Joseph J Zilber School of Public Health, University of Wisconsin, Milwaukee, WI, USA
| | - Liang Wang
- Department of Pathology and Cancer Center, Medical College of Wisconsin, Milwaukee, WI, USA.
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Kohli M, Dehm S, Bhargava V, Gormley M, Sinnwell JP, Tan W, Hillman DW, Li Y, Jimenez RE, Weinshilboum RM, Kalari KR, Wang L, Sicotte H. A transcriptome analysis of castration resistant prostate cancer metastases in a prospective cohort study reveals high expression of AKT pathway genes predictive of long term response to abiraterone acetate/prednisone. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.5038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | - Scott Dehm
- University of Minnesota, Minneapolis, MN
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Kohli M, Hart S, Lilyquist J, Hu C, Hillman DW, Lee K, Gnanaolivu RD, Polley E, Couch F. Prognostic impact of DNA repair germline variants in hormone sensitive prostate cancer stage. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.262] [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: 11/20/2022] Open
Abstract
262 Background: Inherited and somatic aberrations in DNA repair genes in castrate resistant prostate cancer (CRPC) are associated with poor prognosis, but respond well to poly ADP ribose polymerase (PARP) inhibitors. We evaluated the prevalence and prognostic impact of harboring germline DNA repair variants in hormone sensitive prostate cancer (HSPC). Methods: Germline DNA from buffy coat was sequenced on HiSeq4000 with a median coverage of 200X for DNA repair variants in 20 genes in HSPC and CRPC patients (pts) enrolled in a hospital registry. Pts were divided into two groups; Group A: pts enrolled at the time of CRPC stage; Group B: treatment naïve HSPC stage pts. The primary endpoints were to determine any impact of harboring DNA repair variants on time to progression from HSPC to CRPC and, from CRPC to death. Group A pts were retrospectively analyzed for time to progression from HSPC to CRPC while Group B patients were followed prospectively for outcomes. Statistical analysis included Cox proportional hazard models and Wilcoxon Rank sum test with significance at p≤0.05. Results: In Group A, 51/562 CRPC pts (9.07%) had variants in the 20 genes (most frequently in BRCA2; n = 15). 44/51 pts with variants and 399/511 without variants had died. Median time of progression from HSPC to CRPC with/without variants was 22.1 vs. 25.1 months (mths); p-value = 0.679. Median time from CRPC to death with/without variants was 32.2 Vs. 27.7 mths (p = 0.6). In HSPC Group B, 14/100 pts were identified with germline variants in ATM (n = 5), CHEK2 (n = 3), BRCA1 (n = 2), BRCA2 (n = 2), RAD50 (n = 1), and MSH2 (n = 1). 31/100 have died and median time to progression from HSPC to CRPC with/without variants was 15.6 vs.11.8 mths, p-value = 0.76. Conclusions: Pts with germline DNA repair variants detected in HSPC stage were not associated with poor prognosis. Presence of additional somatic DNA repair gene aberrations in cell-free DNA, not investigated in this cohort may add to the prevalence of DNA repair gene variations in HSPC and together impact prognosis adversely so as to provide a rationale for PARP inhibitor therapy in select HSPC stage pts.
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Giridhar K, Sanhueza CT, Hillman DW, Alkhateeb H, Carlson R, Tan W, Quevedo F, Pagliaro LC, Costello BA, Kohli M. Prognostic value of chromogranin-a (CGA) compared to circulating tumor cells (CTCs) in metastatic castration resistant prostate cancer (mCRPC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.249] [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: 11/20/2022] Open
Abstract
249 Background: Serum CGA has been identified as a candidate prognostic biomarker for mCRPC. In a two cohort study, we compared the prognostic value of serum CGA with a validated CTC assay. Methods: In the discovery cohort (DC), blood samples were collected from 256 men with mCRPC. In an independent validation cohort (VC), 92 men with mCRPC were enrolled in a biospecimen collection study. In both cohorts, men receiving proton pump inhibitors and those with non-castrate levels of testosterone ( > 50ng/dl) were excluded. Serum CGA was measured in a homogeneous automated immunofluorescent assay using time-resolved amplified cryptate emission. In the VC, CTC enumeration was performed using the FDA cleared CELLSEARCH CTC test prior to treatment with abiraterone acetate/ prednisone. Cox proportional hazard regression and Kaplan-Meier analysis were performed for associations with elevated CGA (above reference range), unfavorable (≥ 5) CTCs, and overall survival (OS). Results: In the DC, 200 men were eligible for analysis. The median age was 72 years (yrs), 81/200 pts had a Gleason score (GS) ≥ 8, 34/200 had an elevated CGA. At a median follow up of 2.2 yrs, 156/200 were deceased. In the subset of men with GS ≥ 8, elevated CGA was associated with shorter OS [hazard ratio (HR) 2.19, p = 0.017]. In the VC, 71 men were eligible for analysis. The median age was 71 yrs, 36/71 tumors were GS ≥ 8, 31/71 pts had an elevated CGA, 26/66 had unfavorable CTCs (≥ 5). At a median follow up of 1.8 yrs, 31/71 were deceased. Elevated CGA (HR 1.91, p = 0.043) and unfavorable CTC counts (HR 2.97, p = 0.0012) were adversely associated with OS. In the high GS group, both CTCs and CGA had the same area under the curve (AUC) of 0.72. Pts with elevated CTC and CGA had the poorest OS (HR 3.76, p = 0.008). Conclusions: Elevated serum CGA was negatively associated with OS in men with mCRPC. Serum CGA represents a prognostic biomarker that may complement CTC enumeration. Clinical trial information: NCT#01953640.
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Polley MYC, Leon-Ferre RA, Liu H, Gilbert J, Cafourek V, Hillman DW, Negron V, Boughey JC, Liu MC, Ingle JN, Kalari K, Couch F, Visscher DW, Goetz MP. Abstract P1-06-07: Mayo clinic TNBC outcome calculator: A clinical calculator to predict disease relapse and survival in women with triple-negative breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-06-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Purpose: Triple negative breast cancer (TNBC) is an aggressive breast cancer subtype with substantial risks of disease recurrence. While cytotoxic chemotherapy is commonly administered and reduces recurrence, disease outcomes vary considerably and few prognostic tools are available for risk stratification for TNBC patients. We constructed and validated clinical calculators for invasive-disease free survival (IDFS) and overall survival (OS) for TNBC and compared their performance against AJCC-based models which include only tumor size and nodal status.
Methods: From a surgical cohort of 9,982 patients who underwent breast cancer surgery at Mayo Clinic between January 1985 and December 2012, 605 centrally reviewed TNBC patients were identified and used to construct Cox models for IDFS and OS. Patients treated with neoadjuvant chemotherapy were excluded. Variables considered included age, menopausal status, tumor size, nodal status, Nottingham grade, type of breast surgery (mastectomy vs. lumpectomy), adjuvant radiation therapy, adjuvant chemotherapy, Ki67, stromal tumor infiltrating lymphocytes (sTILs), and neutrophil-to-lymphocyte ratio (NLR). Missing values were imputed using single imputation with all variables (including outcomes) included in the imputation model. Backward step-down procedure was used for model selections. The final models were internally validated for calibration and discrimination using bootstrapping methods and compared with AJCC-based models.
Results: For both IDFS and OS, higher sTIL's, less extensive nodal involvement, use of adjuvant chemotherapy, and lower NLR were significant predictors of improved clinical outcomes. Premenopausal status and younger age were additionally predictive of improved IDFS and OS, respectively. Models for IDFS and OS have good calibration and are associated with bias-corrected C-indices of 0.68 and 0.71, respectively, as compared with C-indices of 0.59 and 0.62 for AJCC-based models.
Conclusions: Our data indicate that a clinical calculator that includes sTIL's, NLR, menopausal status, age, nodal involvement as well as chemotherapy use can provide significantly greater prediction of clinical risk than tumor size and nodal status alone. These tools may be used to identify TNBC patients at elevated risk of disease relapse and to aid physician's communication with patients regarding their long-term disease outlook and planning treatment strategies. External validation is required to further evaluate broader applicability of this tool, which was developed utilizing a single-institutional experience.
Citation Format: Polley M-YC, Leon-Ferre RA, Liu H, Gilbert J, Cafourek V, Hillman DW, Negron V, Boughey JC, Liu MC, Ingle JN, Kalari K, Couch F, Visscher DW, Goetz MP. Mayo clinic TNBC outcome calculator: A clinical calculator to predict disease relapse and survival in women with triple-negative breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-06-07.
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Affiliation(s)
| | | | - H Liu
- Mayo Clinic, Rochester, MN
| | | | | | | | | | | | - MC Liu
- Mayo Clinic, Rochester, MN
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Qin S, Liu D, Kohli M, Wang L, Vedell PT, Hillman DW, Niu N, Yu J, Weinshilboum RM, Wang L. TSPYL Family Regulates CYP17A1 and CYP3A4 Expression: Potential Mechanism Contributing to Abiraterone Response in Metastatic Castration-Resistant Prostate Cancer. Clin Pharmacol Ther 2017; 104:201-210. [PMID: 29027195 PMCID: PMC5899062 DOI: 10.1002/cpt.907] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2016] [Revised: 09/15/2017] [Accepted: 10/06/2017] [Indexed: 12/15/2022]
Abstract
The testis‐specific Y‐encoded‐like protein (TSPYL) gene family includes TSPYL1 to TSPYL6. We previously reported that TSPYL5 regulates cytochrome P450 (CYP) 19A1 expression. Here we show that TSPYLs, especially TSPYL 1, 2, and 4, can regulate the expression of many CYP genes, including CYP17A1, a key enzyme in androgen biosynthesis, and CYP3A4, an enzyme that catalyzes the metabolism of abiraterone, a CYP17 inhibitor. Furthermore, a common TSPYL1 single nucleotide polymorphism (SNP), rs3828743 (G/A) (Pro62Ser), abolishes TSPYL1's ability to suppress CYP3A4 expression, resulting in reduced abiraterone concentrations and increased cell proliferation. Data from a prospective clinical trial of 87 metastatic castration‐resistant prostate cancer patients treated with abiraterone acetate/prednisone showed that the variant SNP genotype (A) was significantly associated with worse response and progression‐free survival. In summary, TSPYL genes are novel CYP gene transcription regulators, and genetic alteration within these genes significantly influences response to drug therapy through transcriptional regulation of CYP450 genes.
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Affiliation(s)
- Sisi Qin
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Duan Liu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Manish Kohli
- Department of Oncology, Mayo Clinic, Rochester, Minnesota, USA
| | - Liguo Wang
- Department of Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Peter T Vedell
- Department of Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - David W Hillman
- Department of Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Nifang Niu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Jia Yu
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Richard M Weinshilboum
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota, USA
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Giridhar KV, Sosa CP, Hillman DW, Sanhueza C, Dalpiaz CL, Costello BA, Quevedo FJ, Pitot HC, Dronca RS, Ertz D, Cheville JC, Donkena KV, Kohli M. Whole Blood mRNA Expression-Based Prognosis of Metastatic Renal Cell Carcinoma. Int J Mol Sci 2017; 18:ijms18112326. [PMID: 29099775 PMCID: PMC5713295 DOI: 10.3390/ijms18112326] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [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: 10/05/2017] [Revised: 10/28/2017] [Accepted: 10/31/2017] [Indexed: 12/20/2022] Open
Abstract
The Memorial Sloan Kettering Cancer Center (MSKCC) prognostic score is based on clinical parameters. We analyzed whole blood mRNA expression in metastatic clear cell renal cell carcinoma (mCCRCC) patients and compared it to the MSKCC score for predicting overall survival. In a discovery set of 19 patients with mRCC, we performed whole transcriptome RNA sequencing and selected eighteen candidate genes for further evaluation based on associations with overall survival and statistical significance. In an independent validation of set of 47 patients with mCCRCC, transcript expression of the 18 candidate genes were quantified using a customized NanoString probeset. Cox regression multivariate analysis confirmed that two of the candidate genes were significantly associated with overall survival. Higher expression of BAG1 [hazard ratio (HR) of 0.14, p < 0.0001, 95% confidence interval (CI) 0.04–0.36] and NOP56 (HR 0.13, p < 0.0001, 95% CI 0.05–0.34) were associated with better prognosis. A prognostic model incorporating expression of BAG1 and NOP56 into the MSKCC score improved prognostication significantly over a model using the MSKCC prognostic score only (p < 0.0001). Prognostic value of using whole blood mRNA gene profiling in mCCRCC is feasible and should be prospectively confirmed in larger studies.
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Affiliation(s)
- Karthik V Giridhar
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Carlos P Sosa
- Biomarker Discovery, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - David W Hillman
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA.
| | - Cristobal Sanhueza
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
- Department of Oncology, Clínica Santa María, Santiago 8320000, Chile.
| | - Candace L Dalpiaz
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Brian A Costello
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Fernando J Quevedo
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Henry C Pitot
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Roxana S Dronca
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Donna Ertz
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - John C Cheville
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Krishna Vanaja Donkena
- Biomarker Discovery, Center for Individualized Medicine, Mayo Clinic, Rochester, MN 55905, USA.
| | - Manish Kohli
- Department of Oncology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Kohli M, Ho Y, Hillman DW, Etten JLV, Henzler C, Yang R, Li Y, Tseng E, Hon T, Clark TA, Wang L, Silverstein K, Wang L, Dehm SM. Abstract 425: SMRT® Sequencing of full-length androgen receptor isoforms in prostate cancer reveals previously hidden drug resistant variants. Cancer Res 2017. [DOI: 10.1158/1538-7445.am2017-425] [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
Prostate cancer is the most frequently diagnosed male cancer. For prostate cancer that has progressed to an advanced or metastatic stage, androgen deprivation therapy (ADT) is the standard of care. ADT inhibits activity of the androgen receptor (AR), a master regulator transcription factor in normal and cancerous prostate cells. The major limitation of ADT is the development of castration-resistant prostate cancer (CRPC), which is almost invariably due to transcriptional re-activation of the AR. One mechanism of AR transcriptional re-activation is expression of AR-V7, a truncated, constitutively active AR variant (AR-V) arising from alternative AR pre-mRNA splicing. Noteworthy, AR-V7 is being developed as a predictive biomarker of primary resistance to androgen receptor (AR)-targeted therapies in CRPC. Multiple additional AR-V species are expressed in clinical CRPC, but the extent to which these may be co-expressed with AR-V7 or predict resistance is not known. Here we utilized long read sequencing to identify and quantify AR isoforms expressed in CRPC. To unambiguously characterize all AR isoforms, we prepared Iso-Seq™ libraries via 3’ rapid amplification of cDNA ends (RACE) with RNA isolated from prostate cancer cell lines and xenograft tissues using a forward primer anchored in AR exon 1. 3’RACE reactions were subjected to single molecule, real-time (SMRT®) long-read sequencing with a Pacific Biosciences RSII System. Our work identified AR-V9 as a truncated isoform that is frequently co-expressed with AR-V7 in CRPC. Mechanistically, our work re-annotated AR-V7 and AR-V9 mRNAs, showing these two species shared a common 3’ terminal exon containing separate splice acceptor sites. Taking into account this new information, novel siRNAs and antibodies which could distinguish between AR-V7 and AR-V9 were designed, validated and used to measure the relative expression of these two AR isoforms in CRPC cells with a view to determining the potential of AR-V9 as a predictive biomarker of primary resistance to AR-targeted therapies.
Citation Format: Manish Kohli, Yeung Ho, David W. Hillman, Jamie L. Van Etten, Christine Henzler, Rendong Yang, Yingming Li, Elizabeth Tseng, Ting Hon, Tyson A. Clark, Liguo Wang, Kevin Silverstein, Liewei Wang, Scott M. Dehm. SMRT® Sequencing of full-length androgen receptor isoforms in prostate cancer reveals previously hidden drug resistant variants [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2017; 2017 Apr 1-5; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2017;77(13 Suppl):Abstract nr 425. doi:10.1158/1538-7445.AM2017-425
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Affiliation(s)
| | - Yeung Ho
- 2University of Minnesota, Minneapolis, MN
| | | | | | | | | | | | | | - Ting Hon
- 3Pacific Biosciences, Menlo Park, CA
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Giridhar K, Sosa C, Hillman DW, Sanhueza CT, Wang L, Cheville JC, Dehm S, Kohli M. Whole blood androgen receptor (AR) variant (ARV12, ARV14) expression and overall survival (OS) in metastatic castrate resistant prostate cancer (mCRPC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5058] [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: 11/20/2022] Open
Abstract
5058 Background: The detection of full length AR (AR-FL) or AR variants (AR-Vs) in blood and association with outcomes in mCRPC is unknown. We compared whole blood mRNA expression of AR-FL and AR-Vs to circulating tumor cells (CTCs) for predicting OS and time to treatment failure (TTF). Methods: We isolated RNA from whole blood collected in PAXgene RNA tubes and concurrent metastatic tissue biopsy from 51 men with mCRPC prior to initiation of abiraterone acetate in a prospective clinical trial (NCT#01953640). Whole transcriptome sequencing (RNAseq) was performed on blood samples and paired biopsies to detect AR-FL, ARV1, ARV3, ARV7, ARV8, AR12, ARV14, and ARV45. Reads were aligned to the GRCh38 reference genome with the spliced-alignment TopHat2 package. The Pearson correlation coefficient was calculated between AR-FL in blood and matched bone biopsy. CTCs were determined using the CELLSEARCH assay. Cox proportional hazard regression analysis was performed on AR-FL, each AR-V, and CTCs for association with OS and TTF. We compared the area under the curve (AUC) using CTCs alone to a multivariable model that included AR-Vs for predicting OS. Results: The median follow up was 3.0 years, (range 0.3-3.5); the median CTC count was 3 (range 0-372); 34/53 men were deceased. Blood based AR-FL or AR-Vs were detected in 50/53 patients with following distribution: AR-FL (41/53), ARV3 (9/53), ARV45 (8/53), ARV12 (4/53), ARV14 (4/53), ARV7 (2/53), and ARV8 (2/53). Whole blood AR-FL transcripts were highly correlated to paired bone biopsy (r2= 0.76). Elevated transcripts of either ARV12 or ARV14 were associated with decreased OS [hazard ratio (HR) 3.46, p = 0.006]. CTC count ≥5 was associated with poorer OS [HR 3.42, p = 0.02] and shorter TTF [HR 3.52, p = < 0.001]. Adjusting for CTC counts, in a multivariate model, blood AR12 expression was associated with poor OS [HR = 6.33, p = 0.009]. AR12 and CTCs trended toward improved AUC compared to CTC alone (0.78 vs 0.71, p = 0.07). Conclusions: AR-FL and AR-Vs are detectable in whole blood and are highly correlated with metastatic bone AR-FL expression. AR-Vs may add to prognostication in mCRPC and further validation is needed. Clinical trial information: NCT#01953640.
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Affiliation(s)
| | | | | | | | | | | | - Scott Dehm
- University of Minnesota, Minneapolis, MN
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Leon-Ferre RA, Polley MY, Liu H, Gilbert JA, Cafourek V, Hillman DW, Elkhanany A, Akinhanmi M, Negron V, Boughey JC, Liu MC, Ingle JN, Kalari KR, Couch F, Visscher DW, Goetz MP. Prognostic value of histopathology, stromal tumor infiltrating lymphocytes (sTILs) and adjuvant chemotherapy (AdjCT) in early stage triple negative breast cancer (TNBC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.533] [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: 11/20/2022] Open
Abstract
533 Background: Current guidelines define TNBC as complete absence of estrogen (ER) and progesterone receptor (PR), without HER2 amplification. However, the prognostic impact of clinical and histopathological factors, sTILs, and AdjCT in TNBC meeting these strict criteria is unknown. Methods: From a cohort of 9985 women who underwent upfront surgery for M0 breast cancer (BC) at Mayo Clinic Rochester from 1985-2012, 1159 pts with ER negative or low (≤10%) BC were identified for central ER/PR/HER2 staining and HER2 FISH (IHC2+ only) to select those with TNBC by modern definitions. Cox proportional hazards models were used to assess the impact of clinicopathological variables on invasive disease-free (IDFS) and overall survival (OS). Results: Tumors from 605 pts (median age 56.3 yrs) met criteria for TNBC (ER < 1%, PR < 1% and HER2 0, 1 or 2+ and FISH negative). 51% were T1, 65% N0, 88% grade 3, and 75% had Ki67 > 15%. Histologically, 39% were anaplastic, 26% invasive ductal, 16% medullary, 8% metaplastic, 6% apocrine and 5% others. Median sTILs was 20% (0-90%). 55% pts received AdjCT [21% anthracycline (A), 19% A + taxane, and 15% other]. Median follow-up for IDFS and OS were 7.4 and 10.6 yrs, respectively. Multivariate analyses demonstrated that higher N stage (p < 0.01), lower sTILs (p = 0.01) and no AdjCT (p < 0.01) were independently associated with worse IDFS and OS. Histology (medullary subtype) was associated with better IDFS in univariate (HR 0.56, 95% CI, 0.35-0.89) but not in multivariate analyses, once sTILs were accounted for. Among systemically untreated pts (n = 182), higher N (p < 0.01) and lower sTILs (p = 0.04) were associated with worse IDFS. For systemically untreated T1N0 pts (n = 111), the 5-yr IDFS was 70% (95% CI, 61-81) [T1a: 83% (95% CI, 63-100), T1b: 68% (95% CI, 52-88) and T1c: 67% (95% CI, 55-83)], compared to 78% (95% CI, 68-84) for T1N0 pts treated with AdjCT. Conclusions: In TNBC pts, N stage, sTILs and receipt of AdjCT were independently prognostic for IDFS and OS. sTILs remained prognostic for IDFS in systemically untreated TNBC. In N0 TNBC, the risk of recurrence or death was substantial in the absence of chemotherapy, even for those with T1 tumors.
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Affiliation(s)
| | | | - Heshan Liu
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN
| | | | | | | | - Ahmed Elkhanany
- University of Missouri at Kansas City Medical School, Kansas City, MO
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Moreno-Aspitia A, Holmes EM, Jackisch C, De Azambuja E, Boyle FM, Hillman DW, Korde LA, Fumagalli D, Izquierdo MA, McCullough AE, Wolff AC, Pritchard KI, Untch M, Lang I, Xu B, Smith IE, Barrios CH, Gelber RD, Baselga J, Piccart-Gebhart MJ. Updated results from the phase III ALTTO trial (BIG 2-06; NCCTG (Alliance) N063D) comparing one year of anti-HER2 therapy with lapatinib alone (L), trastuzumab alone (T), their sequence (T→L) or their combination (L+T) in the adjuvant treatment of HER2-positive early breast cancer. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.502] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
502 Background: Pre-specified 5-year analyses of the phase III Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation (ALTTO) Trial defined in Amendments 11&12. Methods: From June 2007 to July 2011, 8381 patients (pts) were randomised from 946 sites in 44 countries to receive either L+T, T→L, L, or T. In 2011, due to futility the L arm was closed and is not included in this analysis. The primary end point is disease-free survival (DFS). Secondary objectives include treatment comparisons with respect to overall survival (OS), time to recurrence (TTR), time to distant recurrence (TDR), cardiac and overall safety and tolerability. Primary analysis results of the study were published in JCO 2015 34:1034-1042. This updated analysis occurs at a 6.9 yrs median follow up (MFU). Results: All patients have reached 5-years of follow-up. 705 DFS events for L+T vs T have been observed. HR for DFS was 0.86 (95% CI, 0.74-1.00; 6-yr DFS%=85% vs 82%) for L+T vs T and 0.93 (95% CI, 0.81-1.08; 6-yr DFS%=84% vs 82%) for T→L vs. T. The 6-year OS was 93%, 92%, and 91% for L+T, T→L, and T, respectively. HR for OS was 0.86 (95% CI, 0.70-1.06) for L+T vs. T and 0.88 (95% CI, 0.71-1.08) for T→L vs. T. DFS differences for L+T vs. T were slightly higher for the hormone-receptor(ER)-negative [HR 0.80 (95% CI, 0.64-1.00; 6-yr DFS%=84% vs. 80%)] and the sequential chemotherapy [HR 0.83 (95% CI, 0.69-1.00; 6-yr DFS%=83% vs.79%)] subgroups. There were no differences in sites of first DFS events according to treatment arm for CNS, loco-regional, or distant recurrences. There were more AEs related to study treatment (L+T 93% vs T 64%). The incidence of primary cardiac end points was low: 1% for L+T, 0.5% for T→L and 0.9% for T. Conclusions: The HRs for this updated analysis are similar to those from the Primary Analysis and the event rate remains lower than anticipated (705 vs 850 planned). Cardiac toxicity remains low. This analysis suggests that HER2+/ER- tumors may have a different biology than HER2+/ER+ and may benefit more from dual HER2 blockade. Long-term follow up continues. Clinical trial information: NCT00490139.
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Affiliation(s)
| | | | | | | | | | | | - Larissa A. Korde
- Head, Breast Cancer Therapeutics, Clinical Investigations Branch, National Cancer Institute, Bethesda, MD
| | | | | | | | - Antonio C. Wolff
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore, MD
| | | | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | - Binghe Xu
- Cancer Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Carlos H. Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | | | - Jose Baselga
- Memorial Sloan-Kettering Cancer Center, New York, NY
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41
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Kohli M, Wang L, Dehm S, Hillman DW, Sicotte H, Gormley M, Bhargava V, Li W, Tan W, Pitot HC, Ho TH, Costello BA, Bryce AH, Zhenqing Y, Vedell PT, Barman P, Jimenez RE, Carlson R, Wang L. Genome-wide analysis of metastases to reveal association of pathway activation with abiraterone acetate/prednisone (AA/P) primary resistance and cell cycle proliferation pathway activation with response duration in metastatic castrate resistant prostate cancer (mCRPC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.5053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
5053 Background: Genomic aberrations associated with resistance/response to AA/P are not known. In a prospective study we assessed whole-exome/RNA-seq based aberrations in CRPC metastatic biopsies for identifying molecular markers associated with primary resistance and response duration. Methods: Sequencing of metastatic biopsies was performed for analyzing molecular aberrations that predict primary resistance (defined as progression at 12-weeks of therapy (non-responders) using PSA, RECIST, bone scan criteria per PCWG2). Gene network analysis was performed in genes mutated more frequently in non-responders and in genes differentially expressed between non-responders and responders using a “risk ratio” (RR) of ≥2. Cox regression models with multiple gene network pathways were used for determining association with time to treatment change (TTTC). Results: Of 92 enrolled pts 82 had complete whole-exome, RNA-seq & 12-week outcome data available for analysis. At 12-weeks 33/82 had progressed. Using a RR of ≥2, 113 genes were more frequently mutated in non-responders & 292 in responders. In non-responders, gene network analysis revealed frequent mutations in Wnt/β-catenin pathway genes; frequent deletion of negative regulators of Wnt pathway ( DKK4, SFRP2, LRP6). Gene expression analyses revealed significantly reduced expression levels of Wnt/β-catenin pathway inhibitors and increased expression levels of cell cycle proliferation (CCP) genes in non-responders. Median study follow up was 32 months during which time 58/82 pts progressed and switched treatments. Median TTTC was 10.1 months (IQR:4.4-24.1). In multivariate analysis CCP scores of ≥50 predicted shorter TTTC (HR = 2.11, 95% CI: 1.17-3.80; p = 0.01). Conclusions: In metastases Wnt/β-catenin pathway activation is associated with primary AA/P resistance and increased CCP with acquired drug resistance. These findings offer molecular based predictive biomarkers in CRPC stage treatment. Clinical trial information: NCT#01953640.
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Affiliation(s)
| | | | - Scott Dehm
- University of Minnesota, Minneapolis, MN
| | | | | | | | | | - Weimin Li
- Janssen Research and Development, LLC, Spring House, PA
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42
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Kohli M, Ho Y, Hillman DW, Van Etten JL, Henzler C, Yang R, Sperger JM, Li Y, Tseng E, Hon T, Clark T, Tan W, Carlson RE, Wang L, Sicotte H, Thai H, Jimenez R, Huang H, Vedell PT, Eckloff BW, Quevedo JF, Pitot HC, Costello BA, Jen J, Wieben ED, Silverstein KAT, Lang JM, Wang L, Dehm SM. Androgen Receptor Variant AR-V9 Is Coexpressed with AR-V7 in Prostate Cancer Metastases and Predicts Abiraterone Resistance. Clin Cancer Res 2017; 23:4704-4715. [PMID: 28473535 DOI: 10.1158/1078-0432.ccr-17-0017] [Citation(s) in RCA: 103] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/13/2017] [Accepted: 04/27/2017] [Indexed: 01/22/2023]
Abstract
Purpose: Androgen receptor (AR) variant AR-V7 is a ligand-independent transcription factor that promotes prostate cancer resistance to AR-targeted therapies. Accordingly, efforts are under way to develop strategies for monitoring and inhibiting AR-V7 in castration-resistant prostate cancer (CRPC). The purpose of this study was to understand whether other AR variants may be coexpressed with AR-V7 and promote resistance to AR-targeted therapies.Experimental Design: We utilized complementary short- and long-read sequencing of intact AR mRNA isoforms to characterize AR expression in CRPC models. Coexpression of AR-V7 and AR-V9 mRNA in CRPC metastases and circulating tumor cells was assessed by RNA-seq and RT-PCR, respectively. Expression of AR-V9 protein in CRPC models was evaluated with polyclonal antisera. Multivariate analysis was performed to test whether AR variant mRNA expression in metastatic tissues was associated with a 12-week progression-free survival endpoint in a prospective clinical trial of 78 CRPC-stage patients initiating therapy with the androgen synthesis inhibitor, abiraterone acetate.Results: AR-V9 was frequently coexpressed with AR-V7. Both AR variant species were found to share a common 3' terminal cryptic exon, which rendered AR-V9 susceptible to experimental manipulations that were previously thought to target AR-V7 uniquely. AR-V9 promoted ligand-independent growth of prostate cancer cells. High AR-V9 mRNA expression in CRPC metastases was predictive of primary resistance to abiraterone acetate (HR = 4.0; 95% confidence interval, 1.31-12.2; P = 0.02).Conclusions: AR-V9 may be an important component of therapeutic resistance in CRPC. Clin Cancer Res; 23(16); 4704-15. ©2017 AACR.
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Affiliation(s)
- Manish Kohli
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota.
| | - Yeung Ho
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - David W Hillman
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, Minnesota
| | - Jamie L Van Etten
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Christine Henzler
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, Minnesota
| | - Rendong Yang
- Minnesota Supercomputing Institute, University of Minnesota, Minneapolis, Minnesota
| | - Jamie M Sperger
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Yingming Li
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | | | - Ting Hon
- Pacific Biosciences, Menlo Park, California
| | | | - Winston Tan
- Department of Medicine, Mayo Clinic, Jacksonville, Florida
| | - Rachel E Carlson
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, Minnesota
| | - Liguo Wang
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, Minnesota.,Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Hugues Sicotte
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, Minnesota
| | - Ho Thai
- Department of Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Rafael Jimenez
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota
| | - Haojie Huang
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, Minnesota
| | - Peter T Vedell
- Division of Biomedical Statistics and Informatics, Department of Health Sciences, Rochester, Minnesota
| | | | - Jorge F Quevedo
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Henry C Pitot
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Brian A Costello
- Division of Medical Oncology, Department of Oncology, Mayo Clinic, Rochester, Minnesota
| | - Jin Jen
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, Minnesota.,Medical Genome Facility, Mayo Clinic, Rochester, Minnesota.,Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota
| | - Eric D Wieben
- Medical Genome Facility, Mayo Clinic, Rochester, Minnesota
| | | | - Joshua M Lang
- Department of Medicine, Carbone Cancer Center, University of Wisconsin-Madison, Madison, Wisconsin
| | - Liewei Wang
- Department of Molecular Pharmacology and Experimental Therapeutics, Mayo Clinic, Rochester, Minnesota
| | - Scott M Dehm
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota. .,Department of Laboratory Medicine and Pathology, University of Minnesota, Minneapolis, Minnesota.,Department of Urology, University of Minnesota, Minneapolis, Minnesota
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Giridhar K, Hillman DW, Sosa C, Dalpiaz CL, Costello BA, Quevedo F, Pitot HC, Dronca RS, Ertz D, Cheville JC, Donkena K, Kohli M. Whole blood mRNA expression for prognosis of metastatic clear cell renal carcinoma (mCCRCC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.500] [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: 11/20/2022] Open
Abstract
500 Background: The Memorial Sloan Kettering Cancer Center (MSKCC) prognostic score is based on clinical parameters and has several limitations. We analyzed whole blood mRNA expression in mCCRCC patients (pts) and compared it to MSKCC for predicting overall survival (OS). Methods: A prospective collection of whole blood in PAXgene RNA tubes from mCCRCC pts was performed between 2011 and 2015 with uniform processing. A discovery set (DS) of 19 randomly selected pt samples was used to generate whole transcriptome RNA sequencing and signatures describing differential gene expression patterns associated with OS. We calculated the fragment per kilobase of transcript per million (FPKM) of each transcript and gene to identify correlations between the differentially expressed genes and MSKCC score. Candidate genes were selected based on statistical significance (p<0.05) and associations with OS. In an independent validation set (VS) of 47 pts with mCCRCC, we used the nCounter Analysis System (NanoString Technologies, Seattle, WA, USA) to quantify gene transcript expression selected from the DS. Cox regression and Kaplan-Meier analysis were used for association of candidate mRNAs in the VS with OS (time of metastatic recurrence to death or last follow-up). We compared our gene signature to the MSKCC prognostic score for poor versus good survival. Results: In the DS, at a median follow-up of 4.13 years (yrs) (range: 1.3-4.5), 11 patients had died. We identified eighteen genes in the DS with statistically significant differential gene expression patterns and ability to discriminate patient OS. In the VS at a median follow-up of 4.9 yrs (range: 0.1-11.3), twenty-five patients had died. We confirmed two of the eighteen selected genes that had strong prognostic significance: BAG1 [hazard ratio (HR) 0.31, p=0.007] and NOP56 [HR 0.28, p=0.004]. Comparing OS between good and poor outcome groups for these 2 scores, our two-gene panel had higher prognostic ability (HR 20.07, p <0.0001) than the MSKCC prognostic score (HR 3.19, p 0.04). Conclusions: Prognostic value of using whole blood mRNA gene profiling in mCCRCC is feasible and should be prospectively confirmed in larger studies.
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Kohli M, Wang L, Dehm S, Hillman DW, Sicotte H, Gormley M, Bhargava V, Ricci DS, Li W, Tan W, Costello BA, Pitot HC, Dronca RS, Ho TH, Bryce AH, Zhenqing Y, Vedell PT, Barman P, Carlson R, Wang L. Association of Wnt pathway activation with prechemotherapy abiraterone acetate resistance in metastatic castration-resistant prostate cancer (mCRPC) by genome-wide analysis of metastases. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
175 Background: Genome and transcriptome aberrations associated with primary resistance to abiraterone acetate/prednisone (AA/P) in mCRPC are not known. In a prospective trial (NCT#01953640) we assessed whole-exome and RNA-seq based aberrations in metastases of CRPC stage patients (pts) for identifying markers associated with primary resistance to AA/P. Methods: Whole-exome and RNA-seq of biopsies from metastases was performed followed by analyses for association between genomic aberrations & primary resistance. Primary resistance was defined by progression on AA/P after 12-weeks of therapy(non-responders) using PSA, RECIST, bone scan and symptom criteria (per PCWG2). Gene network analysis was performed in genes mutated more frequently in non-responders, and also in genes that were differentially expressed between non-responders and responders and a “risk ratio” (RR) was calculated thereof. Results: Between 6/2013 & 8/2015, 92 pts were enrolled of which 82 had complete whole-exome, RNA-seq and 12-week outcome data available for analysis. Median age was 72.5 yrs (IQR: 68.5-78); median PSA-18 ng/ml (IQR: 8.1- 46.6). At 12-weeks 33/82 had progressed. Using the RR of 2 as threshold, we identified 113 and 292 genes that were more frequently mutated in non-responders & responders respectively. Among the 113 genes, OBSCN, ADAM21, LPHN3, DOCK10 ( P = 0.08, RR= inf) & USP42 ( P = 0.16, RR = 5.71) were the top candidates.Gene network analysis revealed that in non-responders, genes involved in the Wnt/β-catenin pathway were frequently mutated and negative regulators of Wnt pathway ( DKK4, SFRP2 & LRP6) were also frequently deleted. Gene expression analyses revealed the expression levels of Wnt/β-catenin pathway inhibitors were significantly reduced while expression levels of cell cycle regulatory genes were significantly increased in non-responders. Conclusions: In this study we observed Wnt/β-catenin pathway activation to be associated with primary AA/P resistance. This finding offers a potential for the development of predictive biomarkers and modulation of targeted pathways to overcome AA/P resistance. Clinical trial information: NCT# 01953640.
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Affiliation(s)
| | | | - Scott Dehm
- University of Minnesota, Minneapolis, MN
| | | | | | | | | | | | - Weimin Li
- Janssen Research & Development, Spring House, PA
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Kohli M, Li J, Du M, Hillman DW, Tan W, Carlson R, Wang L, Wang L, Liu MC, Zhang H, Zhang P, Wang L. Circulating tumor cells (CTCs) and plasma cell free DNA (cfDNA) androgen receptor amplification ( ARamp)-based prognosis in metastatic castration-resistant prostate cancer (mCRPC). J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.152] [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: 11/20/2022] Open
Abstract
152 Background: Plasma cfDNA ARcopy number variations (CNV) have been suggested to have prognostic significance in mCRPC stage. We compared plasma AR amplification ( ARamp) with CTC counts (the only FDA approved prognostic marker in mCRPC stage) in a prospective trial of patients (pts) progressing on androgen deprivation therapy. Methods: Plasma and CTC counts were obtained concurrently as part of a prospective clinical trial in mCRPC stage pts initiating abiraterone acetate (NCT# 01953640). Plasma cfDNA was purified using DNA Blood Mini Kit (Qiagen, Valencia, CA) and AR CNVs were detected using QuantStudio3D digital PCR system (Life Technologies, Carlsbad, CA, USA). CTC enumeration was performed using the FDA cleared CellSearch platform. The distributions of overall survival (OS) time based on ARamp status and CTC counts ( < 5 vs ≥ 5 cells) were estimated using the Kaplan-Meier method. Log-rank tests were used to test association of ARamp status and CTC counts with overall survival (OS). Univariate and multivariate logistic regression models and ROC evaluated association of OS at 24 months by ARamp status and CTCs ≥ 5. Results: Between 05/2013 and 09/2015, 92 pts were enrolled of which complete CTC, plasma and outcome data was available for 70 pts. Median age of the cohort (range) was 72 yrs (39-91); Median PSA–16.2 ng/ml (range: 0.9-2026.0); Median CTC count was 2.0 (range: 0-372); 58/70 pts had bone metastases; 38/70 had high volume and 32/70 had low volume metastatic disease at the time of sample collection. The median (range) follow up time at the time of this analysis was: 26.5 (7.9-37.0) months at which time 28/70 patients had died. ARamp was present in 19/70 pts while 51/70 did not have amplification. 24/70 had CTCs ≥ 5. A significant association of increased ARamp status with OS (p < 0.0001, log-rank test; AUC: 0.66) as well as with CTC counts ≥ 5 (p = 0.001, log-rank test; AUC: 0.67) was observed. Combining CTC status and plasma ARamp status the AUC was 0.75. Conclusions: Plasma cfDNA ARamp status and CTC counts have comparable and clinically meaningful prognostic marker value in mCRPC stage patients.
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Affiliation(s)
| | - Jian Li
- Medical College Wisconsin, Milwaukee, WI
| | - Meijun Du
- Medical College Wisconsin, Milwaukee, WI
| | | | | | | | | | | | | | | | - Peng Zhang
- Medical College Wisconsin, Milwaukee, WI
| | - Liang Wang
- Medical College Wisconsin, Milwaukee, WI
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Kohli M, Hillman DW, Wang L, Li Y, Sicotte H, Carlson R, Tan W, Wu K, Eiken PW, Jimenez RE, Cernigliaro J, Quevedo F, Costello BA, Pitot HC, Moynihan TJ, Ho TH, Bryce AH, Wang L, Dehm S. Association of androgen receptor variant 9 ( AR-V9) mRNA expression levels in metastatic tissue with resistance to abiraterone acetate/prednisone (AA/P). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.5036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Scott Dehm
- University of Minnesota, Minneapolis, MN
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Kohli M, Hillman DW, Carlson R, Wang L, Li Y, Tan W, Ho TH, Sicotte H, Wang L, Costello BA, Pitot HC, Quevedo F, Dronca RS, Moynihan TJ, Atwell TD, Eiken PW, McMenomy BP, Bryce AH, Wu K, Dehm S. Association of androgen receptor V9 (ARV9) mRNA expression in metastatic tissue with early resistance to pre-chemotherapy abiraterone acetate/prednisone (AA/P). J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.2_suppl.237] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
237 Background: AA/P is an approved treatment for mCRPC but there are no known predictive markers of response or resistance. We conducted a prospective trial to evaluate if Androgen Receptor (AR) & AR-variant (ARV) expression in tissue metastases can predict resistance to AA/P. Methods: mCRPC stage patients (pts) initiating pre-chemo AA/P underwent metastatic site biopsies prior to (pre-AA/P) and after 12 weeks of treatment. Composite progression at 12 weeks, (primary endpoint) was evaluated with PSA, RECIST, bone scan and symptoms (per PCWG2). mRNA expressions of pre-AA/P ARFL, ARV3, ARV7, ARV9, ARV23, ARV45, four cell cycle division genes, Chromogranin-A (CHGA) together with PSA/testosterone levels, Gleason Score (GS) at initial diagnosis; high versus low volume disease; time from starting hormone therapy to mCRPC stage and serum CHGA levels were evaluated using a logistic regression model for predicting resistance at 12 weeks of therapy. A final multivariate model fitted only those factors thought to be clinically relevant or with an entry threshold of p ≤ 0.3 in univariate analysis. Results: Between 6/2013 & 3/2015, 82 pts were enrolled of which 52 had complete mRNA expression & disease assessment data at the12-week time point for analysis. Median age of the cohort was 72.5 yrs (IQR: 68.5-78); median pre-AA/P PSA was 18 ng/ml (IQR: 8.1- 46.6); GS distribution at initial diagnosis for GS 2-6; 7; 8-10 was 11; 14; 27 respectively. Progression was observed in 21/52 pts after 12 weeks. At the univariate level elevated pre-AA/P expression of ARV3 (p = 0.08), ARV7 (p = 0.26), ARV9 (p = 0.04), and cell division cycle gene CDC45 (p = 0.19) along with GS at diagnosis (p = 0.29) met the threshold for inclusion into multivariate analysis. Elevated expression of pre-therapy ARV9 in metastases alone was associated with progression at 12 weeks (OR: 3.9; CI 1.07 – 14.16; C-Index: 0.63). The 12-week biopsy of pts with progression had increased ARV9 mRNA expression compared to pts responding at 12 weeks (p = 0.14). Conclusions: Increased ARV9 mRNA expression in metastases is associated with early resistance to AA/P. This observation will need further validation in comparable datasets. Clinical trial information: NCT #0195364.
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Affiliation(s)
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- University of Minnesota, Minneapolis, MN
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Piccart-Gebhart M, Holmes E, Baselga J, de Azambuja E, Dueck AC, Viale G, Zujewski JA, Goldhirsch A, Armour A, Pritchard KI, McCullough AE, Dolci S, McFadden E, Holmes AP, Tonghua L, Eidtmann H, Dinh P, Di Cosimo S, Harbeck N, Tjulandin S, Im YH, Huang CS, Diéras V, Hillman DW, Wolff AC, Jackisch C, Lang I, Untch M, Smith I, Boyle F, Xu B, Gomez H, Suter T, Gelber RD, Perez EA. Adjuvant Lapatinib and Trastuzumab for Early Human Epidermal Growth Factor Receptor 2-Positive Breast Cancer: Results From the Randomized Phase III Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization Trial. J Clin Oncol 2015; 34:1034-42. [PMID: 26598744 DOI: 10.1200/jco.2015.62.1797] [Citation(s) in RCA: 268] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Lapatinib (L) plus trastuzumab (T) improves outcomes for metastatic human epidermal growth factor 2-positive breast cancer and increases the pathologic complete response in the neoadjuvant setting, but their role as adjuvant therapy remains uncertain. METHODS In the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization trial, patients with centrally confirmed human epidermal growth factor 2-positive early breast cancer were randomly assigned to 1 year of adjuvant therapy with T, L, their sequence (T→L), or their combination (L+T). The primary end point was disease-free survival (DFS), with 850 events required for 80% power to detect a hazard ratio (HR) of 0.8 for L+T versus T. RESULTS Between June 2007 and July 2011, 8,381 patients were enrolled. In 2011, due to futility to demonstrate noninferiority of L versus T, the L arm was closed, and patients free of disease were offered adjuvant T. A protocol modification required P ≤ .025 for the two remaining pairwise comparisons. At a protocol-specified analysis with a median follow-up of 4.5 years, a 16% reduction in the DFS hazard rate was observed with L+T compared with T (555 DFS events; HR, 0.84; 97.5% CI, 0.70 to 1.02; P = .048), and a 4% reduction was observed with T→L compared with T (HR, 0.96; 97.5% CI, 0.80 to 1.15; P = .61). L-treated patients experienced more diarrhea, cutaneous rash, and hepatic toxicity compared with T-treated patients. The incidence of cardiac toxicity was low in all treatment arms. CONCLUSION Adjuvant treatment that includes L did not significantly improve DFS compared with T alone and added toxicity. One year of adjuvant T remains standard of care.
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Affiliation(s)
- Martine Piccart-Gebhart
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Eileen Holmes
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - José Baselga
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Evandro de Azambuja
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Amylou C Dueck
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Giuseppe Viale
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Jo Anne Zujewski
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Aron Goldhirsch
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Alison Armour
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Kathleen I Pritchard
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Ann E McCullough
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Stella Dolci
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Eleanor McFadden
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Andrew P Holmes
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Liu Tonghua
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Holger Eidtmann
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Phuong Dinh
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Serena Di Cosimo
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Nadia Harbeck
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Sergei Tjulandin
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Young-Hyuck Im
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Chiun-Sheng Huang
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Véronique Diéras
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - David W Hillman
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Antonio C Wolff
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Christian Jackisch
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Istvan Lang
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Michael Untch
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Ian Smith
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Frances Boyle
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Binghe Xu
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Henry Gomez
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Thomas Suter
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Richard D Gelber
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
| | - Edith A Perez
- Martine Piccart-Gebhart, Université Libre de Bruxelles, Brussels, Belgium; Eileen Holmes, Eleanor McFadden, and Andrew P. Holmes, Frontier Science (Scotland), Kincraig, Kingussie, United Kingdom; José Baselga, Memorial Sloan Kettering Cancer Center, New York, NY; Evandro de Azambuja, Institut Jules Bordet, Brussels, Belgium; Evandro de Azambuja and Stella Dolci, Breast European Adjuvant Study Team, Brussels, Belgium; Amylou C. Dueck and Anne E. McCullough, Mayo Clinic, Scottsdale, AZ; Giuseppe Viale, University of Milan, Milan, Italy; Giuseppe Viale and Aron Goldhirsch, Istituto Europeo di Oncologia, Milan, Italy; Jo Anne Zujewski, National Cancer Institute, Bethesda, MD; Aron Goldhirsch, Ospedale Regionale di Lugano, Viganello-Lugano, Switzerland; Alison Armour, GlaxoSmithKline, Collegeville, PA; Kathleen I. Pritchard, Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada; Kathleen I. Pritchard, University of Toronto, Toronto, Ontario, Canada; Liu Tonghua, Peking Union Medical College Hospital, Beijing, People's Republic of China; Liu Tonghua and Binghe Xu, China Academy of Chinese Medical Sciences, Beijing, People's Republic of China; Holger Eidtmann, University Hospital Kiel, Kiel, Germany; Phuong Dinh, Breast International Group, Brussels, Belgium; Serena Di Cosimo, Istituto Nazionale del Tumori, Milan, Italy; Serena Di Cosimo, SOLTI Breast Cancer Research Group, Barcelona, Spain; Nadia Harbeck, Frauenklinik der Universität München, Munich, Germany; Sergei Tjulandin, Blokhin Russian Cancer Research Center of RAMS, Moscow, Russia; Young-Hyuck Im, Korean Cancer Study Group, Seoul, South Korea; Young-Hyuck Im, Samsung Medical Center, Seoul, South Korea; Chiun-Shen Huang, National Taiwan University Hospital, Taipei, Republic of China; Véronique Diéras, Institut Curie, Paris, France; David W. Hillman, Mayo Clinic, Rochester, MN; Antonio C. Wolff, The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD; Christian Jackisch, Klinikum Offenba
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Liu MC, Rack B, Dueck AC, Hillman DW, Campion MB, Reinholz MM, Halling KC, Sotiriou C, Rothé F, Maetens M, Rouas G, Janni W, Wolff AC, Harris LN, Gralow JR, Pritchard KI, Ellard S, Le-Lindqwister NA, Boyle F, De Azambuja E, Piccart-Gebhart MJ, Ignatiadis M, Perez EA. Abstract P4-01-01: Circulating tumor cell (CTC) enumeration and HER2 assessment as predictors of breast cancer outcomes in the ALTTO (BIG 2-06, Alliance N063D) Trial. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p4-01-01] [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: CTCs are associated with clinical outcomes in metastatic breast cancer irrespective of ER/PR/HER2 status. Some data support the prognostic relevance of serial CTC enumeration relative to adjuvant chemotherapy in early stage breast cancer. However, data from a large scale study focused on HER2 directed therapy for HER2+ disease have been lacking. We therefore sought to prospectively evaluate the effect of trastuzumab +/- lapatinib on CTCs and assess the prognostic/predictive value of CTC monitoring in HER2+ early stage breast cancer patients (pts).
Methods: The Adjuvant Lapatinib and/or Trastuzumab Treatment Optimisation (ALTTO; NCT00490139) Trial is an international, randomized, open-label phase III study of two targeted agents for HER2+ breast cancer. From June 2007 to July 2011, 8381 pts were randomised from 946 sites in 44 countries to 1 of 4 arms with sequential or concurrent chemotherapy: (i) 52 wks of trastuzumab (T); (ii) 52 wks of oral lapatinib (L); (iii) 12 or 18 wks of T followed by a washout and then 34 or 38 wks of L; or (iv) 52 wks of L+T. 540 (6%) pts provided optional informed consent and up to 30 mL peripheral blood suitable for CTC analyses at baseline with additional collections at 13 or 19 wks, 52 wks, 18 mos, 24 mos, and recurrence. CTC analyses are being conducted in three laboratories (Mayo Clinic Rochester, n=431; Institut Jules Bordet and University of Munich, n=109). 2-3 x 10 mL CellSave™ samples are pooled and processed at each time point for CTC enumeration and HER2 expression using the immunomagnetic/immunofluorescence assay (CellSearch™). A round-robin concordance project was done between Mayo Clinic Rochester and Institut Jules Bordet before embarking on the primary correlative work.
Results: At baseline, 20% pts had detectable (i.e., ≥1) EpCAM+/CK+/DAPI+/CD45- CTCs, and 16% pts had detectable EpCAM+/CK+/DAPI+/CD45-/HER2+ CTCs. Correlative analyses with clinical outcome are ongoing with plans for completion by Fall 2014.
Conclusions: CTCs were detected in 20% of pts with HER2+ early stage breast cancer. This is similar to the frequency of detection in mixed early stage breast cancer populations relative to ER/PR and HER2 status. Concordance of enumeration and HER2 assessments between the two experienced laboratories, and correlation between disease free survival and CTC findings (from serial samples collected at baseline, during the course of HER2 directed therapy, and at set intervals of follow-up) will be reported.
Citation Format: Minetta C Liu, Brigitte Rack, Amylou C Dueck, David W Hillman, Michael B Campion, Monica M Reinholz, Kevin C Halling, Christos Sotiriou, Françoise Rothé, Marion Maetens, Ghizlane Rouas, Wolfgang Janni, Antonio C Wolff, Lyndsay N Harris, Julie R Gralow, Kathleen I Pritchard, Susan Ellard, Nguyet A Le-Lindqwister, Frances Boyle, Evandro De Azambuja, Martine J Piccart-Gebhart, Michail Ignatiadis, Edith A Perez. Circulating tumor cell (CTC) enumeration and HER2 assessment as predictors of breast cancer outcomes in the ALTTO (BIG 2-06, Alliance N063D) Trial [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P4-01-01.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Antonio C Wolff
- 7Johns Hopkins Hpsital/Sidney Kimmel Comprehensive Cancer Center
| | | | | | | | - Susan Ellard
- 12British Columbia Cancer Agency, Southern Interior
| | | | - Frances Boyle
- 14Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Mater Hospital
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Dueck AC, Hillman DW, Kottschade LA, Halyard MY, Sloan JA, Flickinger LM, Wolff AC, Harris L, Gralow J, Pritchard KI, Ellard S, Le-Lindqwister N, Boyle FM, De Azambuja E, McCaskill-Stevens WJ, Zujewski JA, Piccart-Gebhart MJ, Perez EA. Quality of life (QOL) among patients (pts) with HER2+ breast cancer (bc) treated with adjuvant lapatinib and/or trastuzumab in the ALTTO study (BIG 2-06, Alliance N063D). J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.647] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Antonio C. Wolff
- The Johns Hopkins Hospital and The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD
| | | | | | | | - Susan Ellard
- British Columbia Cancer Agency (Centre for the Southern Interior), Kelowna, BC, Canada
| | | | - Frances M. Boyle
- Patricial Rigchie Centre for Cancer Care and Research, North Sydney NSW, Australia
| | - Evandro De Azambuja
- Institut Jules Bordet, Brussels, Université Libre de Bruxelles, Brussels, Belgium
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