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Ferrigno Guajardo AS, Vaca-Cartagena BF, Mayer EL, Bousrih C, Oluchi O, Saura C, Peccatori F, Muñoz-Montaño W, Cabrera-Garcia A, Lambertini M, Corrales L, Becerril-Gaitan A, Sella T, Newman AB, Pistilli B, Martinez A, Ortiz C, Joval-Ramentol L, Scarfone G, Buonomo B, Lara-Medina F, Sanchez J, Arecco L, Ramos-Esquivel A, Susnjar S, Morgan G, Villarreal-Garza C, Azim HA. Taxanes for the treatment of breast cancer during pregnancy: an international cohort study. J Natl Cancer Inst 2024; 116:239-248. [PMID: 38059798 DOI: 10.1093/jnci/djad219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/19/2023] [Accepted: 10/11/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION The addition of taxanes to anthracycline-based chemotherapy is considered standard of care in the treatment of breast cancer. However, there are insufficient data regarding the safety of taxanes during pregnancy. The aim of this study was to describe the incidence of obstetric and neonatal adverse events associated with the use of taxane-containing chemotherapy regimens for the treatment of breast cancer during pregnancy. METHODS This is a multicenter, international cohort study of breast cancer patients treated with taxanes during pregnancy. A descriptive analysis was undertaken to synthetize available data. RESULTS A total of 103 patients were included, most of whom were treated with paclitaxel and anthracyclines given in sequence during gestation (90.1%). The median gestational age at taxane initiation was 28 weeks (range = 12-37 weeks). Grade 3-4 adverse events were reported in 7 of 103 (6.8%) patients. The most common reported obstetric complications were intrauterine growth restriction (n = 8 of 94, 8.5%) and preterm premature rupture of membranes (n = 5 of 94, 5.3%). The live birth rate was 92 of 94 (97.9%), and the median gestational age at delivery was 37 weeks (range = 32-40 weeks). Admission to an intensive care unit was reported in 14 of 88 (15.9%) neonates, and 17 of 70 (24.3%) live births resulted in small for gestational age neonates. Congenital malformations were reported in 2 of 93 (2.2%). CONCLUSION Obstetric and neonatal outcomes after taxane exposure during pregnancy were generally favorable and did not seem to differ from those reported in the literature with standard anthracycline-based regimens. This study supports the use of taxanes during gestation when clinically indicated.
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Affiliation(s)
| | - Bryan F Vaca-Cartagena
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Erica L Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Chayma Bousrih
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Oke Oluchi
- Department of General Oncology and Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cristina Saura
- Medical Oncology Service, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Fedro Peccatori
- Gynecologic Oncology Program, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) European Institute of Oncology, Milan, Italy
| | - Wendy Muñoz-Montaño
- Clinica de Tumores Mamarios, Instituto Nacional de Cancerología, Ciudad de Mexico, Mexico
| | - Alvaro Cabrera-Garcia
- Servicio de Hematología, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, State of Mexico, Mexico
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Luis Corrales
- Department of Medical Oncology, Centro de Investigación y Manejo del Cáncer, San José, Costa Rica
| | | | - Tal Sella
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Ashley Martinez
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carolina Ortiz
- Medical Oncology Service, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Laia Joval-Ramentol
- Oncology Data Science Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Giovanna Scarfone
- Gynecologic Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Buonomo
- Gynecologic Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Fernando Lara-Medina
- Clinica de Tumores Mamarios, Instituto Nacional de Cancerología, Ciudad de Mexico, Mexico
| | - Jacqueline Sanchez
- Servicio de Hematología, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, State of Mexico, Mexico
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Allan Ramos-Esquivel
- Servicio de Oncología Medica, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Snezana Susnjar
- Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Gilberto Morgan
- Division of Medical/Radiation Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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Aranda-Gutierrez A, Ferrigno Guajardo AS, Vaca-Cartagena BF, Gonzalez-Sanchez DG, Ramirez-Cisneros A, Becerril-Gaitan A, Azim HA, Villarreal-Garza C. Obstetric and neonatal outcomes following taxane use during pregnancy: a systematic review. BMC Cancer 2024; 24:9. [PMID: 38166767 PMCID: PMC10763111 DOI: 10.1186/s12885-023-11704-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 12/02/2023] [Indexed: 01/05/2024] Open
Abstract
BACKGROUND The use of taxanes following the first trimester of pregnancy is endorsed by current clinical guidelines. However, evidence regarding their safety in terms of obstetric and neonatal outcomes is limited. METHODS A comprehensive literature search was performed using the MEDLINE, CENTRAL and Web of Sciences databases from their inception up to 12/16/2022. Eligibility criteria included gestational taxane use, presentation of original findings, and individual case data presented. A descriptive statistical analysis was undertaken. RESULTS A total of 159 patients treated with taxane-containing regimens during pregnancy were identified, resulting in 162 fetuses exposed in utero. The majority of patients had breast cancer (n = 88; 55.3%) or cervical cancer (n = 45; 28.3%). The most commonly employed taxane was paclitaxel (n = 131; 82.4%). A total of 111 (69.8%) patients were also treated with other cytotoxic drugs during pregnancy, including platinum salts (n = 70; 63.0%) and doxorubicin/cyclophosphamide (n = 20; 18.0%). While most patients received taxanes during the second trimester of pregnancy (n = 79; 70.0%), two were exposed to taxanes in the first trimester. Obstetric outcomes were reported in 105 (66.0%) cases, with the most frequent adverse events being preterm contractions or premature rupture of membranes (n = 12; 11.4%), pre-eclampsia/HELLP syndrome (n = 6; 5.7%), and oligohydramnios/anhydramnios (n = 6; 5.7%). All cases with pregnancy outcome available resulted in live births (n = 132). Overall, 72 (54.5%) neonates were delivered preterm, 40 (30.3%) were classified as small for gestational age (SGA), and 2 (1.5%) had an Apgar score of < 7 at 5 min. Perinatal complications included acute respiratory distress syndrome (n = 14; 10.6%), hyperbilirubinemia (n = 5; 3.8%), and hypoglycemia (n = 2; 1.5%). In addition, 7 (5.3%) cases of congenital malformations were reported. At a median follow-up of 16 months, offspring health status was available for 86 (65.2%), of which 13 (15.1%) had a documented complication, including delayed speech development, recurrent otitis media, and acute myeloid leukemia. CONCLUSIONS Taxanes appear to be safe following the first trimester of pregnancy, with obstetric and fetal outcomes being similar to those observed in the general obstetric population. Future studies should aim to determine the most effective taxane regimen and dosage for use during gestation, with a specific focus on treatment safety.
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Affiliation(s)
- Alejandro Aranda-Gutierrez
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran, Mexico City, Mexico
| | | | - Bryan F Vaca-Cartagena
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - David G Gonzalez-Sanchez
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Arantxa Ramirez-Cisneros
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Andrea Becerril-Gaitan
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico.
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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Lambertini M, Blondeaux E, Agostinetto E, Hamy AS, Kim HJ, Di Meglio A, Bernstein Molho R, Hilbers F, Pogoda K, Carrasco E, Punie K, Bajpai J, Ignatiadis M, Moore HCF, Phillips KA, Toss A, Rousset-Jablonski C, Peccatori FA, Renaud T, Ferrari A, Paluch-Shimon S, Fruscio R, Cui W, Wong SM, Vernieri C, Ruddy KJ, Dieci MV, Matikas A, Rozenblit M, Villarreal-Garza C, De Marchis L, Del Mastro L, Puglisi F, Del Pilar Estevez-Diz M, Rodriguez-Wallberg KA, Mrinakova B, Meister S, Livraghi L, Clatot F, Yerushalmi R, De Angelis C, Sánchez-Bayona R, Meattini I, Cichowska-Cwalińska N, Berlière M, Salama M, De Giorgi U, Sonnenblick A, Chiodi C, Lee YJ, Maria C, Azim HA, Boni L, Partridge AH. Pregnancy After Breast Cancer in Young BRCA Carriers: An International Hospital-Based Cohort Study. JAMA 2024; 331:49-59. [PMID: 38059899 PMCID: PMC10704340 DOI: 10.1001/jama.2023.25463] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 11/17/2023] [Indexed: 12/08/2023]
Abstract
Importance Young women with breast cancer who have germline pathogenic variants in BRCA1 or BRCA2 face unique challenges regarding fertility. Previous studies demonstrating the feasibility and safety of pregnancy in breast cancer survivors included limited data regarding BRCA carriers. Objective To investigate cumulative incidence of pregnancy and disease-free survival in young women who are BRCA carriers. Design, Setting, and Participants International, multicenter, hospital-based, retrospective cohort study conducted at 78 participating centers worldwide. The study included female participants diagnosed with invasive breast cancer at age 40 years or younger between January 2000 and December 2020 carrying germline pathogenic variants in BRCA1 and/or BRCA2. Last delivery was October 7, 2022; last follow-up was February 20, 2023. Exposure Pregnancy after breast cancer. Main Outcomes and Measures Primary end points were cumulative incidence of pregnancy after breast cancer and disease-free survival. Secondary end points were breast cancer-specific survival, overall survival, pregnancy, and fetal and obstetric outcomes. Results Of 4732 BRCA carriers included, 659 had at least 1 pregnancy after breast cancer and 4073 did not. Median age at diagnosis in the overall cohort was 35 years (IQR, 31-38 years). Cumulative incidence of pregnancy at 10 years was 22% (95% CI, 21%-24%), with a median time from breast cancer diagnosis to conception of 3.5 years (IQR, 2.2-5.3 years). Among the 659 patients who had a pregnancy, 45 (6.9%) and 63 (9.7%) had an induced abortion or a miscarriage, respectively. Of the 517 patients (79.7%) with a completed pregnancy, 406 (91.0%) delivered at term (≥37 weeks) and 54 (10.4%) had twins. Among the 470 infants born with known information on pregnancy complications, 4 (0.9%) had documented congenital anomalies. Median follow-up was 7.8 years (IQR, 4.5-12.6 years). No significant difference in disease-free survival was observed between patients with or without a pregnancy after breast cancer (adjusted hazard ratio, 0.99; 95% CI, 0.81-1.20). Patients who had a pregnancy had significantly better breast cancer-specific survival and overall survival. Conclusions and Relevance In this global study, 1 in 5 young BRCA carriers conceived within 10 years after breast cancer diagnosis. Pregnancy following breast cancer in BRCA carriers was not associated with decreased disease-free survival. Trial Registration ClinicalTrials.gov Identifier: NCT03673306.
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Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Eva Blondeaux
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Elisa Agostinetto
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Anne-Sophie Hamy
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hee Jeong Kim
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Antonio Di Meglio
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Rinat Bernstein Molho
- Susanne Levy Gertner Oncogenetics Unit, Danek Gertner Institute of Human Genetics, Chaim Sheba Medical Center Affiliated to Tel Aviv University, Tel Hashomer, Israel
| | - Florentine Hilbers
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Estela Carrasco
- Hereditary Cancer Genetics Unit, Medical Oncology Department, Vall d´Hebron University Hospital, Vall d´Hebron Institute of Oncology, Barcelona, Spain
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Center, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Jyoti Bajpai
- Department of Medical Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Michail Ignatiadis
- Breast Medical Oncology Clinic, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - Halle C. F. Moore
- Department of Hematology and Medical Oncology, Cleveland Clinic Taussig Cancer Institute, Cleveland, Ohio
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
- Centre for Epidemiology and Biostatistics, School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Angela Toss
- Department of Oncology and Haematology, Azienda Ospedaliero–Universitaria di Modena, Modena, Italy
- Department of Medical and Surgical Sciences, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Fedro A. Peccatori
- Gynecologic Oncology Department, European Institute of Oncology (IRCCS), Milan, Italy
| | | | - Alberta Ferrari
- Hereditary Breast and Ovarian Cancer Unit and General Surgery 3–Senology, Surgical Department, Fondazione IRCCS Policlinico San Matteo, and University of Pavia, Pavia, Italy
| | - Shani Paluch-Shimon
- Breast Oncology Unit, Sharett Institute of Oncology, Hadassah University Hospital, and Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Robert Fruscio
- UO Gynecology, Department of Medicine and Surgery, University of Milan–Bicocca, IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Victoria, Australia
| | - Stephanie M. Wong
- Stroll Cancer Prevention Centre, Jewish General Hospital, and McGill University Medical School, Montreal, Quebec, Canada
| | - Claudio Vernieri
- Department of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
- IFOM ETS, AIRC Institute of Molecular Oncology, Milan, Italy
| | - Kathryn J. Ruddy
- Department of Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota
| | - Maria Vittoria Dieci
- Dipartimento di Scienze Chirurgiche, Oncologiche, e Gastroenterologiche, Università di Padova, Padova, Italy
- Oncologia 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Alexios Matikas
- Department of Oncology/Pathology, Karolinska Institute, and Breast Center, Karolinska University Hospital, Stockholm, Sweden
| | - Mariya Rozenblit
- Department of Medical Oncology, Smilow Cancer Hospital at Yale New Haven, New Haven, Connecticut
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
| | - Laura De Marchis
- Department of Radiological, Oncological, and Pathological Sciences, Sapienza University of Rome, Rome, Italy
- Division of Oncology, Department of Hematology, Oncology, and Dermatology, Umberto 1 University Hospital, Rome, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U. O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Avano (CRO) IRCCS, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Maria Del Pilar Estevez-Diz
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Kenny A. Rodriguez-Wallberg
- Department of Oncology-Pathology, Laboratory of Translational Fertility Preservation, Karolinska Institute, Stockholm, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Bela Mrinakova
- First Department of Oncology, Comenius University and St Elisabeth Cancer Institute, Bratislava, Slovakia
| | - Sarah Meister
- Department of Obstetrics and Gynecology, Ludwig Maximilian University (LMU) Hospital, LMU Munich, Germany
| | - Luca Livraghi
- Department of Medical Oncology, Azienda Ospedaliera Papa Giovanni XXIII, Bergamo, Italy
- Department of Medical Oncology, Hospital of Prato, Azienda USL Toscana Centro, Italy
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Rinat Yerushalmi
- Department of Medical Oncology, Davidoff Center, Rabin Medical Center, Petah Tikva, Tel Aviv University, Tel Aviv, Israel
| | - Carmine De Angelis
- Department of Medical Oncology, University of Naples Federico II, Napoli, Italy
| | | | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences M. Serio, University of Florence, and Radiation Oncology Unit, Oncology Department, Florence University Hospital, Florence, Italy
| | - Natalia Cichowska-Cwalińska
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
- Early Phase Clinical Trials Centre, Medical University of Gdańsk, Gdańsk, Poland
| | - Martine Berlière
- Department of Medical Oncology and Breast Surgery, Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCL), Brussels, Belgium
| | - Mahmoud Salama
- Oncofertility Consortium and Department of Obstetrics, Gynecology, and Reproductive Biology, Michigan State University, East Lansing
| | - Ugo De Giorgi
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori Dino Amadori, Meldola, Italy
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center, Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Camila Chiodi
- Cancer Survivorship Program–Molecular Predicitors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Young-Jin Lee
- Division of Breast Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Camille Maria
- Department of Medical Oncology, Universite Paris Cité, Institut Curie, Paris, France
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion–TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
- Cairo Oncology Center, Cairo, Egypt
| | - Luca Boni
- U. O. Epidemiologia Clinica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts
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Azim HA, Loutfy SA, Azim HA, Kamal NS, Abdel Fattah NF, Elberry MH, Abdelaziz MR, Abdelsalam M, Aziz M, Shohdy KS, Kassem L. The Landscape of BRCA Mutations among Egyptian Women with Breast Cancer. Oncol Ther 2023; 11:445-459. [PMID: 37731153 PMCID: PMC10673778 DOI: 10.1007/s40487-023-00240-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/09/2023] [Indexed: 09/22/2023] Open
Abstract
BACKGROUND Deleterious germline mutations in BRCA1 and BRCA2 genes are associated with a high risk of breast and ovarian cancer. In many developing countries, including Egypt, the prevalence of BRCA1/2 mutations among women with breast cancer (BC) is unknown. AIM We aimed to determine the prevalence of deleterious germline BRCA mutations in Egyptian patients with breast cancer. METHODS We report the results of a cohort study of 81 Egyptian patients with breast cancer who were tested for germline BRCA1/2 mutations during routine clinical practice, mostly for their young age of presentation, BC subtype, or presence of family history. In addition, we searched five databases to retrieve studies that reported the prevalence of BRCA1/2 mutation status in Egyptian women with BC. A systematic review of the literature was performed, including prospective and retrospective studies. RESULTS In our patient cohort study, 12 patients (14.8%) were positive for either BRCA1/2 deleterious mutations. Moreover, 13 (16.1%) patients had a variant of unknown significance (VUS) of BRCA1/2 genes. Twelve studies were eligible for the systematic review, including 610 patients. A total of 19 deleterious germline mutations in BRCA1/2 were identified. The pooled prevalence of BRCA1/2 mutations was 40% (95% confidence interval 1-80%). CONCLUSION The reported prevalence was highly variable among the small-sized published studies that adopted adequate techniques. In our patient cohort, there was a high incidence of VUS in BRCA1/2 genes. Accordingly, there is an actual demand to conduct a prospective well-designed national study to accurately estimate the prevalence of BRCA1/2 mutations among patients with BC in Egypt.
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Affiliation(s)
- Hamdy A Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
- Medical Oncology Unit, Cairo Oncology Center, Cairo, Egypt
| | - Samah A Loutfy
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
- Nanotechnology Research Center, BUE, Cairo, Egypt
| | - Hatem A Azim
- Medical Oncology Unit, Cairo Oncology Center, Cairo, Egypt
| | - Nermin S Kamal
- Medical Oncology Unit, Cairo Oncology Center, Cairo, Egypt
| | - Nasra F Abdel Fattah
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | - Mostafa H Elberry
- Virology and Immunology Unit, Cancer Biology Department, National Cancer Institute, Cairo University, Cairo, Egypt
| | | | | | - Madonna Aziz
- Clinical Research Unit, Cairo Oncology Center, Cairo, Egypt
| | - Kyrillus S Shohdy
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt
- Division of Cancer Sciences, The University of Manchester, Manchester, UK
| | - Loay Kassem
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Cairo, Egypt.
- Medical Oncology Unit, Cairo Oncology Center, Cairo, Egypt.
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5
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Arecco L, Blondeaux E, Bruzzone M, Latocca MM, Mariamidze E, Begijanashvili S, Sokolovic E, Gentile G, Scavone G, Ottonello S, Boutros A, Vaz-Luis I, Saura C, Anderson RA, Demeestere I, Azim HA, de Azambuja E, Peccatori FA, Del Mastro L, Partridge AH, Lambertini M. Safety of pregnancy after breast cancer in young women with hormone receptor-positive disease: a systematic review and meta-analysis. ESMO Open 2023; 8:102031. [PMID: 37879234 PMCID: PMC10774870 DOI: 10.1016/j.esmoop.2023.102031] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Despite increasing evidence on the safety of pregnancy after anticancer treatments in breast cancer survivors, many physicians and patients remain concerned about a potential risk of pregnancy specifically in the case of hormone receptor-positive breast cancer. MATERIALS AND METHODS A systematic literature search of Medline, Embase and Cochrane library with no language or date restriction up to 31 March 2023 was carried out. To be included, articles had to be retrospective and prospective case-control and cohort studies as well as clinical trials comparing survival outcomes of premenopausal women with or without a pregnancy after prior diagnosis of hormone receptor-positive breast cancer. Disease-free survival (DFS) and overall survival (OS) were the outcomes of interest. Pooled hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated. Study protocol is registered in PROSPERO (n. CRD42023394232). RESULTS Out of 7796 screened studies, 8 were eligible to be included in the final analysis. A total of 3805 patients with hormone receptor-positive invasive early breast cancer were included in these studies, of whom 1285 had a pregnancy after breast cancer diagnosis. Median follow-up time ranged from 3.8 to 15.8 years and was similar in the pregnancy and non-pregnancy cohorts. In three studies (n = 987 patients) reporting on DFS, no difference was observed between patients with and those without a subsequent pregnancy (HR 0.96, 95% CI 0.75-1.24, P = 0.781). In the six studies (n = 3504 patients) reporting on OS, patients with a pregnancy after breast cancer had a statistically significant better OS than those without a pregnancy (HR 0.46, 95% CI 0.27-0.77, P < 0.05). CONCLUSIONS This systematic review and meta-analysis of retrospective cohort studies provides updated evidence that having a pregnancy in patients with prior history of hormone receptor-positive invasive early breast cancer appears safe without detrimental effect on prognosis.
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Affiliation(s)
- L Arecco
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova. https://twitter.com/Lucarecco
| | - E Blondeaux
- U.O. Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Bruzzone
- U.O. Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M M Latocca
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - E Mariamidze
- Department of Oncology and Hematology, Todua Clinic, Tbilisi
| | - S Begijanashvili
- Department of Clinical Oncology, American Hospital, Tbilisi, Georgia
| | - E Sokolovic
- Clinic of Oncology, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - G Gentile
- Medical Oncology Unit B, Department of Radiology, Oncology and Pathology, Policlinico Umberto I, Sapienza University of Rome, Rome
| | - G Scavone
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - S Ottonello
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - A Boutros
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, Oncologia Medica 2, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - I Vaz-Luis
- Unit 981-Molecular Predictors and New Targets in Oncology, Interdisciplinary Department for the Organization of Patient Pathways (DIOPP), INSERM and Institut Gustave Roussy, Paris, France
| | - C Saura
- Breast Cancer Unit, Medical Oncology Service, Vall d'Hebron University Hospital, Barcelona, Spain
| | - R A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, UK
| | - I Demeestere
- Research Laboratory on Human Reproduction, Fertility Clinic (HUB-Erasme), Brussels, Belgium
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - E de Azambuja
- Academic Trials Promoting Team, Institut Jules Bordet and l'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - F A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - A H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova.
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Loibl S, Azim HA, Bachelot T, Berveiller P, Bosch A, Cardonick E, Denkert C, Halaska MJ, Hoeltzenbein M, Johansson ALV, Maggen C, Markert UR, Peccatori F, Poortmans P, Saloustros E, Saura C, Schmid P, Stamatakis E, van den Heuvel-Eibrink M, van Gerwen M, Vandecaveye V, Pentheroudakis G, Curigliano G, Amant F. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC). Ann Oncol 2023; 34:849-866. [PMID: 37572987 DOI: 10.1016/j.annonc.2023.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
The management of breast cancer during pregnancy (PrBC) is a relatively rare indication and an area where no or little evidence is available since randomized controlled trials cannot be conducted. In general, advances related to breast cancer (BC) treatment outside pregnancy cannot always be translated to PrBC, because both the interests of the mother and of the unborn should be considered. Evidence remains limited and/or conflicting in some specific areas where the optimal approach remains controversial. In 2022, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process on this topic to gain insights from a multidisciplinary group of experts and develop statements on controversial topics that cannot be adequately addressed in the current evidence-based ESMO Clinical Practice Guideline. The aim of this consensus-building process was to discuss controversial issues relating to the management of patients with PrBC. The virtual meeting included a multidisciplinary panel of 24 leading experts from 13 countries and was chaired by S. Loibl and F. Amant. All experts were allocated to one of four different working groups. Each working group covered a specific subject area with two chairs appointed: Planning, preparation and execution of the consensus process was conducted according to the ESMO standard operating procedures.
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Affiliation(s)
- S Loibl
- GBG c/o GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology Bethanien, Frankfurt am Main, Frankfurt; Goethe University Frankfurt, Frankfurt am Main, Frankfurt, Germany.
| | - H A Azim
- Breast Cancer Center, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - T Bachelot
- Department of medical oncology, Centre Léon Bérard, Lyon, France
| | - P Berveiller
- Department of Gynecology and Obstetrics, Poissy-Saint Germain Hospital, Poissy; UMR 1198 - BREED, INRAE, Paris Saclay University, RHuMA, Montigny-Le-Bretonneux, France
| | - A Bosch
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - E Cardonick
- Cooper Medical School at Rowan University, Camden, USA
| | - C Denkert
- Philipps-University Marburg and Marburg University Hospital (UKGM), Marburg, Germany
| | - M J Halaska
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University in Prague and Universital Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - M Hoeltzenbein
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Cancer Registry of Norway, Oslo, Norway
| | - C Maggen
- Department of Obstetrics and Prenatal Medicine, University Hospital Brussels, Brussels, Belgium
| | - U R Markert
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - F Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Iridium Netwerk, Antwerp; University of Antwerp, Antwerp, Belgium
| | - E Saloustros
- Department of Oncology, University General Hospital of Larissa, Larissa, Greece
| | - C Saura
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Schmid
- Cancer Institute, Queen Mary University London, London, UK
| | - E Stamatakis
- Department of Anesthesiology, 'Alexandra' General Hospital, Athens, Greece
| | | | - M van Gerwen
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - V Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Curigliano
- Division of Early Drug Development, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - F Amant
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Division Gynaecologic Oncology, UZ Leuven, Belgium
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7
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Partridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA, Colleoni M, Saura C, Shimizu C, Sætersdal AB, Kroep JR, Mailliez A, Warner E, Borges VF, Amant F, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Takei J, Lee JE, Walshe JM, Ruíz-Borrego M, Moore HCF, Saunders C, Bjelic-Radisic V, Susnjar S, Cardoso F, Smith KL, Ferreiro T, Ribi K, Ruddy K, Kammler R, El-Abed S, Viale G, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O. Interrupting Endocrine Therapy to Attempt Pregnancy after Breast Cancer. N Engl J Med 2023; 388:1645-1656. [PMID: 37133584 PMCID: PMC10358451 DOI: 10.1056/nejmoa2212856] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
BACKGROUND Prospective data on the risk of recurrence among women with hormone receptor-positive early breast cancer who temporarily discontinue endocrine therapy to attempt pregnancy are lacking. METHODS We conducted a single-group trial in which we evaluated the temporary interruption of adjuvant endocrine therapy to attempt pregnancy in young women with previous breast cancer. Eligible women were 42 years of age or younger; had had stage I, II, or III disease; had received adjuvant endocrine therapy for 18 to 30 months; and desired pregnancy. The primary end point was the number of breast cancer events (defined as local, regional, or distant recurrence of invasive breast cancer or new contralateral invasive breast cancer) during follow-up. The primary analysis was planned to be performed after 1600 patient-years of follow-up. The prespecified safety threshold was the occurrence of 46 breast cancer events during this period. Breast cancer outcomes in this treatment-interruption group were compared with those in an external control cohort consisting of women who would have met the entry criteria for the current trial. RESULTS Among 516 women, the median age was 37 years, the median time from breast cancer diagnosis to enrollment was 29 months, and 93.4% had stage I or II disease. Among 497 women who were followed for pregnancy status, 368 (74.0%) had at least one pregnancy and 317 (63.8%) had at least one live birth. In total, 365 babies were born. At 1638 patient-years of follow-up (median follow-up, 41 months), 44 patients had a breast cancer event, a result that did not exceed the safety threshold. The 3-year incidence of breast cancer events was 8.9% (95% confidence interval [CI], 6.3 to 11.6) in the treatment-interruption group and 9.2% (95% CI, 7.6 to 10.8) in the control cohort. CONCLUSIONS Among select women with previous hormone receptor-positive early breast cancer, temporary interruption of endocrine therapy to attempt pregnancy did not confer a greater short-term risk of breast cancer events, including distant recurrence, than that in the external control cohort. Further follow-up is critical to inform longer-term safety. (Funded by ETOP IBCSG Partners Foundation and others; POSITIVE ClinicalTrials.gov number, NCT02308085.).
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Affiliation(s)
- Ann H Partridge
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Samuel M Niman
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Monica Ruggeri
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Fedro A Peccatori
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Hatem A Azim
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Marco Colleoni
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Cristina Saura
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Chikako Shimizu
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Anna B Sætersdal
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Judith R Kroep
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Audrey Mailliez
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Ellen Warner
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Virginia F Borges
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Frédéric Amant
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Andrea Gombos
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Akemi Kataoka
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Christine Rousset-Jablonski
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Simona Borstnar
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Junko Takei
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Jeong E Lee
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Janice M Walshe
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Manuel Ruíz-Borrego
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Halle C F Moore
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Christobel Saunders
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Vesna Bjelic-Radisic
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Snezana Susnjar
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Fatima Cardoso
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Karen L Smith
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Teresa Ferreiro
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Karin Ribi
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Kathryn Ruddy
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Roswitha Kammler
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Sarra El-Abed
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Giuseppe Viale
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Martine Piccart
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Larissa A Korde
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Aron Goldhirsch
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Richard D Gelber
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
| | - Olivia Pagani
- From the Department of Medical Oncology, Dana-Farber Cancer Institute (A.H.P.), Harvard Medical School (A.H.P., R.D.G.), the International Breast Cancer Study Group Statistical Center and the Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute (S.M.N., R.D.G.), and Frontier Science and Technology Research Foundation and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the International Breast Cancer Study Group (M.R., K. Ribi, R.K., G.V., A. Goldhirsch) and the Swiss Group for Clinical Cancer Research (O.P.), Bern, the Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva (O.P.), and University Hospitals, Lugano University, Lugano (O.P.) - all in Switzerland; the European Institute of Oncology, Scientific Institutes for Research, Hospitalization and Healthcare (IRCCS) (F.A.P., M.C., G.V., A. Goldhirsch), Milan; the Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico (H.A.A.); Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, and SOLTI Breast Cancer Research Group (C. Saura) and Soul Reconnect (T.F.), Barcelona, GEICAM Spanish Breast Cancer Research Group, Madrid (M.R.-B.), and Hospital Virgen del Rocio de Sevilla, Seville (M.R.-B.) - all in Spain; the Department of Breast and Medical Oncology, National Center for Global Health and Medicine (C. Shimizu), Breast Oncology Center, the Cancer Institute Hospital of the Japanese Foundation for Cancer Research (A.K.), and St. Luke's International Hospital, Breast Center (J.T.) - all in Tokyo; the Breast Cancer Unit, Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo (A.B.S.); the Department of Medical Oncology, Leiden University Medical Center, Leiden (J.R.K.), and Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam (F.A.) - both in the Netherlands; the Department of Medical Oncology, Centre Oscar Lambret, Lille (A.M.), and the Department of Surgery, Leon Berard Cancer Center, Centre Léon Bérard, Lyon (C.R.-J.) - both in France; Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto (E.W.); the Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora (V.F.B.); the Department of Oncology, KU Leuven and Leuven Cancer Institute, and the Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven (F.A.), and Institut Jules Bordet and Université Libre de Bruxelles (A. Gombos, M.P.) and Breast International Group (S.E.-A.), Brussels - all in Belgium; the Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia (S.B.); the Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, and the Department of Clinical Research and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University - both in Seoul, South Korea (J.E.L.); Cancer Trials Ireland, the Department of Medical Oncology, St. Vincent's University Hospital, and Tallaght University Hospital - all in Dublin (J.M.W.); the Breast Oncology Program, Cleveland Clinic Taussig Cancer Institute, Cleveland (H.C.F.M.); the Department of Surgery, Centre for Cancer Research, Melbourne Medical School, and the Royal Melbourne Hospital, University of Melbourne - both in Melbourne, VIC, Australia (C. Saunders); the Breast Unit, Helios University Hospital Wuppertal, University Witten-Herdecke, Wuppertal, Germany (V.B.-R.); the Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria (V.B.-R.); the Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade (S.S.); the Breast Unit, Champalimaud Clinical Center-Champalimaud Foundation, Lisbon, Portugal (F.C.); the Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins University, Baltimore (K.L.S.), and Breast Cancer and Melanoma Therapeutics, Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda (L.A.K.) - both in Maryland; and the Department of Oncology, Mayo Clinic, Rochester, MN (K. Ruddy)
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Partridge A, Pagani O, Niman SM, Ruggeri M, Peccatori FAA, Azim HA, Colleoni M, Saura C, Shimizu C, Saetersdal A, Kroep J, Mailliez A, Warner E, Borges VF, Amant F, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Takei J, Lee JE, Walshe J, Borrego MR, Moore H, Saunders C, Bjelic-Radisic V, Susnjar S, Cardoso F, Smith KL, Vilarino TF, Ribi K, Ruddy K, El-Abed S, Piccart M, Korde LA, Goldhirsch A, Gelber RD. Abstract GS4-09: Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer: Primary Results from the POSITIVE Trial (IBCSG 48-14/BIG 8-13). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-gs4-09] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Pregnancy after breast cancer (BC) is of substantial importance for many young women at diagnosis and during follow-up. BC treatment including standard endocrine therapy (ET) (5-10 years) may reduce ovarian reserve and the chances of subsequent successful pregnancy, given conception is contraindicated during ET. A temporary interruption of ET to attempt and carry a pregnancy in this population has never been prospectively studied.
Methods: POSITIVE is a single-arm, prospective, investigator-initiated, international trial evaluating the safety and pregnancy outcomes of interrupting ET for young women with early-stage hormone-receptor-positive (HR+) BC who desire pregnancy. The primary objective is to assess the risk of BC relapse associated with ET interruption for ~2 years to achieve pregnancy. Women ≤42 years with stage I-III HR+ BC who received adjuvant ET (SERM alone, GnRH analogue plus SERM or AI) for 18 to 30 months and wished to interrupt ET to attempt pregnancy were eligible. The primary endpoint is breast cancer free interval (BCFI) defined as the time from enrollment to the first BC event (local, regional, distant recurrence or a new invasive contralateral BC). Planned sample size was 500 patients. Three interim analyses of BCFI were reviewed by the Data Safety Monitoring Committee (DSMC) to assure a 95% chance of stopping the trial early if the annual BCFI event rate exceeded 4%; with primary analysis triggered after 1600 patient years of follow-up (pyfu) and no more than 46 BCFI events defined as the safety threshold. The DSMC recommended continuing the study following each interim analysis. We now report the primary results.
Results: From 12/2014 to 12/2019, 518 women were enrolled. At enrollment, the median age of participants was 37 years (27-43 years); 75.0% were nulliparous, 93.4% had stage I/II disease, 66.3% node-negative. Median time from BC diagnosis to enrollment was 29 months (IQR: 25-32). Tamoxifen alone was the most prescribed ET (41.7%), followed by tamoxifen+ovarian function suppression (35.7%). 62.0% of participants had received neo/adjuvant chemotherapy. At a median follow-up of 41 months (1638 pyfu), 44 participants had experienced a BCFI event, not exceeding the pre-specified safety threshold of 46 events. The 3-year BCFI failure percent was 8.9% (95% CI: 6.3 to 11.6%), similar to the 9.2% (95% CI: 7.6 to 10.8%) calculated in the comparative external control cohort from the SOFT/TEXT trials (Sun et al, Breast 2020). Of 497 women followed for pregnancy status, 368 (74.0%) had at least one pregnancy, 317 (63.8%) had at least one live birth, with a total of 365 babies born. Based on competing risk analysis, 76.3% of patients resumed ET (half within 26 months), 8.3% had BCFI event/death before ET resumption, and 15.4% had not resumed ET yet.
Conclusions: The POSITIVE trial demonstrates that for young women with early HR+ BC desiring pregnancy, temporary interruption of ET to attempt pregnancy does not confer a greater short-term risk of recurrence than that observed in a modern historical control group that did not interrupt ET. Most participants have had a live birth. Further follow-up is planned to confirm long-term safety. These results should be considered in counselling BC patients desiring future pregnancy.
Citation Format: Ann Partridge, Olivia Pagani, Samuel M. Niman, Monica Ruggeri, Fedro Alessandro A. Peccatori, Hatem A. Azim, Marco Colleoni, Cristina Saura, Chikako Shimizu, Anna Saetersdal, Judith Kroep, Audrey Mailliez, Ellen Warner, Virginia F. Borges, Frédéric Amant, Andrea Gombos, Akemi Kataoka, Christine Rousset-Jablonski, Simona Borstnar, Junko Takei, Jeong Eon Lee, Janice Walshe, Manuel Ruiz Borrego, Halle Moore, Christobel Saunders, Vesna Bjelic-Radisic, Snezana Susnjar, Fatima Cardoso, Karen L. Smith, Teresa Ferreiro Vilarino, Karin Ribi, Kathryn Ruddy, Sarra El-Abed, Martine Piccart, Larissa A. Korde, Aron Goldhirsch, Richard D. Gelber. Pregnancy Outcome and Safety of Interrupting Therapy for women with endocrine responsIVE breast cancer: Primary Results from the POSITIVE Trial (IBCSG 48-14/BIG 8-13) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr GS4-09.
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Affiliation(s)
| | - Olivia Pagani
- 2Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz; Geneva University Hospitals, Lugano University and Swiss Group for Clinical Cancer Research (SAKK), Vaud, Switzerland
| | | | - Monica Ruggeri
- 4ETOP IBCSG Partners Foundation, Bern, Bern, Switzerland
| | | | - Hatem A. Azim
- 6School of Medecine, Monterrey Institute of Technology
| | - Marco Colleoni
- 7Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Lombardia, Italy
| | - Cristina Saura
- 8Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron University Hospital, Barcelona, Catalonia
| | - Chikako Shimizu
- 9National Center for Global Health and Medicine, Shinjuku-ku, Tokyo, Japan
| | | | | | | | - Ellen Warner
- 13Sunnybrook Odette Cancer Centre, Toronto, Ontario, Canada
| | | | | | | | - Akemi Kataoka
- 17The Cancer Institute Hospital Of JFCR, Koto-ku, Tokyo, Japan
| | | | | | - Junko Takei
- 20Department of Breast Surgical Oncology and Department of Clinical Genetics, St. Luke’s international hospital, Chu-o-ku, Tokyo, Japan
| | | | - Janice Walshe
- 22Department of Medical Oncology St. Vincent’s University Hospital and Tallaght University Hospital
| | | | | | | | | | - Snezana Susnjar
- 27Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Fatima Cardoso
- 28Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal, Lisbon, Portugal
| | - Karen L. Smith
- 29Johns Hopkins Sidney Kimmel Comprehensive Cancer Center
| | | | - Karin Ribi
- 31International Breast Cancer Study Group, Bern, Bern, Switzerland
| | | | | | - Martine Piccart
- 34Institut Jules Bordet – Université Libre de Bruxelles, Anderlecht, Brussels Hoofdstedelijk Gewest, Belgium
| | - Larissa A. Korde
- 35Division of Cancer Treatment and Diagnosis, National Cancer Institute
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Paluch-Shimon S, Cardoso F, Partridge AH, Abulkhair O, Azim HA, Bianchi-Micheli G, Cardoso MJ, Curigliano G, Gelmon KA, Gentilini O, Harbeck N, Kaufman B, Kim SB, Liu Q, Merschdorf J, Poortmans P, Pruneri G, Senkus E, Sirohi B, Spanic T, Sulosaari V, Peccatori F, Pagani O. ESO-ESMO fifth international consensus guidelines for breast cancer in young women (BCY5). Ann Oncol 2022; 33:1097-1118. [PMID: 35934170 DOI: 10.1016/j.annonc.2022.07.007] [Citation(s) in RCA: 41] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 07/14/2022] [Accepted: 07/17/2022] [Indexed: 12/31/2022] Open
Abstract
We dedicate this manuscript in memory of a dear friend and colleague Bella Kaufman. The fifth International Consensus Symposium for Breast Cancer in Young Women (BCY5) took place virtually in October 2020, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY4 with incorporation of new evidence to inform the guidelines. Areas of research priorities as well as specificities in different geographic and minority populations were identified. This manuscript summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
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Affiliation(s)
- S Paluch-Shimon
- Hadassah University Hospital & Faculty of Medicine, Hebrew University, Jerusalem, Israel.
| | - F Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | | | - O Abulkhair
- King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | | | - M J Cardoso
- Breast Unit, Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - G Curigliano
- European Institute of Oncology IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K A Gelmon
- British Columbia Cancer, Vancouver, Canada
| | | | - N Harbeck
- Breast Center, Department of OB&GYN and CCCMunich, LMU University Hospital, Munich, Germany
| | - B Kaufman
- Sheba Medical Center, Ramat Gan, Israel
| | - S B Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Q Liu
- Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | | | - P Poortmans
- Iridium Netwerk, Department of Radiation Oncology & University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - G Pruneri
- National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - E Senkus
- Medical University of Gdansk, Gdansk, Poland
| | - B Sirohi
- Max Institute of Cancer Care, New Delhi and Gurgaon, India
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - V Sulosaari
- European Oncology Nursing Society (EONS) and Turku University of Applied Sciences, Turku, Finland
| | - F Peccatori
- European Institute of Oncology IRCCS, Milan; European Institute of Oncology IRCCS & European School of Oncology, Milan, Italy
| | - O Pagani
- Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Vaud, Geneva University Hospitals, Lugano University, Swiss Group for Clinical Cancer Research (SAKK), Lugano, Switzerland
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Ferrigno AS, Becerril-Gaitan A, Vaca-Cartagena BF, Azim HA, Villarreal-Garza C. Abstract P3-23-03: Use of taxane-containing regimens during pregnancy for the treatment of breast cancer: A systematic review. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p3-23-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Concurrent diagnosis of breast cancer (BC) and pregnancy represents a therapeutic challenge as the indication of any treatment modality requires careful consideration of expected clinical benefit and fetal safety. Anthracycline-based chemotherapy regimens have been extensively studied and proven to be relatively safe to use during gestation. However, there is limited data about the safety of taxane-containing regimens during pregnancy or the predominant prescribing practices in real-world clinical settings despite NCCN and ESMO supporting their use when clinically indicated. This study aimed to systematically review and synthesize available evidence regarding gestational taxane use for BC treatment.. Methods: A literature search was conducted in PubMed, Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Science from their inception up to April 14, 2021. Studies considered eligible for this analysis were those that reported gestational taxane use for BC, presented original findings, and disclosed patient-specific outcomes. The retrieved records were independently screened by two authors, with discrepancies resolved by a third. Descriptive statistics were undertaken. Results: A total of 438 unique records were retrieved, of which 32 reports describing 163 BC patients treated with taxane-containing regimens during pregnancy were identified. Of those, 25 publications disclosed sufficient detail to be included in the analysis (63 pregnancies, 64 newborns; median gestational age at taxane initiation = 24 weeks, range 14-32). The most commonly reported regimens were paclitaxel 80 mg/m2 weekly (20%) and docetaxel 75 mg/m2 every three weeks (15%). The median cumulative dose received during pregnancy was 550 mg/m2 (range: 240-1200) for patients treated with paclitaxel and 375 mg/m2 (range: 150-650) for those prescribed docetaxel. A total of 80% were exposed simultaneously or sequentially to other cytotoxic treatments during pregnancy, 13% were additionally treated with anti-HER2 agents, and 10% received G-CSF. Treatment-associated adverse effects or obstetric complications were reported in 41%, predominantly consisting of preterm contractions or rupture of membranes (11%), oligohydramnios (8%), preeclampsia/HELLP syndrome (8%), and cytopenias (8%). The outcome of all pregnancies was reported as live birth. Overall, 52% of deliveries were preterm (<37 weeks) and 27% of the offspring were classified as small for their gestational age. Additionally, neonatal complications of the offspring exposed to taxanes in utero were documented in 18% of cases and consisted mainly of the need for resuscitation or respiratory support (11%) and hyperbilirubinemia (3%).
Conclusions: In this review, a high rate of maternal and fetal adverse outcomes was found in cases exposed to taxanes during pregnancy. Anecdotal evidence suggests that a wide variability of taxane-containing regimens are used in clinical practice, with most cases being exposed simultaneously or sequentially to other systemic treatments. Future studies are needed to fully elucidate the optimal taxane-containing regimen to be used during pregnancy, with a special emphasis on treatment safety.
Use of taxane-containing regimens during pregnancy. Data are shown as n (%). NR: Not reported Gestational age at taxane initiation 1rst trimester 1 (2%) 2nd trimester 26 (41%) 3rd trimester 13 (21%) NR 23 (37%) Taxane agent administered Paclitaxel 32 (51%) Docetaxel 19 (30%) Both/NR 12 (19%) Pregnancy complications Preterm delivery 33 (52%) Preterm contractions/PROM 7 (11%) Oligohydramnios 5 (8%) Pre-eclampsia/HELLP syndrome 5 (8%) IUGR 5 (8%) Method of delivery Vaginal 13 (20%) C-section 16 (25%) NR 35 (55%) Neonatal complications Preterm delivery 33 (52%) Small for gestational age (n=55) 15 (27%) Need for resuscitation or respiratory support 7 (11%) Hyperbilirubinemia 2 (3%)
Citation Format: Ana S. Ferrigno, Andrea Becerril-Gaitan, Bryan F. Vaca-Cartagena, Hatem A. Azim Jr., Cynthia Villarreal-Garza. Use of taxane-containing regimens during pregnancy for the treatment of breast cancer: A systematic review [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 P3-23-03.
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Affiliation(s)
- Ana S. Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, N.L., Mexico
| | - Andrea Becerril-Gaitan
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, N.L., Mexico
| | - Bryan F. Vaca-Cartagena
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, N.L., Mexico
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, N.L., Mexico
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, N.L., Mexico
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11
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Condorelli M, Bruzzone M, Ceppi M, Ferrari A, Grinshpun A, Hamy AS, de Azambuja E, Carrasco E, Peccatori FA, Meglio AD, Paluch-Shimon S, Poorvu PD, Venturelli M, Rousset-Jablonski C, Senechal C, Livraghi L, Ponzone R, De Marchis L, Pogoda K, Sonnenblick A, Villarreal-Garza C, Córdoba O, Teixeira L, Clatot F, Punie K, Galbiati RG, Dieci MV, Pérez-Fidalgo A, Duhoux FP, Puglisi F, Ferreira AR, Blondeaux E, Peretz-Yablonski T, Caron O, Saule C, Ameye L, Balmaña J, Partridge AH, Azim HA, Demeestere I, Lambertini M. Abstract PD5-06: Safety of assisted reproductive technologies (ART) following treatment completion in young women with germline BRCA pathogenic variants having a pregnancy after breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd5-06] [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: Young breast cancer (BC) survivors are at risk of infertility. Ovarian stimulation for fertility preservation before (neo)adjuvant chemotherapy is standard of care. Research efforts have shown no negative prognostic effect of pregnancy following BC therapy, also among BRCA carriers. Currently, poor evidence is available on the safety to undergo ART following BC treatment, with no data in carriers of germline BRCA pathogenic variants. To provide evidence on the safety of fertility treatments in this specific population, we assessed the outcomes of a cohort of BRCA-mutated BC survivors who had a pregnancy after prior BC history by comparing the group of patients who underwent ART to achieve pregnancy to the group with spontaneous pregnancy. METHODS: We conducted a multicenter retrospective cohort study across 30 centers worldwide including women diagnosed at ≤ 40 years with stage I-III BC, between January 2000 and December 2012, bearing germline BRCA1/2 pathogenic variants. Survivors with a pregnancy (any outcome) after BC, with no disease-free survival (DFS) event before pregnancy, were assigned to the ART and non-ART group if their pregnancy was achieved through ART or spontaneously, respectively. ART procedures included ovulation induction, ovarian stimulation for in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI), and embryo transfer under hormonal replacement therapy (HRT). RESULTS: Of 1,424 patients registered in the study, 168 with a pregnancy after BC were included in the present analysis. A total of 22 patients were included in the ART group and 146 in the non-ART group. Before BC diagnosis, 18.2% patients in the ART group had at least one child, compared to 38.4% in the non-ART group (P=0.030). Patients had a median age at BC diagnosis of 33.0 vs 30.2 years old in the ART group and in the non-ART group, respectively (P=0.004); 45.4% and 17.1% had grade 1-2 tumors, respectively (P=0.008), and 59.1% vs 31.5% had hormone receptor-positive tumors, respectively (P=0.016). Both cohorts had similar tumor size and nodal stage characteristics. Type and duration of endocrine therapy were comparable between groups. The type of ART was not specified in 5 survivors (22.7%). Ovulation induction was used in 1 patient (4.5%), ovarian stimulation in 7 patients (31.8%), embryo transfer under HRT following oocyte donation in 5 patients (22.7%), and embryo transfer under HRT following oocyte and/or embryo cryopreservation for fertility preservation in 4 patients (18.2%). Median age at conception among survivors was 39.7 years in the ART group versus 35.4 years in the non-ART group (P<0.001). Overall, no differences in obstetrical outcomes were observed between groups, although there were more delivery complications in the ART group vs the non-ART group (22.1% vs 4.1%, respectively, P=0.011). Median follow-up from pregnancy was 3.4 years (range: 0.8-8.6) for patients in the ART group vs 5.0 years (range: 0.8-17.6) in the non-ART group (P=0.009). In the ART group, 2 patients (9.1%) experienced a DFS event (both were loco-regional recurrences) as compared to 40 patients (27.4%) in the non-ART group (P=0.182). No patients died in the ART group compared to 10 patients (6.9%) in the non-ART group. CONCLUSIONS: To our knowledge, this is the first study assessing the safety of ART in BC survivors bearing germline BRCA pathogenic variants. Even though the exposed cohort was small, results showed that the use of ART does not appear to increase the relapse risk at short-term follow-up. Further reproductive studies in BRCA-mutated BC patients are warranted.
Citation Format: Margherita Condorelli, Marco Bruzzone, Marcello Ceppi, Alberta Ferrari, Albert Grinshpun, Anne-Sophie Hamy, Evandro de Azambuja, Estela Carrasco, Fedro A. Peccatori, Antonio Di Meglio, Shani Paluch-Shimon, Philip D. Poorvu, Marta Venturelli, Christine Rousset-Jablonski, Claire Senechal, Luca Livraghi, Riccardo Ponzone, Laura De Marchis, Katarzyna Pogoda, Amir Sonnenblick, Cynthia Villarreal-Garza, Octavi Córdoba, Luis Teixeira, Florian Clatot, Kevin Punie, Rossella Graffeo Galbiati, Maria Vittoria Dieci, Alejandro Pérez-Fidalgo, Francois P. Duhoux, Fabio Puglisi, Arlindo R. Ferreira, Eva Blondeaux, Tamar Peretz-Yablonski, Olivier Caron, Claire Saule, Lieveke Ameye, Judith Balmaña, Ann H. Partridge, Hatem A. Azim, Jr, Isabelle Demeestere, Matteo Lambertini. Safety of assisted reproductive technologies (ART) following treatment completion in young women with germline BRCA pathogenic variants having a pregnancy after breast cancer [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 PD5-06.
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Affiliation(s)
- Margherita Condorelli
- Hôpital Erasme, Fertility Clinic, and Université Libre de Bruxelles, Research Laboratory on Human Reproduction, Bruxelles, Belgium
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Alberta Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, and Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | - Albert Grinshpun
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | | | - Evandro de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Fedro A. Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - Antonio Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Shani Paluch-Shimon
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center & Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - Philip D. Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Marta Venturelli
- Department of Oncology and Haematology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Christine Rousset-Jablonski
- Department of Surgery, Centre Léon Bérard, Lyon, France, and INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | | | - Luca Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
| | - Riccardo Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - Laura De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Cynthia Villarreal-Garza
- Department of Research and Breast Tumors, Instituto Nacional de Cancerologia and, Mexico City, Mexico
| | - Octavi Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Luis Teixeira
- Breast Disease Unit, Saint-Louis Hospital, APHP, Université de Paris, INSERM U976, Paris, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - Rossella Graffeo Galbiati
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua and Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Alejandro Pérez-Fidalgo
- Department of Medical Oncology, INCLIVA University Hospital of Valencia, CIBERONC, Valencia, Spain
| | - Francois P. Duhoux
- Department of Medical Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc, UCLouvain, Bruxelles, Belgium
| | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
| | - Arlindo R. Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Eva Blondeaux
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Tamar Peretz-Yablonski
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Olivier Caron
- Department of Medical Oncology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Claire Saule
- Department of Genetics, Institut Curie, Paris, France
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Bruxelles, Belgium
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Isabelle Demeestere
- Hôpital Erasme, Fertility Clinic, and Université Libre de Bruxelles, Research Laboratory on Human Reproduction, Bruxelles, Belgium
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova and Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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12
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Khan SZ, Arecco L, Villarreal-Garza C, Sirohi B, Ponde NF, Habeeb B, Brandão M, Azim HA, Chowdhury AR, Bozovic-Spasojevic I, Kovalenko I, Odhiambo A, Seid FU, Mutombo AB, Petracci F, Vidra R, Altuna SC, Petrova M, Kourie HR, Ozturk MA, Razeti MG, Lengyel CG, Talibova N, Mariamidze E, Sacardo KP, Duma N, Gyawali B, Trapani D, Tagliamento M, Lambertini M. Knowledge, Practice, and Attitudes of Physicians in Low- and Middle-Income Countries on Fertility and Pregnancy-Related Issues in Young Women With Breast Cancer. JCO Glob Oncol 2022; 8:e2100153. [PMID: 35025688 PMCID: PMC8769103 DOI: 10.1200/go.21.00153] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Fertility and pregnancy-related issues are highly relevant for young (≤ 40 years) patients with breast cancer. Limited evidence exists on knowledge, practice, and attitudes of physicians from low- and middle-income countries (LMICs) regarding these issues. Online in @ASCO_pubs #JCOGlobOncol large survey by @matteolambe et al. showing suboptimal practice and attitudes of physicians in #LMICs on #fertility and #pregnancy issues in young #BreastCancer patients: increased awareness and education in #oncofertility are needed@OncoAlert![]()
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Affiliation(s)
- Shah Zeb Khan
- Department of Clinical Oncology, BINOR, Bannu, Pakistan
| | - Luca Arecco
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Bhawna Sirohi
- Department of Medical Oncology, Apollo Proton Cancer Centre, Chennai, India
| | | | - Baker Habeeb
- Department of Medical Oncology, Shaqlawa Teaching Hospital, Erbil, Iraq
| | - Mariana Brandão
- Department of Medical Oncology, Institut Jules Bordet, Brussels, Belgium
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Arman Reza Chowdhury
- Department of Oncology, Evercare Cancer Centre, Evercare Hospital, Dhaka, Bangladesh
| | | | | | - Andrew Odhiambo
- Unit of Medical Oncology, Department of Clinical Medicine, University of Nairobi, Kenya
| | - Fahmi Usman Seid
- Department of Oncology, Hawassa University School of Medicine and Health Sciences, Hawassa, Sidama, Ethiopia.,Department of Oncology, Tikur Anbessa Hospital College of Health Sciences, Addis Ababa University, Ethiopia
| | | | | | - Radu Vidra
- Oncology Department, The Regional Institute of Gastroenterology and Hepatology "Prof Dr Octavian Fodor," Cluj-Napoca, Romania.,Oncology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Mila Petrova
- MHAT Nadezhda Department of Medical Oncology, Sofia, Bulgaria
| | | | - Mehmet Akif Ozturk
- Bahçeşehir University Faculty of Medicine, Department of Internal Medicine, Istanbul, Turkey
| | - Maria Grazia Razeti
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Narmin Talibova
- Department of Medical Oncology, National Oncology Center, Baku, Azerbaijan
| | - Elene Mariamidze
- Department of Oncology and Hematology, Todua Clinic, Tbilisi, Georgia
| | | | - Narjust Duma
- The Cancer Care Equity Program, Lowe Center For Thoracic Oncology, Dana-Farber Cancer Institute, Boston, MA
| | | | | | - Marco Tagliamento
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genova, Italy
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13
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Condorelli M, Bruzzone M, Ceppi M, Ferrari A, Grinshpun A, Hamy AS, de Azambuja E, Carrasco E, Peccatori FA, Di Meglio A, Paluch-Shimon S, Poorvu PD, Venturelli M, Rousset-Jablonski C, Senechal C, Livraghi L, Ponzone R, De Marchis L, Pogoda K, Sonnenblick A, Villarreal-Garza C, Córdoba O, Teixeira L, Clatot F, Punie K, Graffeo R, Dieci MV, Pérez-Fidalgo JA, Duhoux FP, Puglisi F, Ferreira AR, Blondeaux E, Peretz-Yablonski T, Caron O, Saule C, Ameye L, Balmaña J, Partridge AH, Azim HA, Demeestere I, Lambertini M. Safety of assisted reproductive techniques in young women harboring germline pathogenic variants in BRCA1/2 with a pregnancy after prior history of breast cancer. ESMO Open 2021; 6:100300. [PMID: 34775302 PMCID: PMC8593447 DOI: 10.1016/j.esmoop.2021.100300] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/06/2021] [Accepted: 10/07/2021] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Knowledge is growing on the safety of assisted reproductive techniques (ART) in cancer survivors. No data exist, however, for the specific population of breast cancer patients harboring germline BRCA1/2 pathogenic variants. PATIENTS AND METHODS This is a multicenter retrospective cohort study across 30 centers worldwide including women diagnosed at ≤40 years with stage I-III breast cancer, between January 2000 and December 2012, harboring known germline BRCA1/2 pathogenic variants. Patients included in this analysis had a post-treatment pregnancy either achieved through use of ART (ART group) or naturally (non-ART group). ART procedures included ovulation induction, ovarian stimulation for in vitro fertilization or intracytoplasmic sperm injection, and embryo transfer under hormonal replacement therapy. RESULTS Among the 1424 patients registered in the study, 168 were eligible for inclusion in the present analysis, of whom 22 were in the ART group and 146 in the non-ART group. Survivors in the ART group conceived at an older age compared with those in the non-ART group (median age: 39.7 versus 35.4 years, respectively). Women in the ART group experienced more delivery complications compared with those in the non-ART group (22.1% versus 4.1%, respectively). No other apparent differences in obstetrical outcomes were observed between cohorts. The median follow-up from pregnancy was 3.4 years (range: 0.8-8.6 years) in the ART group and 5.0 years (range: 0.8-17.6 years) in the non-ART group. Two patients (9.1%) in the ART group experienced a disease-free survival event (specifically, a locoregional recurrence) compared with 40 patients (27.4%) in the non-ART group. In the ART group, no patients deceased compared with 10 patients (6.9%) in the non-ART group. CONCLUSION This study provides encouraging safety data on the use of ART in breast cancer survivors harboring germline pathogenic variants in BRCA1/2, when natural conception fails or when they opt for ART in order to carry out preimplantation genetic testing.
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Affiliation(s)
- M Condorelli
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - M Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - A Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy; Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | - A Grinshpun
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - A S Hamy
- Department of Medical Oncology, Institut Curie, Paris, France
| | - E de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - E Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - F A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - A Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - S Paluch-Shimon
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University, Jerusalem, Israel
| | - P D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Venturelli
- Department of Oncology and Haematology, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - C Rousset-Jablonski
- Department of Surgery, Centre Léon Bérard and INSERM U1290 RESHAPE, Université Claude Bernard Lyon 1, Lyon, France
| | - C Senechal
- Cancer Genetics Unit, Bergonie Institute, Bordeaux, France
| | - L Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy; University of Siena, Siena, Italy
| | - R Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - L De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - K Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - A Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - C Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - O Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - L Teixeira
- Breast Disease Unit, Saint-Louis Hospital, APHP, Université de Paris, INSERM U976, Paris, France
| | - F Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - K Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | - R Graffeo
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - M V Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy; Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - J A Pérez-Fidalgo
- Department of Medical Oncology, INCLIVA University Hospital of Valencia, CIBERONC, Valencia, Spain
| | - F P Duhoux
- Department of Medical Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - F Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - A R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - E Blondeaux
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - T Peretz-Yablonski
- Breast Oncology Unit Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - O Caron
- Department of Medical Oncology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - C Saule
- Department of Genetics, Institut Curie, Paris, France
| | - L Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - J Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - A H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - H A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - I Demeestere
- Department of Obstetrics and Gynecology, Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Fertility Clinic, Brussels, Belgium; Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
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14
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Partridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA, Colleoni M, Saura C, Shimizu C, Sætersdal AB, Kroep JR, Mailliez A, Warner E, Borges VF, Amant F, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Takei J, Lee JE, Walshe JM, Borrego MR, Moore HC, Saunders C, Cardoso F, Susnjar S, Bjelic-Radisic V, Smith KL, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O. Who are the women who enrolled in the POSITIVE trial: A global study to support young hormone receptor positive breast cancer survivors desiring pregnancy. Breast 2021; 59:327-338. [PMID: 34390999 PMCID: PMC8365381 DOI: 10.1016/j.breast.2021.07.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 07/22/2021] [Accepted: 07/30/2021] [Indexed: 11/17/2022] Open
Abstract
Background Premenopausal women with early hormone-receptor positive (HR+) breast cancer receive 5–10 years of adjuvant endocrine therapy (ET) during which pregnancy is contraindicated and fertility may wane. The POSITIVE study investigates the impact of temporary ET interruption to allow pregnancy. Methods POSITIVE enrolled women with stage I-III HR + early breast cancer, ≤42 years, who had received 18–30 months of adjuvant ET and wished to interrupt ET for pregnancy. Treatment interruption for up to 2 years was permitted to allow pregnancy, delivery and breastfeeding, followed by ET resumption to complete the planned duration. Findings From 12/2014 to 12/2019, 518 women were enrolled at 116 institutions/20 countries/4 continents. At enrolment, the median age was 37 years and 74.9 % were nulliparous. Fertility preservation was used by 51.5 % of women. 93.2 % of patients had stage I/II disease, 66.0 % were node-negative, 54.7 % had breast conserving surgery, 61.9 % had received neo/adjuvant chemotherapy. Tamoxifen alone was the most prescribed ET (41.8 %), followed by tamoxifen + ovarian function suppression (OFS) (35.4 %). A greater proportion of North American women were <35 years at enrolment (42.7 %), had mastectomy (59.0 %) and received tamoxifen alone (59.8 %). More Asian women were nulliparous (81.0 %), had node-negative disease (76.2%) and received tamoxifen + OFS (56.0 %). More European women had received chemotherapy (69.3 %). Interpretation The characteristics of participants in the POSITIVE study provide insights to which patients and doctors considered it acceptable to interrupt ET to pursue pregnancy. Similarities and variations from a regional, sociodemographic, disease and treatment standpoint suggest specific sociocultural attitudes across the world. Fertility and pregnancy are priority concerns for young breast cancer survivors. POSITIVE explores a transient interruption of endocrine therapy to allow conception. Patients' characteristics highlight features considered suitable to study enrolment. Overall, patients enrolled had a relatively high median age and low-risk disease. Variations emerged across continents suggesting specific sociocultural attitudes.
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Affiliation(s)
- Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA.
| | - Samuel M Niman
- International Breast Cancer Study Group Statistical Center, Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, MA, USA.
| | - Monica Ruggeri
- International Breast Cancer Study Group, Program for Young Patients, Coordinating Center, Effingerstrasse 40, Bern, 3008, Switzerland.
| | - Fedro A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Program, European Institute of Oncology IRCCS, Via Ripamonti 435, Milan, 20141, Italy.
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, San Pedro Garza Garcia, 66278, Mexico.
| | - Marco Colleoni
- International Breast Cancer Study Group, Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Cristina Saura
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Medical Oncology Service, Barcelona, Spain.
| | - Chikako Shimizu
- Department of Breast and Medical Oncology, National Center for Global Health and Medicine, Toyama, Shinjuku-ku, Tokyo, 1-21-1, Japan.
| | - Anna Barbro Sætersdal
- Department of Oncology, Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway.
| | - Judith R Kroep
- Department of Medical Oncology, Leiden University Medical Center, Leiden, the Netherlands.
| | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France.
| | - Ellen Warner
- Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Canada.
| | - Virginia F Borges
- Division of Medical Oncology, Department of Medicine, University of Colorado Cancer Center, Aurora, CO, USA.
| | - Frédéric Amant
- Department of Oncology, KU Leuven and Leuven Cancer Institute, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium; Center for Gynecologic Oncology Amsterdam, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam University Medical Center, Amsterdam, the Netherlands.
| | - Andrea Gombos
- Institut Jules Bordet and L'Universite Libre de Bruxelles, Brussels, Belgium.
| | - Akemi Kataoka
- Breast Oncology Cancer, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.
| | | | - Simona Borstnar
- Division of Medical Oncology, Institute of Oncology, Ljubljana, Slovenia.
| | - Junko Takei
- St Luke's International Hospital, Breast Center, Tokyo, Japan.
| | - Jeong Eon Lee
- Breast Division, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Department of Clinical Research and Evaluation, SAIHST, Sungkyunkwan University, Seoul, South Korea.
| | - Janice M Walshe
- Cancer Trials Ireland and Medical Oncology Department, St. Vincent's University Hospital and Tallaght University Hosptial, Dublin, Ireland.
| | - Manuel Ruíz Borrego
- Hospital Virgen del Rocio Sevilla, GEICAM Spanish Breast Cancer Group, Sevilla, Spain.
| | - Halle Cf Moore
- Cleveland Clinic Taussig Cancer Institute, Cleveland, OH, USA.
| | - Christobel Saunders
- Division of Surgery, Faculty of Health and Medical Sciences, University of Western Australia, Crawley, WA, Australia.
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal.
| | - Snezana Susnjar
- Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia.
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Hospital Wuppertal, University Witten/Herdecke, Wuppertal, Germany; Medical University Graz, Department Gynaecology, Graz, Austria.
| | - Karen L Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA.
| | - Martine Piccart
- Institut Jules Bordet and L'Universite Libre de Bruxelles, Brussels, Belgium.
| | - Larissa A Korde
- Cancer Therapy Evaluation Program, National Cancer Institute, Bethesda, MD, USA.
| | - Aron Goldhirsch
- International Breast Cancer Study Group, IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - Richard D Gelber
- International Breast Cancer Study Group Statistical Center, Department of Data Science, Division of Biostatistics, Dana-Farber Cancer Institute, Frontier Science and Technology Research Foundation, Harvard TH Chan School of Public Health and Harvard Medical School, Boston, MA, USA.
| | - Olivia Pagani
- Interdisciplinary Cancer Service Hospital Riviera-Chablais Rennaz, Geneva University Hospitals, Lugano University, Swiss Group for Clinical Cancer Research (SAKK), Vaud, Switzerland.
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15
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Lambertini M, Blondeaux E, Bruzzone M, Perachino M, Anderson RA, de Azambuja E, Poorvu PD, Kim HJ, Villarreal-Garza C, Pistilli B, Vaz-Luis I, Saura C, Ruddy KJ, Franzoi MA, Sertoli C, Ceppi M, Azim HA, Amant F, Demeestere I, Del Mastro L, Partridge AH, Pagani O, Peccatori FA. Pregnancy After Breast Cancer: A Systematic Review and Meta-Analysis. J Clin Oncol 2021; 39:3293-3305. [PMID: 34197218 DOI: 10.1200/jco.21.00535] [Citation(s) in RCA: 59] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
PURPOSE Many patients and physicians remain concerned about the potential detrimental effects of pregnancy after breast cancer (BC) in terms of reproductive outcomes and maternal safety. This systematic review and meta-analysis aimed at providing updated evidence on these topics. METHODS A systematic literature review was conducted to identify studies including patients with a pregnancy after BC (PROSPERO number CRD42020158324). Likelihood of pregnancy after BC, their reproductive outcomes, and maternal safety were assessed. Pooled relative risks, odds ratios (ORs), and hazard ratios (HRs) with 95% CIs were calculated using random effects models. RESULTS Of 6,462 identified records, 39 were included involving 8,093,401 women from the general population and 112,840 patients with BC of whom 7,505 had a pregnancy after diagnosis. BC survivors were significantly less likely to have a subsequent pregnancy compared with the general population (relative risk, 0.40; 95% CI, 0.32 to 0.49). Risks of caesarean section (OR, 1.14; 95% CI, 1.04 to 1.25), low birth weight (OR, 1.50; 95% CI, 1.31 to 1.73), preterm birth (OR, 1.45; 95% CI, 1.11 to 1.88), and small for gestational age (OR, 1.16; 95% CI, 1.01 to 1.33) were significantly higher in BC survivors, particularly in those with previous chemotherapy exposure, compared with the general population. No significantly increased risk of congenital abnormalities or other reproductive complications were observed. Compared to patients with BC without subsequent pregnancy, those with a pregnancy had better disease-free survival (HR, 0.66; 95% CI, 0.49 to 0.89) and overall survival (HR, 0.56; 95% CI, 0.45 to 0.68). Similar results were observed after correcting for potential confounders and irrespective of patient, tumor, and treatment characteristics, pregnancy outcome, and timing of pregnancy. CONCLUSION These results provide reassuring evidence on the safety of conceiving in BC survivors. Patients' pregnancy desire should be considered a crucial component of their survivorship care plan.
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Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Eva Blondeaux
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Marta Perachino
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Richard A Anderson
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - Evandro de Azambuja
- Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Philip D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston MA
| | - Hee Jeong Kim
- Department of Surgical Oncology, Asan Medical Center, Seoul, Korea
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico.,Department of Breast Tumors, Instituo Nacional de Cancerologia, Mexico City, Mexico
| | - Barbara Pistilli
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Cristina Saura
- Department of Medical Oncology, Vall d'Hebron University Hospital (HUVH), Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Chiara Sertoli
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - Frederic Amant
- Netherlands Cancer Institute and Amsterdam University Medical Centers, Amsterdam, the Netherlands.,Department of Oncology, KU Leuven, Leuven, Belgium
| | - Isabelle Demeestere
- Fertility Clinic, CUB-Erasme Hospital, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.,Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston MA
| | - Olivia Pagani
- Geneva University Hospitals, European School of Oncology, Geneva, Switzerland
| | - Fedro A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
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16
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Muñoz-Montaño WR, Cabrera-Galeana P, De la Garza-Ramos C, Azim HA, Tabares A, Perez V, Porras Reyes F, Sanchez Benitez D, Alvarado-Miranda A, Lara-Medina F, Vazquez Romo R, Bargallo-Rocha E, Arrieta O, Villarreal-Garza C. Prognosis of breast cancer diagnosed during pregnancy and early postpartum according to immunohistochemical subtype: A matched case-control study. Breast Cancer Res Treat 2021; 188:489-500. [PMID: 34132938 DOI: 10.1007/s10549-021-06225-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Pregnancy-associated breast cancer (PABC) poses a clinical challenge and its prognosis remains controversial. During the pregnancy and postpartum periods, the breast undergoes biological events that may uniquely influence disease behavior and treatment response. This study aimed to assess if a PABC diagnosis influences survival compared to non-PABC. METHODS A single-center record review was performed to identify PABC patients diagnosed from January 2007 through June 2018. Two controls were matched to each PABC case by stage, immunohistochemical (IHC) subtype, age (± 3) and year of diagnosis (± 2). Disease-free survival (DFS) and overall survival (OS) were estimated with the Kaplan-Meier method and compared with the log-rank test. Multivariate analysis was used to assess the impact of PABC on outcomes. RESULTS 125 PABC patients (pregnant: 62; postpartum: 63) and 250 controls were included. Median follow-up was 67.7 and 73.4 months, respectively. 4-year DFS was 62% in pregnant vs 78% in controls (p = 0.010), and 63% in postpartum vs 83% in controls (p = 0.034). Subanalysis by IHC subtype revealed a significantly inferior DFS in PABC with hormone receptor-positive/HER2-negative (p = 0.032) and HER2-positive disease (p = 0.005) compared to corresponding non-PABC patients. 4-year OS was similar between case groups and controls. Multivariate analysis supported the independent impact of pregnant and postpartum status on DFS (p < 0.05). CONCLUSION Patients diagnosed during pregnancy and early postpartum are at high risk of recurrence. Further research is warranted to better characterize PABC tumor biology and enable the identification of novel therapeutic interventions to improve treatment outcomes.
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Affiliation(s)
- Wendy R Muñoz-Montaño
- Breast Medical Oncology, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico
| | - Paula Cabrera-Galeana
- Breast Medical Oncology, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico
| | - Cynthia De la Garza-Ramos
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, Real San Agustin, San Pedro Garza Garcia, NL, Mexico
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, Real San Agustin, San Pedro Garza Garcia, NL, Mexico
| | - Ariana Tabares
- Breast Medical Oncology, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico
| | - Victor Perez
- Oncological Pathology of Mammary Tumors Unit, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico
| | - Fanny Porras Reyes
- Oncological Pathology of Mammary Tumors Unit, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico
| | | | - Alberto Alvarado-Miranda
- Breast Medical Oncology, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico
| | - Fernando Lara-Medina
- Breast Medical Oncology, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico
| | - Rafael Vazquez Romo
- Breast Surgical Oncology, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico
| | - Enrique Bargallo-Rocha
- Breast Surgical Oncology, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico
| | - Oscar Arrieta
- Research Unit, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico. .,Head of Thoracic Oncology Unit and Laboratory of Personalized Medicine, National Institute of Cancer, San Fernando #22, Section XVI, 14080, Tlalpan, Mexico City, Mexico.
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, Real San Agustin, San Pedro Garza Garcia, NL, Mexico.
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17
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Lambertini M, Ceppi M, Hamy AS, Caron O, Poorvu PD, Carrasco E, Grinshpun A, Punie K, Rousset-Jablonski C, Ferrari A, Paluch-Shimon S, Toss A, Senechal C, Puglisi F, Pogoda K, Pérez-Fidalgo JA, De Marchis L, Ponzone R, Livraghi L, Estevez-Diz MDP, Villarreal-Garza C, Dieci MV, Clatot F, Duhoux FP, Graffeo R, Teixeira L, Córdoba O, Sonnenblick A, Ferreira AR, Partridge AH, Meglio AD, Saule C, Peccatori FA, Bruzzone M, Mastro LD, Ameye L, Balmaña J, Azim HA. Abstract PD10-06: Clinical behavior and outcomes of BRCA-mutated breast cancer in young patients according to type of BRCA mutation and hormone receptor status: Results from an international cohort study. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd10-06] [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: Young breast cancer patients (pts) carrying a germline BRCA mutation (mBRCA) have similar outcomes as non-carriers. However, there is currently lack of evidence regarding the impact of mBRCA type and hormone receptor status on clinical behavior and outcomes of mBRCA breast cancer. We aim to address these questions in the largest dataset to date of young mBRCA breast cancer pts.
Methods: This was an international, multicenter, hospital-based, retrospective cohort study. Women harboring deleterious germline mBRCA1 or mBRCA2 that received a diagnosis of stage I-III invasive early breast cancer at age ≤40 years between January 2000 and December 2012 were included. Baseline pts, tumor, and treatment characteristics, pattern and risk over time of disease-free survival (DFS) events, and survival outcomes (DFS, distant recurrence-free interval [DRFI] and overall survival [OS]) were compared between mBRCA1 and mBRCA2 pts overall and by hormone receptor status. Multivariate Cox proportional hazard models were used to compare hazard rates (HRs).
Results: 1,236 young mBRCA breast cancer pts were included. Among 808 and 428 pts with mBRCA1 or mBRCA2, respectively, 191 (23.6%) and 356 (83.2%) had hormone receptor-positive tumors while 617 (76.4%) and 72 (16.8%) hormone receptor-negative disease (p<0.001). Compared to mBRCA2 breast cancer pts, those with mBRCA1 were younger, more likely to have reported Jewish ancestry, had more grade 3 tumors, less nodal involvement, lobular histology and HER2 positivity, and received more frequently chemotherapy (all p<0.001). More mBRCA1 pts with hormone receptor-positive tumors did not receive adjuvant endocrine therapy (14.7% vs. 4.2%, p<0.001). No difference between mBRCA1 and mBRCA2 pts was observed in risk-reducing mastectomy (43.9% vs. 46.0%; p=0.371) or salpingo-oophorectomy (48.3% vs. 48.8%; p=1.0). Median follow-up was 7.9 years (range 5.6-10.6 years). Second primary breast cancers (17.0% vs. 12.2%, p=0.025) and non-breast primary malignancies (4.3% vs. 1.9%, p=0.033) were more frequent among mBRCA1 pts compared to mBRCA2 pts, while distant recurrences were less frequent (10.4% vs. 15.4%, p=0.013). 8-year DFS was 62.8% and 65.9% for mBRCA1 and mBRCA2 pts, respectively (adjusted HR 0.76; 95% CI 0.60-0.96). The worse DFS in mBRCA1 was observed regardless of hormone receptor status (pinteraction=0.848): hormone receptor-positive (adjusted HR 0.77; 95% CI 0.58-1.03) and hormone receptor-negative (adjusted HR 0.73; 95% CI 0.48-1.13). No differences in DRFI and OS were observed between mBRCA1 and mBRCA2 pts. Compared to pts with hormone receptor-negative disease, those with hormone receptor-positive breast cancer had higher chances of developing distant (± loco-regional) recurrences (16.1% vs. 9.0%; p<0.001) and less frequent second primary malignancies (BC: 12.1% vs. 17.9%, p=0.005; non-BC: 2.8% vs. 4.0%, p=0.216). No differences in DFS and OS were observed between pts with hormone receptor-positive or negative breast cancer. However, there was a trend towards worse DRFI in women with hormone receptor-positive breast cancer as compared to those with hormone receptor-negative disease (8-year DRFI: 83.4% vs. 90.1%; adjusted HR 1.39; 95% CI 0.94-2.05).
Conclusions: In this large unique dataset, young mBRCA1 breast cancer pts had worse DFS than those with mBRCA2 mostly due to higher rates of second primary malignancies. Hormone receptor positivity had no positive prognostic value in young mBRCA breast cancer pts with a trend towards worse DRFI in those with hormone receptor-negative disease. These results provide important information for counseling young mBRCA breast cancer pts regarding treatment, prevention and follow-up care strategies.
Citation Format: Matteo Lambertini, Marcello Ceppi, Anne-Sophie Hamy, Olivier Caron, Philip D. Poorvu, Estela Carrasco, Albert Grinshpun, Kevin Punie, Christine Rousset-Jablonski, Alberta Ferrari, Shani Paluch-Shimon, Angela Toss, Claire Senechal, Fabio Puglisi, Katarzyna Pogoda, Jose Alejandro Pérez-Fidalgo, Laura De Marchis, Riccardo Ponzone, Luca Livraghi, Maria Del Pilar Estevez-Diz, Cynthia Villarreal-Garza, Maria Vittoria Dieci, Florian Clatot, Francois P. Duhoux, Rossella Graffeo, Luis Teixeira, Octavi Córdoba, Amir Sonnenblick, Arlindo R. Ferreira, Ann H. Partridge, Antonio Di Meglio, Claire Saule, Fedro A. Peccatori, Marco Bruzzone, Lucia Del Mastro, Lieveke Ameye, Judith Balmaña, Hatem A. Azim, Jr. Clinical behavior and outcomes of BRCA-mutated breast cancer in young patients according to type of BRCA mutation and hormone receptor status: Results from an international cohort study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD10-06.
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Affiliation(s)
- Matteo Lambertini
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marcello Ceppi
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | | | - Philip D. Poorvu
- 4Dana-Farber Cancer Institute, Harvard Medical School, Harvard Medical School, Boston, MA
| | - Estela Carrasco
- 5Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | - Kevin Punie
- 7Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - Alberta Ferrari
- 9Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | - Angela Toss
- 11Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | | | - Fabio Puglisi
- 13Centro di Riferimento Oncologico di Avano (CRO) IRCCS, Aviano, Italy
| | - Katarzyna Pogoda
- 14Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | | | | | | | - Maria Del Pilar Estevez-Diz
- 19Instituto do Cancer do Estado de Sao Paulo – Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | | | | | | | | | - Rossella Graffeo
- 24Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luis Teixeira
- 25Saint-Louis Hospital, APHP, Université de Paris, Paris, France
| | | | | | | | - Ann H. Partridge
- 4Dana-Farber Cancer Institute, Harvard Medical School, Harvard Medical School, Boston, MA
| | | | | | | | - Marco Bruzzone
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- 1University of Genova - IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lieveke Ameye
- 31Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Judith Balmaña
- 5Vall d’Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d’Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Hatem A. Azim
- 32Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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Partridge AH, Niman SM, Ruggeri M, Peccatori FA, Azim HA, Colleoni M, Saura C, Shimizu C, Sætersdal AB, Kroep J, Warner E, Borges VF, Gombos A, Kataoka A, Rousset-Jablonski C, Borstnar S, Yamauchi H, Lee JE, Walshe JM, Borrego MR, Moore HCF, Saunders C, Cardoso F, Susnjar S, Bjelic-Radisic V, Smith KL, Piccart M, Korde LA, Goldhirsch A, Gelber RD, Pagani O. Abstract PS12-17: Baseline characteristics of women enrolled in the POSITIVE trial (pregnancy outcome and safety of interrupting therapy for women with endocrine responsIVE breast cancer). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps12-17] [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: Pregnancy is a major concern for young breast cancer (BC) survivors. Conception after BC in women with hormone receptor positive (HR+) disease is affected by the standard 5-10 years of adjuvant endocrine therapy (ET) during which pregnancy is contraindicated and fertility may be waning. The POSITIVE Trial (IBCSG 48-14/BIG 8-13/Alliance A221405/NCT02308085) investigates the impact of temporary ET interruption to allow pregnancy.
Methods: POSITIVE enrolled premenopausal women with stage I-III HR+ early BC, ≤42 years of age, who had received adjuvant ET (SERM alone, ovarian function suppression (OFS) plus SERM or AI) for 18 to 30 months, and wished to interrupt ET to attempt pregnancy. An interruption of ET for up to 2 years was foreseen to allow pregnancy (after a 3-month ET washout period), delivery, and breastfeeding if desired/feasible. Resumption of ET to complete 5-10 years of treatment was planned as soon as pregnancy/breastfeeding was completed or after it was ensured conception was not possible. We report baseline characteristics of participants enrolled in POSITIVE by region of enrollment.
Results: From 12/2014 to 12/2019, 518 participants were enrolled at 116 centers in 20 countries across 4 continents. The table shows the baseline characteristics of the enrolled women.
Several differences were seen across regions: A higher proportion of participants <35 yrs (43%) enrolled in North America than in Europe (33%) or Asia (26%). Eighty-one percent of Asian women had no children at enrollment compared to 75% and 68% of European and North American women, respectively. Consistently, a greater percent of women in Asia (56%) had used fertility preservation measures, compared to Europe (53%) and North America (43%). Stage distribution was also different across continents: a greater percent of Asian participants had stage I, grade 1 and node-negative disease (51%, 29% and 76 %, respectively) compared to European (46%, 14% and 67%) and North American (43%, 16% and 55%) women. Only 19% of Asian women had either 1-3 positive nodes and grade 3 tumors, the proportion increased to 28% and 35% in Europe and to 41% and 38% in North America, respectively. North American women were more likely to have had mastectomy (60% vs. Asian (44%) and European (41%)); European women were more likely to have had chemotherapy (69% vs. North American (56%) and Asian (42%)). ET administration prior to enrollment differed substantially by region: Most North American women had SERM (T) alone (58%), and when OFS was added to oral ET, it was combined with AI in 19% and with T in 8% of participants, respectively. In Asia most women received T + OFS (55%), followed by T alone (36%), and AI + OFS (6%). In Europe, T + OFS was the most frequent treatment (40%), followed by T alone (37%) and AI + OFS (17%). Median duration of ET before enrollment was similar across regions (22-24 months).
Conclusion: Regional variation of baseline characteristics of women enrolled in the POSITIVE trial may provide important insights into different medical and sociocultural attributes and attitudes of the study participants and investigators from those regions.
Affiliation: POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group
CharacteristicRegion: Europe / North America / Asia-Pacific61% / 23% / 16%Median age at enrollment, yrs (IQR)37 (33-39)Caucasian race77%No children prior to enrollment74%Prior fertility preservation measures taken51%Stage I / II46% / 45%0 / 1 positive nodes65% / 21%Grade 2 / 348% / 33%HER2-negative74%Mastectomy46%Chemotherapy61%ET: SERM alone / SERM+OFS / AI+OFS41% / 35% / 16%Median duration of prior ET, mos (IQR)23 (20-27)
Citation Format: Ann H Partridge, Samuel M Niman, Monica Ruggeri, Fedro A Peccatori, Hatem A Azim, Jr, Marco Colleoni, Cristina Saura, Chikako Shimizu, Anna Barbro Sætersdal, Judith Kroep, Ellen Warner, Virginia F Borges, Andrea Gombos, Akemi Kataoka, Christine Rousset-Jablonski, Simona Borstnar, Hideko Yamauchi, Jeong Eon Lee, Janice M Walshe, Manuel Ruíz Borrego, Halle CF Moore, Christobel Saunders, Fatima Cardoso, Snezana Susnjar, Vesna Bjelic-Radisic, Karen L Smith, Martine Piccart, Larissa A Korde, Aron Goldhirsch, Richard D Gelber, Olivia Pagani. Baseline characteristics of women enrolled in the POSITIVE trial (pregnancy outcome and safety of interrupting therapy for women with endocrine responsIVE 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 PS12-17.
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Affiliation(s)
- Ann H Partridge
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Samuel M Niman
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Monica Ruggeri
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Fedro A Peccatori
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Hatem A Azim
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Marco Colleoni
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Cristina Saura
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Chikako Shimizu
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Anna Barbro Sætersdal
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Judith Kroep
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Ellen Warner
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Virginia F Borges
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Andrea Gombos
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Akemi Kataoka
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Christine Rousset-Jablonski
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Simona Borstnar
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Hideko Yamauchi
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Jeong Eon Lee
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Janice M Walshe
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Manuel Ruíz Borrego
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Halle CF Moore
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Christobel Saunders
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Fatima Cardoso
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Snezana Susnjar
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Vesna Bjelic-Radisic
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Karen L Smith
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Martine Piccart
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Larissa A Korde
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Aron Goldhirsch
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Richard D Gelber
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
| | - Olivia Pagani
- POSITIVE Investigators, International Breast Cancer Study Group, Alliance for Clinical Trials in Oncology, Breast International Group, North American Breast Cancer Group, Bern, Switzerland
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Lambertini M, Ceppi M, Hamy AS, Caron O, Poorvu PD, Carrasco E, Grinshpun A, Punie K, Rousset-Jablonski C, Ferrari A, Paluch-Shimon S, Toss A, Senechal C, Puglisi F, Pogoda K, Pérez-Fidalgo JA, De Marchis L, Ponzone R, Livraghi L, Estevez-Diz MDP, Villarreal-Garza C, Dieci MV, Clatot F, Duhoux FP, Graffeo R, Teixeira L, Córdoba O, Sonnenblick A, Ferreira AR, Partridge AH, Di Meglio A, Saule C, Peccatori FA, Bruzzone M, t'Kint de Roodenbeke MD, Ameye L, Balmaña J, Del Mastro L, Azim HA. Clinical behavior and outcomes of breast cancer in young women with germline BRCA pathogenic variants. NPJ Breast Cancer 2021; 7:16. [PMID: 33579978 PMCID: PMC7880991 DOI: 10.1038/s41523-021-00224-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 01/07/2021] [Indexed: 02/06/2023] Open
Abstract
Young breast cancer (BC) patients carrying a germline BRCA pathogenic variant (mBRCA) have similar outcomes as non-carriers. However, the impact of the type of gene (BRCA1 vs. BRCA2) and hormone receptor status (positive [HR+] vs. negative [HR-]) on clinical behavior and outcomes of mBRCA BC remains largely unknown. This is an international, multicenter, hospital-based, retrospective cohort study that included mBRCA patients diagnosed, between January 2000 and December 2012, with stage I-III invasive early BC at age ≤40 years. From 30 centers worldwide, 1236 young mBRCA BC patients were included. Among 808 and 428 patients with mBRCA1 or mBRCA2, 191 (23.6%) and 356 (83.2%) had HR+tumors, respectively (P < 0.001). Median follow-up was 7.9 years. Second primary BC (P = 0.009) and non-BC malignancies (P = 0.02) were more frequent among mBRCA1 patients while distant recurrences were less frequent (P = 0.02). Irrespective of hormone receptor status, mBRCA1 patients had worse disease-free survival (DFS; adjusted HR = 0.76, 95% CI = 0.60-0.96), with no difference in distant recurrence-free interval (DRFI) and overall survival (OS). Patients with HR+ disease had more frequent distant recurrences (P < 0.001) and less frequent second primary malignancies (BC: P = 0.005; non-BC: P = 0.18). No differences in DFS and OS were observed according to hormone receptor status, with a tendency for worse DRFI (adjusted HR = 1.39, 95% CI = 0.94-2.05) in patients with HR+ BC. Type of mBRCA gene and hormone receptor status strongly impact BC clinical behavior and outcomes in mBRCA young patients. These results provide important information for patients' counseling on treatment, prevention, and surveillance strategies.
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Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy.
- Department of Medical Oncology, U.O.C, Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.
| | - Marcello Ceppi
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Olivier Caron
- Department of Medical Oncology, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Philip D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Albert Grinshpun
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Kevin Punie
- Department of General Medical Oncology and Multidisciplinary Breast Centre, Leuven Cancer Institute, University Hospitals Leuven, Leuven, Belgium
| | | | - Alberta Ferrari
- Department of Surgical Sciences, General Surgery III - Breast Surgery, Fondazione IRCCS Policlinico San Matteo, University of Pavia, aBRCAdaBRA onlus, Pavia, Italy
| | - Shani Paluch-Shimon
- Breast Oncology Unit, Shaare Zedek Medical Centre and Department of Oncology, Sheba Medical Center, Tel Hashomer, Jerusalem, Israel
| | - Angela Toss
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | | | - Fabio Puglisi
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano (CRO) IRCCS, Aviano, Italy
- Department of Medicine, University of Udine, Udine, Italy
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Laura De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - Riccardo Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO - IRCCS, Candiolo, Turin, Italy
| | - Luca Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy
- University of Siena, Siena, Italy
| | - Maria Del Pilar Estevez-Diz
- Departament of Oncology, Instituto do Cancer do Estado de Sao Paulo - Faculdade de Medicina da Universidade de Sao Paulo, Pacaembu, Sao Paulo, Brazil
| | - Cynthia Villarreal-Garza
- Department of Research and Breast Tumors, Mexican National Cancer Institute, Mexico City, Mexico
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, NL, Mexico
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padua, Italy
- Medical Oncology 2, Veneto Institute of Oncology IOV - IRCCS, Padua, Italy
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Francois P Duhoux
- Department of Medical Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc, UCLouvain, Brussels, Belgium
| | - Rossella Graffeo
- Breast Unit of Southern Switzerland (CSSI), Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luis Teixeira
- Breast Disease Unit, Saint-Louis Hospital, APHP, Université de Paris, INSERM U976, Paris, France
| | - Octavi Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Arlindo R Ferreira
- Breast Unit, Champalimaud Clinical Center, Champalimaud Foundation, Lisbon, Portugal
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Antonio Di Meglio
- Predictive Biomarkers and New Therapeutic Strategies in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Claire Saule
- Department of Genetics, Institut Curie, Paris, France
| | - Fedro A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - Marco Bruzzone
- Clinical Epidemiology Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Lieveke Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - Judith Balmaña
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genova, Italy
- Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, NL, Mexico
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Affiliation(s)
- Hatem A Azim
- Hatem A. Azim Jr, MD, PhD, Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Monterrey, Nuevo Leon, Mexico; Lieveke Ameye, MSc, PhD and Marianne Paesmans, MSc, Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; and Matteo Lambertini, MD, PhD, Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova; and Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lieveke Ameye
- Hatem A. Azim Jr, MD, PhD, Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Monterrey, Nuevo Leon, Mexico; Lieveke Ameye, MSc, PhD and Marianne Paesmans, MSc, Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; and Matteo Lambertini, MD, PhD, Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova; and Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Marianne Paesmans
- Hatem A. Azim Jr, MD, PhD, Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Monterrey, Nuevo Leon, Mexico; Lieveke Ameye, MSc, PhD and Marianne Paesmans, MSc, Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; and Matteo Lambertini, MD, PhD, Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova; and Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Hatem A. Azim Jr, MD, PhD, Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Monterrey, Nuevo Leon, Mexico; Lieveke Ameye, MSc, PhD and Marianne Paesmans, MSc, Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; and Matteo Lambertini, MD, PhD, Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova; and Department of Medical Oncology, U.O.C Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
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Gómez-Aleza C, Nguyen B, Yoldi G, Ciscar M, Barranco A, Hernández-Jiménez E, Maetens M, Salgado R, Zafeiroglou M, Pellegrini P, Venet D, Garaud S, Trinidad EM, Benítez S, Vuylsteke P, Polastro L, Wildiers H, Simon P, Lindeman G, Larsimont D, Van den Eynden G, Velghe C, Rothé F, Willard-Gallo K, Michiels S, Muñoz P, Walzer T, Planelles L, Penninger J, Azim HA, Loi S, Piccart M, Sotiriou C, González-Suárez E. Inhibition of RANK signaling in breast cancer induces an anti-tumor immune response orchestrated by CD8+ T cells. Nat Commun 2020; 11:6335. [PMID: 33303745 PMCID: PMC7728758 DOI: 10.1038/s41467-020-20138-8] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [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: 06/09/2020] [Accepted: 11/12/2020] [Indexed: 12/13/2022] Open
Abstract
Most breast cancers exhibit low immune infiltration and are unresponsive to immunotherapy. We hypothesized that inhibition of the receptor activator of nuclear factor-κB (RANK) signaling pathway may enhance immune activation. Here we report that loss of RANK signaling in mouse tumor cells increases leukocytes, lymphocytes, and CD8+ T cells, and reduces macrophage and neutrophil infiltration. CD8+ T cells mediate the attenuated tumor phenotype observed upon RANK loss, whereas neutrophils, supported by RANK-expressing tumor cells, induce immunosuppression. RANKL inhibition increases the anti-tumor effect of immunotherapies in breast cancer through a tumor cell mediated effect. Comparably, pre-operative single-agent denosumab in premenopausal early-stage breast cancer patients from the Phase-II D-BEYOND clinical trial (NCT01864798) is well tolerated, inhibits RANK pathway and increases tumor infiltrating lymphocytes and CD8+ T cells. Higher RANK signaling activation in tumors and serum RANKL levels at baseline predict these immune-modulatory effects. No changes in tumor cell proliferation (primary endpoint) or other secondary endpoints are observed. Overall, our preclinical and clinical findings reveal that tumor cells exploit RANK pathway as a mechanism to evade immune surveillance and support the use of RANK pathway inhibitors to prime luminal breast cancer for immunotherapy. Receptor activator of nuclear factor-κB (RANK)/RANK-ligand (RANKL) signaling regulates the tumor-immune crosstalk. Here the authors show that systemic RANKL inhibition promotes CD8 + T cell infiltration in patients with early breast cancer and that loss of RANK signaling in tumor cells drives a T cell-dependent anti-tumor response in preclinical models.
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Affiliation(s)
- Clara Gómez-Aleza
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain
| | - Bastien Nguyen
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Marie-Josée and Henry R. Kravis Center for Molecular Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, 10065, USA
| | - Guillermo Yoldi
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain
| | - Marina Ciscar
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain.,Molecular Oncology, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | - Alexandra Barranco
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain.,Molecular Oncology, Spanish National Cancer Research Centre (CNIO), Madrid, Spain
| | | | - Marion Maetens
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.,Department of Pathology, GZA-ZNA Ziekenhuizen, Antwerp, Belgium
| | - Maria Zafeiroglou
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain
| | - Pasquale Pellegrini
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain
| | - David Venet
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Soizic Garaud
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Eva M Trinidad
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain
| | - Sandra Benítez
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain
| | - Peter Vuylsteke
- Department of Medical Oncology, Université Catholique de Louvain, CHU UCL, Namur, site Sainte-Elisabeth, Namur, Belgium
| | - Laura Polastro
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Hans Wildiers
- Department of Oncology, KU Leuven-University of Leuven, Leuven, Belgium
| | - Philippe Simon
- Department of Obstetrics and Gynaecology, Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Geoffrey Lindeman
- Peter MacCallum Cancer Centre, The Walter and Eliza Hall Institute of Medical Research and The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gert Van den Eynden
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Chloé Velghe
- Clinical Trial Supporting Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Françoise Rothé
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan Michiels
- Service de Biostatistique et D'Epidémiologie, Gustave Roussy, CESP, U1018, Université Paris-Sud, Faculté de Médcine, Université Paris-Saclay, Villejuif, France
| | - Purificación Muñoz
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain
| | - Thierry Walzer
- Centre International de Recherche en Infectiologie, CIRI, Inserm U1111, CNRS, Université Claude Bernard, Lyon, France
| | - Lourdes Planelles
- BiOncotech Therapeutics, Parc Cientific Universitat, Valencia, Spain
| | - Josef Penninger
- Life Sciences Institute, University of British Columbia, Vancouver, BC, Canada.,IMBA, Institute of Molecular Biotechnology of the Austrian Academy of Sciences, Vienna, Austria
| | - Hatem A Azim
- Division of Hematology/Oncology, Department of Medicine, American University of Beirut, Beirut, Lebanon
| | - Sherene Loi
- Peter MacCallum Cancer Centre, The Walter and Eliza Hall Institute of Medical Research and The Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Martine Piccart
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium. .,Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - Eva González-Suárez
- Oncobell, Bellvitge Biomedical Research Institute, IDIBELL, Barcelona, Spain. .,Molecular Oncology, Spanish National Cancer Research Centre (CNIO), Madrid, Spain.
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22
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Villarreal-Garza C, Ferrigno AS, De la Garza-Ramos C, Barragan-Carrillo R, Lambertini M, Azim HA. Clinical utility of genomic signatures in young breast cancer patients: a systematic review. NPJ Breast Cancer 2020; 6:46. [PMID: 33062888 PMCID: PMC7519162 DOI: 10.1038/s41523-020-00188-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 08/06/2020] [Indexed: 12/14/2022] Open
Abstract
Risk stratification by genomic signatures has been shown to improve prognostication and guide treatment decisions among patients with hormone-sensitive breast cancer. However, their role in young women has not been fully elucidated. In this review, a systematic search was conducted for published articles and abstracts from major congresses that evaluated the use of genomic signatures in young breast cancer patients. A total of 71 studies were analyzed, including 561,188 patients of whom 27,748 (4.9%) were young. Women aged ≤40 years were subjected to genomic testing at a similar rate to older women but had a higher proportion of intermediate- to high-risk tumors when classified by EndoPredict (p = 0.04), MammaPrint (p < 0.01), and Oncotype DX (p < 0.01). In young women with low genomic risk, 6-year distant recurrence-free survival was 94%, while 5-year overall survival was nearly 100%. Nonetheless, young patients classified as low-risk had a higher tendency to receive chemotherapy compared to their older counterparts. In conclusion, genomic tests are useful tools for identifying young patients in whom chemotherapy omission is appropriate.
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Affiliation(s)
- Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Ana S. Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Cynthia De la Garza-Ramos
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Regina Barragan-Carrillo
- Department of Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genova, Genoa, Italy
| | - Hatem A. Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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23
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Lambertini M, Ameye L, Hamy AS, Zingarello A, Poorvu PD, Carrasco E, Grinshpun A, Han S, Rousset-Jablonski C, Ferrari A, Paluch-Shimon S, Cortesi L, Senechal C, Miolo G, Pogoda K, Pérez-Fidalgo JA, De Marchis L, Ponzone R, Livraghi L, Estevez-Diz MDP, Villarreal-Garza C, Dieci MV, Clatot F, Berlière M, Graffeo R, Teixeira L, Córdoba O, Sonnenblick A, Luna Pais H, Ignatiadis M, Paesmans M, Partridge AH, Caron O, Saule C, Del Mastro L, Peccatori FA, Azim HA. Pregnancy After Breast Cancer in Patients With Germline BRCA Mutations. J Clin Oncol 2020; 38:3012-3023. [PMID: 32673153 DOI: 10.1200/jco.19.02399] [Citation(s) in RCA: 55] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Young women with germline BRCA mutations have unique reproductive challenges. Pregnancy after breast cancer does not increase the risk of recurrence; however, very limited data are available in patients with BRCA mutations. This study investigated the impact of pregnancy on breast cancer outcomes in patients with germline BRCA mutations. PATIENTS AND METHODS This is an international, multicenter, hospital-based, retrospective cohort study. Eligible patients were diagnosed between January 2000 and December 2012 with invasive early breast cancer at age ≤ 40 years and harbored deleterious germline BRCA mutations. Primary end points were pregnancy rate, and disease-free survival (DFS) between patients with and without a pregnancy after breast cancer. Pregnancy outcomes and overall survival (OS) were secondary end points. Survival analyses were adjusted for guarantee-time bias controlling for known prognostic factors. RESULTS Of 1,252 patients with germline BRCA mutations (BRCA1, 811 patients; BRCA2, 430 patients; BRCA1/2, 11 patients) included, 195 had at least 1 pregnancy after breast cancer (pregnancy rate at 10 years, 19%; 95% CI, 17% to 22%). Induced abortions and miscarriages occurred in 16 (8.2%) and 20 (10.3%) patients, respectively. Among the 150 patients who gave birth (76.9%; 170 babies), pregnancy complications and congenital anomalies occurred in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up from breast cancer diagnosis was 8.3 years. No differences in DFS (adjusted hazard ratio [HR], 0.87; 95% CI, 0.61 to 1.23; P = .41) or OS (adjusted HR, 0.88; 95% CI, 0.50 to 1.56; P = .66) were observed between the pregnancy and nonpregnancy cohorts. CONCLUSION Pregnancy after breast cancer in patients with germline BRCA mutations is safe without apparent worsening of maternal prognosis and is associated with favorable fetal outcomes. These results provide reassurance to patients with BRCA-mutated breast cancer interested in future fertility.
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Affiliation(s)
- Matteo Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy.,Department of Medical Oncology, UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | | | - Anna Zingarello
- Département Médecine Oncologique, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Philip D Poorvu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Estela Carrasco
- Hereditary Cancer Genetics Group, Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Albert Grinshpun
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
| | - Sileny Han
- Multidisciplinary Breast Center, Department of Gynaecology, University Hospitals Leuven, Department of Oncology, KU Leuven, Leuven, Belgium
| | | | - Alberta Ferrari
- Department of Surgical Sciences, General Surgery III-Breast Surgery, Fondazione IRCCS Policlinico San Matteo, and Department of Clinical Surgical Sciences, University of Pavia, Pavia, Italy
| | | | - Laura Cortesi
- Department of Oncology and Haematology, Azienda Ospedaliero-Universitaria Policlinico di Modena, Modena, Italy
| | | | - Gianmaria Miolo
- Department of Medical Oncology, Centro di Riferimento Oncologico di Aviano, IRCCS, Aviano, Italy
| | - Katarzyna Pogoda
- Department of Breast Cancer and Reconstructive Surgery, Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | | | - Laura De Marchis
- Division of Medical Oncology, Department of Radiological, Oncological and Pathological Sciences, "La Sapienza" University of Rome, Rome, Italy
| | - Riccardo Ponzone
- Gynecological Oncology, Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Turin, Italy
| | - Luca Livraghi
- Medical Oncology Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.,University of Siena, Siena, Italy
| | - Maria Del Pilar Estevez-Diz
- Department of Oncology, Instituto do Cancer do Estado de São Paulo-Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Cynthia Villarreal-Garza
- Departamento de Investigacion y de Tumores Mamarios, Instituto Nacional de Cancerologia, Mexico City, Mexico.,Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Nuevo Leon, Mexico
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy.,Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Martine Berlière
- Department of Oncology, Breast Clinic, Cliniques Universitaires Saint-Luc UCL, Brussels, Belgium
| | - Rossella Graffeo
- Breast Unit of Southern Switzerland, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Luis Teixeira
- Breast Disease Unit Saint-Louis Hospital, APHP, Université de Paris, Inserm, U976 HIPI Unit, F-75010, Paris, France
| | - Octavi Córdoba
- Obstetrics and Gynecology Department, Hospital Universitari Son Espases, Palma, Spain
| | - Amir Sonnenblick
- Oncology Division, Tel Aviv Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv, Israel
| | - Helena Luna Pais
- Department of Medical Oncology, Centro Hospitalar Universitário Lisboa Norte-Hospital de Santa Maria, Lisbon, Portugal
| | - Michail Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de, Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA
| | - Olivier Caron
- Département Médecine Oncologique, Institut Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Claire Saule
- Department of Genetics, Institut Curie, Paris, France
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genoa, Genoa, Italy.,Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Fedro A Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - Hatem A Azim
- Tecnologico de Monterrey, Centro de Cancer de Mama del Hospital Zambrano Hellion, Nuevo Leon, Mexico
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24
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Azim HA, Shohdy KS, Kaldas DF, Kassem L, Azim HA. Adjuvant ovarian function suppression and tamoxifen in premenopausal breast cancer patients: A meta-analysis. Curr Probl Cancer 2020; 44:100592. [PMID: 32527567 DOI: 10.1016/j.currproblcancer.2020.100592] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Revised: 03/30/2020] [Accepted: 04/23/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND The benefit of adding ovarian function suppression (OFS) to tamoxifen in the adjuvant treatment of premenopausal women with breast cancer is uncertain. We conducted a meta-analysis of randomized controlled trials that addressed this question. METHODS Systematic search of PubMed, the web of science, and the meeting library of ASCO, ESMO, and SABCS was conducted using the following keywords: tamoxifen, ovarian suppression, and breast cancer. Eligible studies were those recruiting patients with breast cancer randomized to receive adjuvant tamoxifen and OFS versus tamoxifen alone. Pooled hazard ratio [HR]) for disease-free (DFS) and overall survival (OS) with 95% confidence interval (CI) were calculated using the fixed effect model. RESULTS We searched a total of 845 records, of which 5 clinical trials, including 7557 patients, were eligible for our analysis. Adding OFS to tamoxifen improved DFS with pooled HR: 0.88 (95% CI: 0.80-0.96, P= 0.004) and OS (pooled HR: 0.87 {95% CI: 0.77-0.98, P= 0.02}) compared to tamoxifen alone. The benefit of the addition of OFS to tamoxifen was mostly observed in patients younger than 40 years where the pooled HRs of DFS was 0.76 (95% CI: 0.63-0.91; P= 0.004), and in those who received adjuvant chemotherapy with pooled HRs of DFS 0.80 (95% CI: 0.65-0.99, P= 0.042). There was an increase in the incidence of all grade musculoskeletal symptoms and high-grade hot flushes with the addition of OFS with risk ratios of 1.12 (95% CI: 1.07-1.17, P< 0.001) and 2.14 (95% CI: 1.01-4.51, P= 0.047) respectively. CONCLUSION Our analysis indicates that the addition of OFS to tamoxifen improves DFS and OS. This strategy could be considered in patients in which tamoxifen alone is not deemed sufficient or in case of poor tolerance to OFS with aromatase inhibitors.
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Affiliation(s)
- Hamdy A Azim
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Kyrillus S Shohdy
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Egypt; Division of Hematology and Medical Oncology, Department of Medicine, Weill Cornell Medical College, New York, NY.
| | - David F Kaldas
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Loay Kassem
- Clinical Oncology Department, Kasr Alainy School of Medicine, Cairo University, Egypt
| | - Hatem A Azim
- School of Medicine, Monterrey Institute of Technology, Monterrey, MX
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25
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Sun Z, Niman SM, Pagani O, Partridge AH, Azim HA, Peccatori FA, Ruggeri M, Di Leo A, Colleoni M, Gelber RD, Regan MM. Estimation of historical control rate for a single arm de-escalation study - Application to the POSITIVE trial. Breast 2020; 53:1-7. [PMID: 32535486 PMCID: PMC7375555 DOI: 10.1016/j.breast.2020.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 04/28/2020] [Revised: 05/28/2020] [Accepted: 05/29/2020] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although randomized controlled clinical trials are optimal to evaluate the effect of an experimental therapy, single-arm trials are required whenever randomization is unethical or not feasible, such as de-escalation studies. We propose using prospectively identified historical controls to place results of single-arm, de-escalation trials into context. METHODS POSITIVE is a prospective, single-arm study in young women with hormone-receptor-positive early breast cancer to determine if temporarily interrupting adjuvant endocrine therapy in order to become pregnant increases the risk of a breast cancer event. After 272 women enrolled in POSITIVE, we identified a cohort of 1499 SOFT/TEXT patients potentially eligible to enroll in POSITIVE who did not interrupt endocrine therapy. Method I used the SOFT/TEXT cohort to calculate annualized hazard rates by a piecewise exponential model. Method II used the SOFT/TEXT cohort to group-match SOFT/TEXT patients to POSITIVE patients; sample sets of SOFT/TEXT patients were randomly drawn 5000 times to obtain sets having patient, disease, and treatment characteristics more balanced with POSITIVE participants. RESULTS Compared with SOFT/TEXT, POSITIVE participants were younger, less likely to be overweight/obese, had fewer positive nodes, and fewer received aromatase inhibitor or chemotherapy. The estimated 3-year breast cancer free interval event rates were 9.5% (95% CI: 7.9%,11.1%) for Method I and 9.4% (95% CI: 7.8%,10.9%) for Method II, compared with 5.8% initially assumed when POSITIVE was designed. CONCLUSION External control datasets should be identified before launching single-arm, de-escalation trials and methods applied during their conduct to provide context for interim monitoring and interpretation of the final analysis.
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Affiliation(s)
- Zhuoxin Sun
- International Breast Cancer Study Group Statistical Center, Department of Data Sciences, Division of Biostatistics, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - Samuel M Niman
- International Breast Cancer Study Group Statistical Center, Department of Data Sciences, Division of Biostatistics, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - Olivia Pagani
- Institute of Oncology of Southern Switzerland, Geneva University Hospitals, Swiss Group for Clinical Cancer Research (SAKK), Lugano Viganello, Switzerland.
| | - Ann H Partridge
- Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, 02215, USA.
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, School of Medicine, Tecnologico de Monterrey, Av. Batallon de San Patricio 112, 66278, San Pedro Garza Garcia, Mexico.
| | - Fedro A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Program, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - Monica Ruggeri
- International Breast Cancer Study Group, Program for Young Patients, Coordinating Center, Effingerstrasse 40, 3008, Bern, Switzerland.
| | - Angelo Di Leo
- "Sandro Pitigliani" Medical Oncology Department, Hospital of Prato, Via Suor Niccolina 20, Prato, 59100, Italy.
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy.
| | - Richard D Gelber
- International Breast Cancer Study Group Statistical Center, Department of Data Sciences, Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, And Frontier Science and Technology Research Foundation, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - Meredith M Regan
- International Breast Cancer Study Group Statistical Center, Department of Data Sciences, Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Ave, Boston, MA, 02215, USA.
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26
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Paluch-Shimon S, Cardoso F, Partridge AH, Abulkhair O, Azim HA, Bianchi-Micheli G, Cardoso MJ, Curigliano G, Gelmon KA, Harbeck N, Merschdorf J, Poortmans P, Pruneri G, Senkus E, Spanic T, Stearns V, Wengström Y, Peccatori F, Pagani O. ESO-ESMO 4th International Consensus Guidelines for Breast Cancer in Young Women (BCY4). Ann Oncol 2020; 31:674-696. [PMID: 32199930 DOI: 10.1016/j.annonc.2020.03.284] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [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: 02/24/2020] [Accepted: 03/07/2020] [Indexed: 12/16/2022] Open
Abstract
The 4th International Consensus Conference for Breast Cancer in Young Women (BCY4) took place in October 2018, in Lugano, Switzerland, organized by the European School of Oncology (ESO) and the European Society of Medical Oncology (ESMO). Consensus recommendations for the management of breast cancer in young women were updated from BCY3 with incorporation of new evidence to inform the guidelines. Areas of research priorities were also identified. This article summarizes the ESO-ESMO international consensus recommendations, which are also endorsed by the European Society of Breast Specialists (EUSOMA).
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Affiliation(s)
| | - F Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal
| | - A H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - O Abulkhair
- King Abdulaziz Medical City for National Guard, Riyadh, Saudi Arabia
| | - H A Azim
- School of Medicine, Monterrey Institute of Technology, Monterrey, MX
| | | | - M-J Cardoso
- Breast Unit Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Nova Medical School Lisbon, Portugal
| | - G Curigliano
- European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K A Gelmon
- British Columbia Cancer, Vancouver, Canada
| | - N Harbeck
- Breast Center, Dept. OB&GYN, University of Munich (LMU), Munich, Germany
| | | | - P Poortmans
- Institut Curie, Department of Radiation Oncology & Paris Sciences & Lettres - PSL University, Paris, France
| | - G Pruneri
- National Cancer Institute, IRCCS Foundation, Milan, Italy
| | - E Senkus
- Medical University of Gdansk, Gdansk, Poland
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - V Stearns
- The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, USA
| | - Y Wengström
- Department of Neurobiology Cancer Science and Society, Karolinska Institute and Theme Cancer Karolinska University Hospital, Sweden
| | - F Peccatori
- European Institute of Oncology IRCCS & European School of Oncology, Milan, Italy
| | - O Pagani
- Oncology Institute of Southern Switzerland and Breast Unit of Southern Switzerland, Geneva University Hospitals, Swiss Group for Clinical Cancer Research (SAKK), Bellinzona, Switzerland
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27
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Abstract
Evidence suggests a likely negative impact of deleterious BRCA mutations on female fertility. Hence, different studies have aimed to address the reproductive potential and performance of fertility preservation strategies in BRCA-mutated breast cancer patients with a prime focus on their safety and efficacy. However, several uncertainties exist in many domains of this field. The aim of the current paper is to overview the reproductive potential and fertility preservation options in breast and ovarian cancer patients harbouring a BRCA mutation. We also discuss pre-implantation genetic testing in an attempt to help physicians during oncofertility counselling of these patients.
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Affiliation(s)
- Suleiman Ghunaim
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Haifa Idriss-ART Unit, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Ghina Ghazeeri
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Haifa Idriss-ART Unit, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Dalia Khalife
- Department of Obstetrics and Gynecology, Division of Reproductive Endocrinology and Infertility, Haifa Idriss-ART Unit, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon
| | - Hatem A Azim
- Breast Cancer Centre, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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Pagani O, Partridge AH, Peccatori FA, Azim HA, Shimizu C, Saura C, Warner E, Sætersdal AB, Kroep JR, Ruggeri M, Gelber RD. Abstract OT1-04-02: POSITIVE: A study evaluating pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsive breast cancer who desire pregnancy (IBCSG 48-14/big 8-13). Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-ot1-04-02] [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: Young patients with breast cancer (BC) are often diagnosed before completing their families. The best available retrospective evidence suggests that pregnancy after BC does not negatively impact disease outcomes overall and in patients with endocrine responsive disease, and is safe for the offspring. However, given also the possibility of extended adjuvant endocrine therapy (ET) (5-10 years), it is not feasible for many of these women to delay pregnancy until completion of therapy. Prospectively evaluating the safety of temporary interruption of ET to allow conception is an unmet, patient-oriented, medical need.
Trial Design: Young patients with endocrine responsive early BC who desire pregnancy will interrupt ET for up to 2 yrs to attempt child-bearing. As resumption of menses and conception depends on many factors (e.g. patient’s age and adjuvant treatment received), the 2-yr interruption period is approximate, intended to include treatment wash-out (3 mos), conception (~3-6 mos), delivery (~9 mos), and breast feeding (~6 mos). Patients will be strongly advised to resume ET as soon as pregnancy attempts/deliveries are concluded, and to complete the planned 5-10 yrs of ET.
Major Eligibility Criteria
- Histologically-proven stage I-III endocrine-responsive BC.
- Patient’s wish to become pregnant.
- Age ≥ 18 and ≤ 42 years at enrollment.
- Adjuvant ET (selective estrogen receptor modulator [SERM] alone, GnRH analogue plus SERM or aromatase inhibitor) for ≥18 months but ≤30 months, stopped within 1 month prior to enrollment.
- Premenopausal status at BC diagnosis.
Specific Aims
1. To assess the risk of BC relapse associated with temporary interruption of ET to permit pregnancy.
2. To evaluate pregnancy success rate and offspring outcome.
Statistical Methods: With 500 pts enrolled and followed for a median of 3 years, the statistical design is based on the 95% CI for the 3-year BC recurrence rate. Interim monitoring assumes a 2% BC recurrence risk/yr with continuous ET and a recommendation to stop the study early if the BC risk exceeds 4%/yr with ET interruption.
Translational Research will evaluate fertility, pregnancy and BC biology determinants (e.g. ovarian function, uterine evaluation and circulating tumor DNA). Fresh frozen paraffin embedded tissue of the primary tumour will be collected to evaluate parameters related to the biology of BC in young women. All material will be banked centrally.
Psycho-oncological Companion Study (POCS) will evaluate fertility concerns, psychological well-being and decisional conflict. It is mandatory in North America and open to interested centers elsewhere.
Accrual: Target: 500; Actual: 421 (30 June 2019)
Psycho-oncological Companion Study Accrual: Target: ~200; Actual: 196 (30 June 2019)
Contact Information: POSITIVE is conducted and sponsored by the International Breast Cancer Study Group. The Alliance for Clinical Trials in Oncology is the US sponsor for NCTN. Contact Monica Ruggeri, IBCSG Coordinating Center, monica.ruggeri@ibcsg.org, or Trial Coordinators at ibcsg48_positive@fstrf.org.
Citation Format: Olivia Pagani, Ann H Partridge, Fedro A Peccatori, Hatem A Azim, Chikako Shimizu, Cristina Saura, Ellen Warner, Anna B Sætersdal, Judith R Kroep, Monica Ruggeri, Richard D Gelber. POSITIVE: A study evaluating pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsive breast cancer who desire pregnancy (IBCSG 48-14/big 8-13) [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr OT1-04-02.
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Affiliation(s)
- Olivia Pagani
- 1Institute of Oncology and Breast Unit of Southern Switzerland, Bellinzona, Switzerland
| | | | | | - Hatem A Azim
- 4American University of Beirut (AUB), Beirut, Lebanon
| | - Chikako Shimizu
- 5National Center for Global Health and Medicine, Shinjuku-ku, Japan
| | - Cristina Saura
- 6Vall d’Hebron University Hospital, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Ellen Warner
- 7Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, ON, Canada
| | | | | | - Monica Ruggeri
- 10International Breast Cancer Study Group, Bern, Switzerland
| | - Richard D Gelber
- 11IBCSG Statistical Center, Dana-Farber Cancer Institute and Frontier Science and Technology Research Foundation, Boston, MA, USA, Boston, MA
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Azim HA, Dawood S, El-Saghir N, Kassem L, Azim HA. Understanding the benefits and challenges of first-line cyclin-dependent kinases 4 and 6 inhibitors in advanced breast cancer among postmenopausal women. Breast J 2019; 26:630-642. [PMID: 31709685 DOI: 10.1111/tbj.13637] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 08/29/2019] [Accepted: 09/06/2019] [Indexed: 01/03/2023]
Abstract
Endocrine therapy (ET) has been regarded for many years as the standard treatment for patients with hormone receptor-positive (ER+), HER2-negative (HER2-) advanced breast cancer (ABC) without visceral crisis. However, the efficacy of single-agent ET is constrained by the development of resistance, attributed to alterations in several intracellular signaling pathways, including those related to cell cycle dysregulation. The cyclin-dependent kinases 4 and 6 (CDK4/6) are principal regulators of cell cycle progression from the G1-phase into the DNA synthesis (S)-phase. In vitro inhibition of CDK4/6 activity has potent antiproliferative properties against luminal breast cancer cell lines, which are enhanced when combined with traditional ET. This has led to a substantial interest in targeting this pathway to overcome endocrine resistance in the clinic. Three selective CDK4/6 inhibitors (palbociclib, ribociclib, and abemaciclib) have been approved as first-line therapy in combination with an aromatase inhibitor, or fulvestrant in the case of ribociclib in patients with ER+/HER2- ABC. To date, there is no clue as to which subgroup of patients might benefit most from these combinations. Here, we outline some of the established approaches to overcome endocrine resistance, with special emphasis on the unique mechanism of action of CDK4/6 inhibitors.
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Affiliation(s)
- Hamdy A Azim
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Cairo Oncology Centre, Cairo, Egypt
| | - Shaheenah Dawood
- Department of Medical Oncology, Mediclinic City Hospital, Comprehensive Cancer Center, Dubai Health Care City, Dubai, UAE
| | - Nagi El-Saghir
- American University of Beirut Medical Center, Beirut, Lebanon
| | - Loay Kassem
- Department of Clinical Oncology, Faculty of Medicine, Cairo University, Cairo, Egypt.,Cairo Oncology Centre, Cairo, Egypt
| | - Hatem A Azim
- American University of Beirut Medical Center, Beirut, Lebanon
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Hui R, Pearson A, Cortes J, Campbell C, Poirot C, Azim HA, Fumagalli D, Lambertini M, Daly F, Arahmani A, Perez-Garcia J, Aftimos P, Bedard PL, Xuereb L, Scheepers ED, Vicente M, Goulioti T, Loibl S, Loi S, Pierrat MJ, Turner NC, Andre F, Curigliano G. Lucitanib for the Treatment of HR+/HER2− Metastatic Breast Cancer: Results from the Multicohort Phase II FINESSE Study. Clin Cancer Res 2019; 26:354-363. [DOI: 10.1158/1078-0432.ccr-19-1164] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/04/2019] [Accepted: 10/09/2019] [Indexed: 11/16/2022]
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Tinker AV, Hirte HW, Provencher D, Butler M, Ritter H, Tu D, Azim HA, Paralejas P, Grenier N, Hahn SA, Ramsahai J, Seymour L. Dose-Ranging and Cohort-Expansion Study of Monalizumab (IPH2201) in Patients with Advanced Gynecologic Malignancies: A Trial of the Canadian Cancer Trials Group (CCTG): IND221. Clin Cancer Res 2019; 25:6052-6060. [PMID: 31308062 DOI: 10.1158/1078-0432.ccr-19-0298] [Citation(s) in RCA: 56] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 04/20/2019] [Accepted: 07/02/2019] [Indexed: 11/16/2022]
Abstract
PURPOSE Monalizumab binds CD94/NKG2A, preventing HLA-E inhibition of tumor lymphocytes. A dose-ranging/cohort expansion trial of monalizumab for recurrent gynecologic malignancies was conducted to determine the recommended phase II dose (RP2D) and to explore clinical activity, pharmacokinetics, pharmacodynamics, safety, and immunogenicity. PATIENTS AND METHODS Participants (and part 2 expansion cohorts) included (i) platinum-sensitive ovarian, (ii) platinum-resistant ovarian, (iii) squamous cervical (CX), and (iv) epithelial endometrial (END) carcinomas. Part 1 assessed monalizumab at 1, 4, or 10 mg/kg every 2 weeks. In part 2, ≥4 patients/cohort underwent pre- and on-treatment tumor biopsies. Preset criteria determined cohort expansion. RESULTS A total of 58 participants were evaluable. The RP2D was 10 mg/kg i.v. every 2 weeks. Dose proportionality and 100% NKG2A saturation were observed. Related adverse events were mild: headache, abdominal pain, fatigue, nausea, and vomiting. Grade 3 related adverse events were nausea (1), vomiting (1), dehydration (1), fatigue (2), anorexia (1), dyspnea (1), and proctitis (1). Dose-limiting toxicities were not observed. Hematologic and biochemical changes were mild and not dose related. Best response was SD: part 1, 7 of 18 (39%) [3.4 months (1.4-5.5)], and part 2, 7 of 39 (18%) [1.7 months (CX) to 14.8 months (END)]. Neither a predictive biomarker for SD nor evidence of pharmacodynamic effects was identified. There was a trend to significance between a reduction in lymphocyte HLA-E total score and pharmacodynamics. CONCLUSIONS Monalizumab 10 mg/kg i.v. every 2 week is well tolerated in patients with pretreated gynecologic cancers. Short-term disease stabilization was observed. Future studies should assess combinations with other agents, including immunotherapeutics.
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Affiliation(s)
| | | | | | - Marcus Butler
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | | | - Dongsheng Tu
- Canadian Cancer Trials Group, Kingston, Ontario, Canada
| | - Hatem A Azim
- Innate Pharma, Research and Development, Marseille, France
| | | | | | | | | | - Lesley Seymour
- Canadian Cancer Trials Group, Kingston, Ontario, Canada.
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Bagot M, Porcu P, Marie-Cardine A, Battistella M, William BM, Vermeer M, Whittaker S, Rotolo F, Ram-Wolff C, Khodadoust MS, Bensussan A, Paturel C, Bonnafous C, Sicard H, Azim HA, Kim YH. IPH4102, a first-in-class anti-KIR3DL2 monoclonal antibody, in patients with relapsed or refractory cutaneous T-cell lymphoma: an international, first-in-human, open-label, phase 1 trial. Lancet Oncol 2019; 20:1160-1170. [PMID: 31253572 DOI: 10.1016/s1470-2045(19)30320-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 04/15/2019] [Accepted: 04/16/2019] [Indexed: 12/28/2022]
Abstract
BACKGROUND IPH4102 is a first-in-class monoclonal antibody targeting KIR3DL2, a cell surface protein that is expressed in cutaneous T-cell lymphoma, and predominantly in its leukaemic form, Sézary syndrome. We aimed to assess the safety and activity of IPH4102 in cutaneous T-cell lymphoma. METHODS We did an international, first-in-human, open-label, phase 1 clinical trial with dose-escalation and cohort-expansion parts in five academic hospitals in the USA, France, the UK, and the Netherlands. Eligible patients had histologically confirmed relapsed or refractory primary cutaneous T-cell lymphoma, an Eastern Cooperative Oncology group performance score of 2 or less, were aged 18 years or older, and had received at least two previous systemic therapies. Ten dose levels of IPH4102, administered as an intravenous infusion, ranging from 0·0001 mg/kg to 10 mg/kg, were assessed using an accelerated 3 + 3 design. The primary endpoint was the occurrence of dose-limiting toxicities during the first 2 weeks of treatment, defined as toxicity grade 3 or worse lasting for 8 or more days, except for lymphopenia. Global overall response by cutaneous T-cell lymphoma subtype was a secondary endpoint. Safety and activity analyses were done in the per-protocol population. The study is ongoing and recruitment is complete. This trial is registered with ClinicalTrials.gov, number NCT02593045. FINDINGS Between Nov 4, 2015, and Nov 20, 2017, 44 patients were enrolled. 35 (80%) patients had Sézary syndrome, eight (18%) had mycosis fungoides, and one (2%) had primary cutaneous T-cell lymphoma, not otherwise specified. In the dose-escalation part, no dose limiting toxicity was reported and the trial's safety committee recommended a flat dose of 750 mg for the cohort-expansion, corresponding to the maximum administered dose. The most common adverse events were peripheral oedema (12 [27%] of 44 patients) and fatigue (nine [20%]), all of which were grade 1-2. Lymphopenia was the most common grade 3 or worse adverse event (three [7%]). One patient developed possibly treatment-related fulminant hepatitis 6 weeks after IPH4102 discontinuation and subsequently died. However, the patient had evidence of human herpes virus-6B infection. Median follow-up was 14·1 months (IQR 11·3-20·5). A confirmed global overall response was achieved in 16 (36·4% [95% CI 23·8-51·1]) of 44 patients, and of those, 15 responses were observed in 35 patients with Sézary syndrome (43% [28·0-59·1]). INTERPRETATION IPH4102 is safe and shows encouraging clinical activity in patients with relapsed or refractory cutaneous T-cell lymphoma, particularly those with Sézary syndrome. If confirmed in future trials, IPH4102 could become a novel treatment option for these patients. A multi-cohort, phase 2 trial (TELLOMAK) is underway to confirm the activity in patients with Sézary syndrome and explore the role of IPH4102 in other subtypes of T-cell lymphomas that express KIR3DL2. FUNDING Innate Pharma.
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Affiliation(s)
- Martine Bagot
- Hôpital Saint Louis, Paris, France; INSERM U976, Paris 7 University, Paris, France.
| | - Pierluigi Porcu
- Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Maxime Battistella
- Hôpital Saint Louis, Paris, France; INSERM U976, Paris 7 University, Paris, France
| | - Basem M William
- The Ohio State University Comprehensive Cancer Center, Columbus, OH, USA
| | | | | | | | - Caroline Ram-Wolff
- Hôpital Saint Louis, Paris, France; INSERM U976, Paris 7 University, Paris, France
| | | | | | | | | | | | | | - Youn H Kim
- Stanford Cancer Institute, Stanford, CA, USA
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Affiliation(s)
- Matteo Lambertini
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Hatem A Azim
- Department of Internal Medicine, Division of Hematology-Oncology, American University of Beirut (AUB), Beirut, Lebanon
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Lambertini M, Ameye L, Hamy AS, Zingarello A, Poorvu PD, Carrasco E, Grinshpun A, Han S, Rousset-Jablonski C, Ferrari A, Paluch-Shimon S, Cortesi L, Senechal C, Miolo G, Pogoda K, Perez-Fidalgo JA, De Marchis L, Del Mastro L, Peccatori F, Azim HA. Safety of pregnancy following breast cancer (BC) in patients (pts) carrying a BRCA mutation (mBRCA): Results of an international cohort study. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.11506] [Citation(s) in RCA: 4] [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
11506 Background: Very limited data are available on the safety of pregnancy and reproductive outcomes in mBRCA pts with prior BC history. We report the results of the largest study to date addressing these questions. Methods: This international, multicenter, hospital-based, retrospective cohort study included consecutive pts with invasive early BC (stage I-III) diagnosed between Jan-2000 and Dec-2012 at the age of ≤40 years and carrying a deleterious germline mBRCA. Primary endpoints were pregnancy rate and disease-free survival (DFS); overall survival (OS) and pregnancy outcomes were secondary endpoints. To account for guarantee-time bias, we performed two survival analyses: 1) Case-control approach matching pregnant and non-pregnant (1:3) pts for classic prognostic factors (each non-pregnant control had a disease-free interval ≥ than the time elapsing between BC diagnosis and date of pregnancy of the matched pregnant case); 2) Extended Cox model with time-varying covariates including all pts. Results: 1,252 mBRCA BC pts (811 mBRCA1, 430 mBRCA2, 11 mBRCA1&2) were included from 30 centers worldwide, of whom 195 pts had a pregnancy (pregnancy rate = 16% [95% CI 14-18]) after a median 4.5 years (range 3.1-6.7 years) following BC diagnosis. Pregnant pts were younger and had more ER-negative tumors (all p < 0.01). 16 (8.2%) and 20 (10.3%) pts had an induced and spontaneous abortion, respectively. Among the 150 (76.9%) pts who conceived (n = 170 babies), pregnancy complications and congenital anomalies were described in 13 (11.6%) and 2 (1.8%) cases, respectively. Median follow-up was 8.3 years (range 8.1-8.7 years). In the case-control analysis, pregnant pts had better DFS (HR 0.71; 95% CI 0.51-0.99; p = 0.045), with no difference in OS (HR 0.86; 95% CI 0.44-1.67; p = 0.65). Subgroup analysis suggested that the superior outcome was restricted to mBRCA1 pregnant pts (p-interaction < 0.01). Similar results were obtained in the second supportive analysis. Conclusions: Pregnancy following BC is safe in mBRCA pts, particularly mBRCA1, with no detrimental impact on maternal prognosis or fetal outcomes . These findings are of paramount importance for fertility counseling in young mBRCA BC pts.
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Affiliation(s)
- Matteo Lambertini
- Policlinico San Martino Hospital - University of Genova, Genova, Italy
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet - Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | | | | | | | - Sileny Han
- BGOG & Department of Gynaecology and Obstetrics, University Hospitals Leuven, Leuven Cancer Institute, Leuven, Belgium
| | | | - Alberta Ferrari
- Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | | | | | | | - Gianmaria Miolo
- Dipartimento di Oncologia Medica, Centro di Riferimento Oncologico di Aviano (CRO), IRCCS, Aviano, Italy
| | - Katarzyna Pogoda
- Maria Sklodowska-Curie Institute - Oncology Center, Warsaw, Poland
| | - Jose Alejandro Perez-Fidalgo
- Hospital Clínico Universitario de Valencia, INCLIVA, Centro de Investigación Biomédica en Red de Oncología, CIBERONC-ISCIII, GEICAM Spanish Breast Cancer Group, Valencia, Spain
| | | | - Lucia Del Mastro
- Ospedale Policlinico San Martino-Oncologia Medica, Genova, Italy
| | | | - Hatem A. Azim
- American University of Beirut (AUB), Beirut, Lebanon
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Lambertini M, Goldrat O, Ferreira AR, Dechene J, Azim HA, Desir J, Delbaere A, t'Kint de Roodenbeke MD, de Azambuja E, Ignatiadis M, Demeestere I. Reproductive potential and performance of fertility preservation strategies in BRCA-mutated breast cancer patients. Ann Oncol 2019; 29:237-243. [PMID: 29045555 DOI: 10.1093/annonc/mdx639] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background Preclinical evidence suggests a possible negative impact of deleterious BRCA mutations on female fertility. However, limited and rather conflicting clinical data are available. This study assessed the reproductive potential and performance of fertility preservation strategies in BRCA-mutated breast cancer patients. Patients and methods This was a retrospective analysis of two prospective studies investigating oocyte cryopreservation and ovarian tissue cryopreservation in newly diagnosed early breast cancer patients. In the current analysis, baseline anti-Mullerian hormone (AMH) and performance of cryopreservation strategies were compared between patients with or without germline deleterious BRCA mutations. Results Out of 156 patients included, 101 had known BRCA status of whom 29 (18.6%) were BRCA-mutated and 72 (46.1%) had no mutation. Median age in the entire cohort was 31 years [interquartile range (IQR) 28-33). Median AMH levels were 1.8 μg/l (IQR 1.0-2.7) and 2.6 µg/l (IQR 1.5-4.1) in the BRCA-positive and BRCA-negative cohorts, respectively (P = 0.109). Among patients who underwent oocyte cryopreservation (N = 29), women in the BRCA-positive cohort tended to retrieve (6.5 versus 9; P = 0.145) and to cryopreserve (3.5 versus 6; P = 0.121) less oocytes than those in the BRCA-negative cohort. Poor response rate (i.e. retrieval of ≤4 oocytes) was 40.0% and 11.1% in the BRCA-positive and BRCA-negative cohorts, respectively (P = 0.147). Among patients who underwent ovarian tissue cryopreservation (N = 72), women in the BRCA-positive cohort tended to have a numerically lower number of oocytes per fragment (0.08 versus 0.14; P = 0.193) and per square millimeter (0.33 versus 0.78; P = 0.153) than those in the BRCA-negative cohort. Two BRCA-mutated patients were transplanted after chemotherapy and one delivered at term a healthy baby. No difference between BRCA1- and BRCA2-mutated patients was observed in any of the above-mentioned outcomes. Conclusion A consistent trend for reduced reproductive potential and performance of cryopreservation strategies was observed in BRCA-mutated breast cancer patients. Independent validation of these results is needed.
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Affiliation(s)
- M Lambertini
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.,Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - O Goldrat
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A R Ferreira
- Hospital de Santa Maria and Instituto de Medicina Molecular, Faculdade de Medicina, Universiade de Lisboa, Lisbon, Portugal
| | - J Dechene
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - H A Azim
- Department of Internal Medicine, American University of Beirut (AUB), Beirut, Lebanon
| | - J Desir
- Medical Genetics Department, CUB-Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A Delbaere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M-D t'Kint de Roodenbeke
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - E de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Ignatiadis
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - I Demeestere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
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Ring A, Borstnar S, Ferreira A, Azim HA, Cottu P, Lu J, Martin M, Zamagni C, Beck JT, Zhou K, Wu J, Menon L, De Laurentiis M. Abstract P6-18-16: Ribociclib (RIBO) + letrozole (LET) in older patients with hormone receptor-positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer (ABC): Preliminary subgroup results from the phase 3b CompLEEment-1 trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-16] [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 cyclin-dependent kinase (CDK)4/6 inhibitor RIBO is approved in combination with an aromatase inhibitor (AI) for HR+, HER2– ABC in postmenopausal women with no prior therapy for ABC, based on the MONALEESA-2 trial (Hortobagyi et al. NEJM 2016). Although a high proportion of patients with HR+, HER2– ABC are >65 years of age, older patients are often under-represented in clinical trials. Furthermore, treatment decisions may be complicated by comorbidities, functional status, and concurrent medications. Here, we report early safety results for patients ≥65 years of age enrolled in CompLEEment-1, an open-label, phase 3b trial evaluating RIBO+LET as first-line endocrine-based therapy in an expanded patient population.
Methods: Patients with HR+, HER2– ABC, ≤1 line of prior chemotherapy (CT), and no prior endocrine therapy for ABC received RIBO (600 mg/day, 3 weeks on/1 week off) + LET (2.5 mg/day); men and premenopausal women received concomitant goserelin (3.6-mg subcutaneous implant every 28 days). The primary outcome was safety and tolerability. A pre-planned interim analysis was conducted ˜15 months after first patient first visit.
Results: Of the first 1,008 patients enrolled who completed 56 days of follow-up or discontinued before the data cut-off date, 377 were ≥65 years of age. Of these, 157 (41.6%) were 65-<70 years, 107 (28.4%) were 70-<75 years, and 113 (30%) were ≥75 years. The majority of patients (94.4%) had an Eastern Cooperative Oncology Group performance status ≤1; 33.2% presented with stage IV disease at diagnosis; 9 patients were male. The most common sites of metastasis were bone (70.0%), lung (44.8%), and lymph nodes (29.7%). The most common all-grade adverse events (AEs) were neutropenia (58.4%), nausea (31.8%), and fatigue (24.1%). The most common grade 3/4 AEs were neutropenia (37.7%) and alanine aminotransferase increase (4.2%). QT prolongation events were mild (majority grade 1/2) and occurred in 6.1% of patients (0.5% grade 3/4). Dose reduction or interruption due to AEs occurred in 54.5% of patients; 6.9% of patients had AEs leading to treatment discontinuation. In the overall patient population, the most frequent grade 3/4 AEs were neutropenia (42.8%), leukopenia (3.4%), and increased alanine aminotransferase (2.9%); QT prolongation occurred in 5.4% of patients (0.5% grade 3/4).
Conclusions: Initial safety results from CompLEEment-1, from the first 56 days of follow-up, demonstrate the tolerability of RIBO+LET in older patients, consistent with the overall patient population. NCT02941926.
Citation Format: Ring A, Borstnar S, Ferreira A, Azim HA, Cottu P, Lu J, Martin M, Zamagni C, Beck JT, Zhou K, Wu J, Menon L, De Laurentiis M. Ribociclib (RIBO) + letrozole (LET) in older patients with hormone receptor-positive (HR+), human epidermal growth factor receptor-2–negative (HER2–) advanced breast cancer (ABC): Preliminary subgroup results from the phase 3b CompLEEment-1 trial [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-18-16.
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Affiliation(s)
- A Ring
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - S Borstnar
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - A Ferreira
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - HA Azim
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - P Cottu
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - J Lu
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - M Martin
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - C Zamagni
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - JT Beck
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - K Zhou
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - J Wu
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - L Menon
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
| | - M De Laurentiis
- Royal Marsden NHS Foundation Trust, Surrey, United Kingdom; Institute of Oncology Ljubljana, Ljubljana, Slovenia; Instituto Português de Oncologia do Porto, Porto, Portugal; Cairo University, Cairo, Egypt; Institut Curie, Paris, France; University of Southern California, Los Angeles, CA; Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc, Geicam, Universidad Complutense, Madrid, Spain; Addarii Medical Oncology Unit, S. Orsola-Malpighi Hospital, Bologna, Italy; Highlands Oncology Group, Fayetteville, AR; Novartis Pharmaceuticals, East Hanover, NJ; National Cancer Institute “Fondazione Pascale”, Napoli, Italy
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Pagani O, Partridge AH, Peccatori F, Azim HA, Colleoni M, Saura C, Kroep JR, Warner E, Gombos A, Sætersdal AB, Ruggeri M, Gelber RD, Sun Z. Abstract OT1-01-06: POSITIVE: A study evaluating Pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsIVE breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-01-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Young patients with breast cancer (BC) are often diagnosed with the disease before completing their families. The best available retrospective evidence suggests that pregnancy after BC does not negatively impact disease outcomes in patients with endocrine responsive BC and is safe for the offspring. However, given the possibility of extended adjuvant endocrine therapy (ET) (5-10 years), it is not feasible for many of these women to delay pregnancy until completion of therapy and thus there is a need to study the safety of interrupting ET to allow pregnancy. To date, no prospective study has been conducted in BC survivors attempting future pregnancy.
Trial Design
Young patients with endocrine responsive early BC who desire pregnancy will interrupt ET for up to 2 yrs to attempt pregnancy. As resumption of menses and conception depends on many factors (e.g. patient's age and adjuvant treatment received), the 2-yr interruption period is approximate, intended to include treatment wash-out (3 mos), conception (˜3-6 mos), delivery (˜9 mos), and breast feeding (˜6 mos). Patients will be strongly advised to resume ET as soon as pregnancy attempts/deliveries are concluded, and to complete the planned 5-10 yrs of ET.
Major Eligibility Criteria
- Histologically-proven stage I-III endocrine-responsive BC.
- Patient's wish to become pregnant.
- Age ≥ 18 and ≤ 42 years at enrollment.
- Adjuvant ET (selective estrogen receptor modulator [SERM] alone, GnRH analogue plus SERM or aromatase inhibitor) for ≥18 months but ≤30 months, stopped within 1 month prior to enrollment.
- Premenopausal status at BC diagnosis.
Specific Aim
To assess the risk of BC relapse associated with the interruption of ET to permit pregnancy, and to evaluate pregnancy success rate and offspring outcome.
Statistical Methods
With 500 pts enrolled and followed for a median of 3 years, the statistical design is based on the 95% CI for the 3-year BC recurrence rate. Interim monitoring assumes a 2% BC recurrence risk/yr with continuous ET and a recommendation to stop the study early if the BC risk exceeds 4%/yr with ET interruption.
Translational Research will investigate various ovarian function and uterine parameters and circulating tumour DNA. Fresh frozen paraffin embedded tissue of the primary tumour will be collected to evaluate parameters related to the biology of BC in young women. All material will be banked centrally.
Psycho-oncological Companion Study (POCS) will evaluate fertility concerns, psychological well-being and decisional conflict. It is mandatory in North America and open to interested centers elsewhere.
Accrual: Target: 500; Actual: 262 (30 June 2018)
Psycho-oncological Companion Study Accrual: Target: 200; Actual: 138 (30 June 2018)
Citation Format: Pagani O, Partridge AH, Peccatori F, Azim HA, Colleoni M, Saura C, Kroep JR, Warner E, Gombos A, Sætersdal AB, Ruggeri M, Gelber RD, Sun Z. POSITIVE: A study evaluating Pregnancy, disease outcome and safety of interrupting endocrine therapy for premenopausal women with endocrine responsIVE breast cancer who desire pregnancy (IBCSG 48-14/BIG 8-13) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr OT1-01-06.
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Affiliation(s)
- O Pagani
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - AH Partridge
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - F Peccatori
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - HA Azim
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - M Colleoni
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - C Saura
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - JR Kroep
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - E Warner
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - A Gombos
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - AB Sætersdal
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - M Ruggeri
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - RD Gelber
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
| | - Z Sun
- Oncology Institute of Southern Switzerland, Bern, Ticino, Switzerland; Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA; European Institute of Oncology (IEO), Milan, Italy; American University of Beirut (AUB), Beirut, Lebanon; Vall d'Hebron University Hospital, Barcelona, Spain; Leiden University Medical Center, Leiden, Netherlands; Sunnybrook Health Sciences Centre, Toronto, Canada; Institut Jules Bordet, Brussels, Belgium; Oslo University Hospital, Oslo, Norway; International Breast Cancer Study Group, Bern, Switzerland; International Breast Cancer Study Group Statistical Center and Frontier Science and Technology Research Foundation, Boston, MA
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Lambertini M, Di Maio M, Poggio F, Pagani O, Curigliano G, Mastro LD, Paluch-Shimon S, Loibl S, Partridge AH, Azim HA, Peccatori FA, Demeestere I. Knowledge, attitudes and practice of physicians towards fertility and pregnancy-related issues in youngBRCA-mutated breast cancer patients. Reprod Biomed Online 2019; 38:835-844. [PMID: 30914152 DOI: 10.1016/j.rbmo.2018.11.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Revised: 11/13/2018] [Accepted: 11/27/2018] [Indexed: 11/30/2022]
Abstract
RESEARCH QUESTION This study explored the knowledge, attitudes and practice of physicians towards fertility and pregnancy-related issues in young BRCA-mutated breast cancer patients. DESIGN Physicians attending two international breast cancer conferences completed a 26-item questionnaire exploring fertility preservation, pregnancy during (BCP) or after breast cancer. A statistical comparison was carried out of the responses exploring the same issues in young breast cancer patients overall or specifically in those with BRCA mutations. RESULTS The survey was completed by 273 physicians. Ovarian tissue cryopreservation (33% versus 40%; P = 0.009) and gonadotrophin-releasing hormone analogues during chemotherapy (74% versus 81%; P = 0.001) were less commonly suggested in BRCA-mutated patients than in the overall breast cancer population. 42% of respondents agreed or were neutral on the statement that ovarian stimulation should not be considered safe in BRCA-mutated breast cancer patients. 45% and 30% agreed or were neutral on the statement that pregnancy in breast cancer survivors may increase the risk of recurrence in BRCA-mutated patients or in the overall breast cancer population, respectively (P < 0.001). 15% and 3% disagreed that transplanting the cryopreserved ovarian tissue can be considered safe in BRCA-mutated patients or in the overall breast cancer population, respectively (P < 0.001). 33.3% were against the addition of platinum agents as neoadjuvant chemotherapy in BRCA-mutated patients with BCP. CONCLUSIONS Several misconceptions on fertility preservation and pregnancy-related issues in breast cancer patients persist even among physicians directly involved in breast cancer care. Focused research efforts to address these issues in BRCA-mutated breast cancer patients and education to improve physicians' knowledge and adherence to available guidelines are urgently needed.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy.
| | - Massimo Di Maio
- Medical Oncology, A.O. Ordine Mauriziano, Department of Oncology, University of Turin, Turin, Italy
| | - Francesca Poggio
- Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Olivia Pagani
- Breast Unit and Institute of Oncology of Southern Switzerland, Geneva University Hospitals, Swiss Group for Clinical Cancer Research, Lugano Viganello, Switzerland
| | - Giuseppe Curigliano
- University of Milan, Department of Oncology and Hemato-Oncology, New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology IRCCS, European School of Oncology, Milan, Italy
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy; Department of Medical Oncology, U.O. Sviluppo Terapie Innovative, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, and Centre for Haematology and Oncology, Frankfurt, Germany
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston MA, USA
| | - Hatem A Azim
- Department of Medicine, Division of Hematology/Oncology, American University of Beirut, Beirut, Lebanon
| | - Fedro A Peccatori
- Fertility and Procreation Unit, Gynecologic Oncology Department, European Institute of Oncology IRCCS, European School of Oncology, Milan, Italy
| | - Isabelle Demeestere
- Fertility Clinic, Research Laboratory on Human Reproduction, CUB-Erasme and Université Libre de Bruxelles, Brussels, Belgium
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Lambertini M, Di Maio M, Pagani O, Curigliano G, Poggio F, Del Mastro L, Paluch-Shimon S, Loibl S, Partridge AH, Demeestere I, Azim HA, Peccatori FA. The BCY3/BCC 2017 survey on physicians' knowledge, attitudes and practice towards fertility and pregnancy-related issues in young breast cancer patients. Breast 2018; 42:41-49. [DOI: 10.1016/j.breast.2018.08.099] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 08/07/2018] [Accepted: 08/20/2018] [Indexed: 10/28/2022] Open
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Lambertini M, Martel S, Campbell C, Guillaume S, Hilbers FS, Schuehly U, Korde L, Azim HA, Di Cosimo S, Tenglin RC, Huober J, Baselga J, Moreno-Aspitia A, Piccart-Gebhart M, Gelber RD, de Azambuja E, Ignatiadis M. Pregnancies during and after trastuzumab and/or lapatinib in patients with human epidermal growth factor receptor 2-positive early breast cancer: Analysis from the NeoALTTO (BIG 1-06) and ALTTO (BIG 2-06) trials. Cancer 2018; 125:307-316. [PMID: 30335191 DOI: 10.1002/cncr.31784] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/08/2018] [Accepted: 06/14/2018] [Indexed: 01/01/2023]
Abstract
BACKGROUND Limited data exist on the safety of using anti-human epidermal growth factor receptor 2 (HER2) targeted agents during pregnancy. To date, only retrospective studies have assessed the prognosis of patients with a pregnancy after prior early breast cancer, with no data in HER2-positive patients. METHODS The Neoadjuvant Lapatinib and/or Trastuzumab Treatment Optimization (NeoALTTO) trial and the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization (ALTTO) trial were randomized phase 3 trials for patients with HER2-positive early breast cancer. In both trials, pregnancy information was prospectively collected. Pregnancy outcomes were compared between patients unintentionally exposed to trastuzumab and/or lapatinib during gestation (the exposed group) and those who became pregnant after trastuzumab and/or lapatinib completion (the unexposed group). In the ALTTO trial, disease-free survival (DFS) was compared between pregnant patients and those aged 40 years or younger without a subsequent pregnancy via an extended Cox model with time-varying covariates to account for a guarantee-time bias. RESULTS Ninety-two patients (12 in the exposed group and 80 in the unexposed group) had a pregnancy: 7 in the NeoALTTO trial and 85 in the ALTTO trial. Seven patients (58.3%) in the exposed group and 10 patients (12.5%) in the unexposed group opted for an induced abortion; in the unexposed group, 10 patients (12.5%) had a spontaneous abortion. No pregnancy/delivery complications were reported for the remaining cases, who successfully completed their pregnancy, with the exception of 1 fetus with trisomy 21 (Down syndrome). No significant difference in DFS (adjusted hazard ratio, 1.12; 95% confidence interval, 0.52-2.42) was observed between young patients with a pregnancy (n = 85) and young patients without a pregnancy (n = 1307). CONCLUSIONS For patients with HER2-positive early breast cancer, having a pregnancy after treatment completion appears to be safe without compromising fetal outcome or maternal prognosis.
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Affiliation(s)
- Matteo Lambertini
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Samuel Martel
- Department of Hemato-Oncology, CISSS Montérégie-Centre/Hôpital Charles-Le Moyne, Université de Sherbrooke, Quebec, Canada
| | | | - Sébastien Guillaume
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | | | - Hatem A Azim
- Department of Medicine, Division of Hematology/Oncology, American University of Beirut, Beirut, Lebanon
| | | | | | - Jens Huober
- Breast Center, University of Ulm, Ulm, Germany
| | - José Baselga
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Martine Piccart-Gebhart
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Richard D Gelber
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts.,Harvard TH Chan School of Public Health, Boston, Massachusetts.,Frontier Science and Technology Research Foundation, Boston, Massachusetts
| | - Evandro de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Michail Ignatiadis
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
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41
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Nguyen B, Venet D, Azim HA, Brown D, Desmedt C, Lambertini M, Majjaj S, Pruneri G, Peccatori F, Piccart M, Rothé F, Sotiriou C. Breast cancer diagnosed during pregnancy is associated with enrichment of non-silent mutations, mismatch repair deficiency signature and mucin mutations. NPJ Breast Cancer 2018; 4:23. [PMID: 30109263 PMCID: PMC6078984 DOI: 10.1038/s41523-018-0077-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 07/04/2018] [Accepted: 07/09/2018] [Indexed: 12/22/2022] Open
Abstract
Breast cancer diagnosed during pregnancy (BCP) is a rare and highly challenging disease. To investigate the impact of pregnancy on the biology of breast cancer, we conducted a comparative analysis of a cohort of BCP patients and non-pregnant control patients by integrating gene expression, copy number alterations and whole genome sequencing data. We showed that BCP exhibit unique molecular characteristics including an enrichment of non-silent mutations, a higher frequency of mutations in mucin gene family and an enrichment of mismatch repair deficiency mutational signature. This provides important insights into the biology of BCP and suggests that these features may be implicated in promoting tumor progression during pregnancy. In addition, it provides an unprecedented resource for further understanding the biology of breast cancer in young women and how pregnancy could modulate tumor biology.
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Affiliation(s)
- Bastien Nguyen
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - David Venet
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Hatem A. Azim
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Internal Medicine, American University of Beirut (AUB), Beirut, Lebanon
| | - David Brown
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Christine Desmedt
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Matteo Lambertini
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Samira Majjaj
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Giancarlo Pruneri
- Department of Pathology, IRCCS Istituto Nazionale Tumori, Milan and University of Milan, School of Medicine, Milan, Italy
| | | | - Martine Piccart
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Françoise Rothé
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
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42
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Nguyen B, Maetens M, Salgado R, Venet D, Vuylsteke P, Polastro L, Wieldiers H, Simon P, Lindeman G, Larsimont D, Eynden GVD, Velghe C, Rothe F, Garaud S, Michiels S, Willard-gallo K, Azim HA, Loi S, Piccart M, Sotiriou C. Abstract CT101: D-BEYOND: A window of opportunity trial evaluating denosumab, a RANK-ligand (RANKL) inhibitor and its biological effects in young pre-menopausal women diagnosed with early breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-ct101] [Citation(s) in RCA: 3] [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: 11/16/2022]
Abstract
Abstract
Background
Breast cancer (BC) in young women has unique biology and poor prognosis. Previous reports suggest that they often express RANKL, which was also shown to play a role in mammary tumorigenesis and the etiology of BRCA1/2 related BC. Here, we present the primary results of D-BEYOND, a window of opportunity study investigating the biological activity of the RANKL inhibitor; denosumab in pre-menopausal BC patients.
Methods
D-BEYOND is a prospective, phase IIa, single-arm, multicenter study assessing the effect of denosumab on BC biology in premenopausal women with early BC (NCT01864798). Patients received two subcutaneous injections of denosumab (120mg), one week apart, followed by breast surgery. Blood, tumor and normal adjacent breast tissue were collected at baseline and at surgery. The primary endpoint was geometric mean change in tumor Ki67 assessed by immunohistochemistry (IHC) from baseline to surgery. Absolute Ki67 responders were defined as having <2.7% IHC staining in the post-treatment tumor. Serum levels of soluble RANKL (sRANKL), OPG and C-terminal telopeptide (CTX) were assessed by ELISA. Ki67, RANK and RANKL expression were assessed by IHC. The percentage of tumor infiltrating lymphocytes (TILs) were also evaluated. Pre- and post-treatment values were compared using a paired t-test.
Results
A total of 27 patients were enrolled in the study between October 2013 and July 2016. The median age was 45 years (range 35-51 years). Tumors of 21 patients were hormone receptor positive (77.8%), 4 were HER2 positive (14.8%) and 2 were triple negative (7.4%). No serious adverse events were reported, the most frequent non-serious adverse event being arthralgia (14.8%). After treatment, serum levels of CTX and sRANKL decreased in all patients (P < 0.001) whereas serum levels of OPG increased in 76.9% of patients (P = 0.009, 95% CI 0.56-0.91). There was no significant reduction of Ki67 values from baseline (geometric mean change after treatment; 0.98, 95% CI 0.76-1.26; P = 0.90) and there were no absolute Ki67 responders. Twenty-four pre- and post-treatment tumor pairs were available for RANK/L staining and TILs assessment. There was no significant difference in RANKL and RANK H-score in tumors after treatment (P = 0.842, P = 0.142, respectively) but we observed a decrease of RANKL H-score in 3 tumors (12.5%) and an increase of RANK H-score in 5 tumors (20%). Interestingly, there was a significant increase in the percentage of stromal TILs after treatment (geometric mean change of 2.51, 95% CI 1.58-3.97; P = 0.004). There were 10/24 patients (41.7%) with a change in TILs of at least 10%, all of them having an increase in TILs presence (P = 0.002).
Conclusion
Short course of denosumab did not reduce tumor proliferation rate. However, it induced a significant increase in TILs. These findings suggest that denosumab may potentiate immunotherapy efficacy, at least in young BC patients. Additional results including immune cell profiling by multiplex IHC and RNA-sequencing of tumor and normal tissues will be presented at the meeting.
Citation Format: Bastien Nguyen, Marion Maetens, Roberto Salgado, David Venet, Peter Vuylsteke, Laura Polastro, Hans Wieldiers, Philippe Simon, Geoff Lindeman, Denis Larsimont, Gert Van den Eynden, Chloe Velghe, Francoise Rothe, Soizic Garaud, Stefan Michiels, Karen Willard-gallo, Hatem A. Azim, Sherene Loi, Martine Piccart, Christos Sotiriou. D-BEYOND: A window of opportunity trial evaluating denosumab, a RANK-ligand (RANKL) inhibitor and its biological effects in young pre-menopausal women diagnosed with early breast cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr CT101.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Geoff Lindeman
- 5Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
| | | | | | | | | | | | | | | | | | - Sherene Loi
- 9Peter MacCallum Cancer Centre, Melbourne, Australia
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43
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Lambertini M, Martel S, Campbell C, Guillaume S, Hilbers F, Schuehly U, Korde L, Azim HA, Di Cosimo S, Tenglin RC, Huober JB, Baselga J, Moreno-Aspitia A, Piccart-Gebhart MJ, Gelber RD, De Azambuja E, Ignatiadis M. Pregnancies during and following trastuzumab (T) and/or lapatinib (L) in patients (pts) with HER2-positive (HER2+) early breast cancer (EBC): Analysis from the NeoALTTO (BIG 1-06) and ALTTO (BIG 2-06) trials. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.10065] [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)
| | - Samuel Martel
- Centre Hospitalier Universitaire Sherbrook - Hopital Fleurimont, Sherbrooke, QC, Canada
| | | | | | | | | | | | - Hatem A Azim
- American University of Beirut (AUB), Beirut, Lebanon
| | - Serena Di Cosimo
- Division of Medical Oncology, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Jens Bodo Huober
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Ulm, Ulm, Germany
| | - Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston, MA
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44
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Partridge AH, Pagani O, Azim HA, Peccatori F, Ruggeri M, Regan MM, Gelber RD, Sun Z. POSITIVE (IBCSG 48-14/BIG 8-13/A221405): Evaluating outcomes after interrupting endocrine therapy (ET) for women with endocrine responsive (ER+) early breast cancer (BC) who desire pregnancy. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.tps596] [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)
| | - Olivia Pagani
- Institute of Oncology of Southern Switzerland, Lugano Viganello, Switzerland
| | - Hatem A. Azim
- American University of Beirut, Department of Internal Medicine, Division of Hematology Oncology, Beruit, Lebanon
| | | | - Monica Ruggeri
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | | | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston, MA
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45
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Sun Z, Pagani O, Partridge AH, Azim HA, Peccatori F, Ruggeri M, Colleoni M, Gelber RD, Regan MM. Estimation of historical control rate for a single arm de-escalation study: Application to the POSITIVE trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.552] [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)
| | - Olivia Pagani
- Institute of Oncology of Southern Switzerland, Lugano Viganello, Switzerland
| | | | - Hatem A. Azim
- American University of Beirut, Department of Internal Medicine, Division of Hematology Oncology, Beruit, Lebanon
| | | | - Monica Ruggeri
- International Breast Cancer Study Group (IBCSG), Bern, Switzerland
| | | | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston, MA
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46
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Gingras I, Azim HA. Response. J Natl Cancer Inst 2018; 110:541. [PMID: 29177472 DOI: 10.1093/jnci/djx242] [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] [Received: 10/02/2017] [Accepted: 10/12/2017] [Indexed: 11/14/2022] Open
Affiliation(s)
- Isabelle Gingras
- Hematology and Oncology department, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
| | - Hatem A Azim
- Department of Internal Medicine, American University of Beirut (AUB), Beirut, Lebanon
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47
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Zardavas D, Te Marvelde L, Milne RL, Fumagalli D, Fountzilas G, Kotoula V, Razis E, Papaxoinis G, Joensuu H, Moynahan ME, Hennessy BT, Bieche I, Saal LH, Stal O, Iacopetta B, Jensen JD, O'Toole S, Lopez-Knowles E, Barbaraeschi M, Noguchi S, Azim HA, Lerma E, Bachelot T, Wang Q, Perez-Tenorio G, Can de Velde CJH, Rea DW, Sabine V, Bartlett JMS, Sotiriou C, Michiels S, Loi S. Tumor PIK3CA Genotype and Prognosis in Early-Stage Breast Cancer: A Pooled Analysis of Individual Patient Data. J Clin Oncol 2018; 36:981-990. [PMID: 29470143 DOI: 10.1200/jco.2017.74.8301] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [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: 11/20/2022] Open
Abstract
Purpose Phosphatidylinositol-4, 5-bisphosphate 3-kinase catalytic subunit alpha ( PIK3CA) mutations are frequently observed in primary breast cancer. We evaluated their prognostic relevance by performing a pooled analysis of individual patient data. Patients and Methods Associations between PIK3CA status and clinicopathologic characteristics were tested by applying Cox regression models adjusted for age, tumor size, nodes, grade, estrogen receptor (ER) status, human epidermal growth factor receptor 2 (HER2) status, treatment, and study. Invasive disease-free survival (IDFS) was the primary end point; distant disease-free survival (DDFS) and overall survival (OS) were also assessed, overall and by breast cancer subtypes. Results Data from 10,319 patients from 19 studies were included (median OS follow-up, 6.9 years); 1,787 patients (17%) received chemotherapy, 4,036 (39%) received endocrine monotherapy, 3,583 (35%) received both, and 913 (9%) received none or their treatment was unknown. PIK3CA mutations occurred in 32% of patients, with significant associations with ER positivity, increasing age, lower grade, and smaller size (all P < .001). Prevalence of PIK3CA mutations was 18%, 22%, and 37% in the ER-negative/HER2-negative, HER2-positive, and ER-positive/HER2-negative subtypes, respectively. In univariable analysis, PIK3CA mutations were associated with better IDFS (HR, 0.77; 95% CI, 0.71 to 0.84; P < .001), with evidence for a stronger effect in the first years of follow-up (0 to 5 years: HR, 0.73; 95% CI, 0.66 to 0.81; P < .001; 5 to 10 years: HR, 0.82; 95% CI, 0.68 to 0.99; P = .037); > 10 years: (HR, 1.15; 95% CI, 0.84 to 1.58; P = .38; P heterogeneity = .02). In multivariable analysis, PIK3CA genotype remained significant for improved IDFS ( P = .043), but not for the DDFS and OS end points. Conclusion In this large pooled analysis, PIK3CA mutations were significantly associated with a better IDFS, DDFS, and OS, but had a lesser prognostic effect after adjustment for other prognostic factors.
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Affiliation(s)
- Dimitrios Zardavas
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Luc Te Marvelde
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Roger L Milne
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Debora Fumagalli
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - George Fountzilas
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Vassiliki Kotoula
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Evangelia Razis
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - George Papaxoinis
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Heikki Joensuu
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Mary Ellen Moynahan
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Bryan T Hennessy
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Ivan Bieche
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Lao H Saal
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Olle Stal
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Barry Iacopetta
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Jeanette Dupont Jensen
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Sandra O'Toole
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Elena Lopez-Knowles
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Mattia Barbaraeschi
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Shinzaburo Noguchi
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Hatem A Azim
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Enrique Lerma
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Thomas Bachelot
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Qing Wang
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Gizeh Perez-Tenorio
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Cornelis J H Can de Velde
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Daniel W Rea
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Vicky Sabine
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - John M S Bartlett
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Christos Sotiriou
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Stefan Michiels
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
| | - Sherene Loi
- Dimitrios Zardavas and Debora Fumagalli, Breast International Group; Christos Sotiriou, Université Libre de Bruxelles, Brussels, Belgium; Luc te Marvelde and Roger L. Milne, Cancer Council; Roger L. Milne and Sherene Loi, University of Melbourne, Melbourne; Barry Iacopetta, University of Western Australia, Western Australia; Sandra O'Toole and Elena Lopez-Knowles, Garvan Institute of Medical Research, Darlinghurst, Australia; George Fountzilas and Vassiliki Kotoula, Hellenic Foundation for Cancer Research/Aristotle University of Thessaloniki, Thessaloniki; Evangelia Razis, Hygeia Hospital; George Papaxoinis, Hippokration Hospital, Athens, Greece; Heikki Joensuu, Helsinki University Hospital and University of Helsinki, Helsinki, Finland; Mary Ellen Moynahan, Memorial Sloan Kettering Cancer Center, New York, NY; Bryan T. Hennessy, Beaumont Hospital and Royal College of Surgeons, Dublin, Ireland; Ivan Bieche, Curie Institut, Paris; Thomas Bachelot, Centre de Recherche en Cancérologie de Lyon, Lyon; Stefan Michiels, Gustave Roussy and Inserm, Univ. Paris-Sud, Univ. Paris-Saclay, Villejuif, France; Lao H. Saal, Lund University, Lund; Olle Stal, Qing Wang, and Gizeh Perez-Tenorio, Linköping University, Linköping, Sweden; Jeanette Dupont Jensen, University of Southern Denmark, on behalf of the Danish Breast Cancer Cooperative Group, Odense, Denmark; Elena Lopez-Knowles, Royal Marsden NHS Trust and Institute of Cancer Research, London; Daniel W. Rea, University of Birmingham, Birmingham, United Kingdom; Mattia Barbaraeschi, Santa Chiara Hospital, Trento, Italy; Shinzaburo Noguchi, Osaka University, Osaka Japan; Hatem A. Azim Jr, American University of Beirut (AUB), Beirut, Lebanon; Enrique Lerma, Universitat Autònoma de Barcelona, Barcelona, Spain; Cornelis J.H. can de Velde, Leiden University Medical Center, Leiden, the Netherlands; Vicky Sabine, University of Guelph, Guelph; John M.S. Bartlett, Ontario Institute for Cancer Research, Toronto, Ontario, Canada
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Lambertini M, Kroman N, Ameye L, Cordoba O, Pinto A, Benedetti G, Jensen MB, Gelber S, Del Grande M, Ignatiadis M, de Azambuja E, Paesmans M, Peccatori FA, Azim HA. Long-term Safety of Pregnancy Following Breast Cancer According to Estrogen Receptor Status. J Natl Cancer Inst 2018; 110:426-429. [PMID: 29087485 PMCID: PMC6658852 DOI: 10.1093/jnci/djx206] [Citation(s) in RCA: 115] [Impact Index Per Article: 19.2] [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: 04/26/2017] [Revised: 07/20/2017] [Accepted: 08/30/2017] [Indexed: 11/13/2022] Open
Abstract
Safety of pregnancy in women with history of estrogen receptor (ER)-positive breast cancer remains controversial. In this multicenter case-control study, 333 patients with pregnancy after breast cancer were matched (1:3) to 874 nonpregnant patients of similar characteristics, adjusting for guaranteed time bias. Survival estimates were calculated using the Kaplan-Meier analysis; groups were compared with the log-rank test. All reported P values were two-sided. At a median follow-up of 7.2 years after pregnancy, no difference in disease-free survival was observed between pregnant and nonpregnant patients with ER-positive (hazard ratio [HR] = 0.94, 95% confidence interval [CI] = 0.70 to 1.26, P = .68) or ER-negative (HR = 0.75, 95% CI = 0.53 to 1.06, P = .10) disease. No overall survival (OS) difference was observed in ER-positive patients (HR = 0.84, 95% CI = 0.60 to 1.18, P = .32); ER-negative patients in the pregnant cohort had better OS (HR = 0.57, 95% CI = 0.36 to 0.90, P = .01). Abortion, time to pregnancy, breastfeeding, and type of adjuvant therapy had no impact on patients' outcomes. This study provides reassuring evidence on the long-term safety of pregnancy in breast cancer survivors, including those with ER-positive disease.
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Affiliation(s)
- Matteo Lambertini
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Niels Kroman
- Department of Breast Surgery, University Hospital Herlev, Copenhagen, Denmark
| | - Lieveke Ameye
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | | | | | | | - Shari Gelber
- International Breast Cancer Study Group Statistical Centre, Dana-Farber Cancer Institute, Boston, MA
| | - Maria Del Grande
- Department of Internal Medicine, American University of Beirut (AUB), Beirut, Lebanon
| | - Michail Ignatiadis
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Evandro de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Marianne Paesmans
- Data Centre, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Hatem A Azim
- Department of Internal Medicine, American University of Beirut (AUB), Beirut, Lebanon
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49
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Nguyen B, Venet D, Desmedt C, Pruneri G, Peccatori F, Mardis ER, Azim HA, Rothé F, Sotiriou C. Abstract P2-05-01: Whole genome sequencing reveals enrichment of mutations in mucin gene family in breast cancer diagnosed during pregnancy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-05-01] [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
Pregnancy is known to modulate breast cancer (BC) risk. Different reproductive behaviors have been shown to impact not only the risk of developing BC but also the phenotypes of these tumors. Breast cancer diagnosed during pregnancy (BCP) is a rare disease but could serve as a good model to understand how pregnancy modulates BC biology. In this project, we aim to interrogate the effect of pregnancy on the biology of BC by performing whole genome sequencing (WGS) using a unique series of BC patients diagnosed during pregnancy (BCP).
Method
Whole genome sequencing was performed for 35 BCP and 20 non-pregnant controls matched for age and stage with available clinic-pathological data. DNA extracted from primary tumor and matched adjacent normal FFPE tissues was assessed using WGS on Illumina HiSeqXTen platform targeting 60x and 30x coverage for tumor and normal DNA respectively. Briefly, 2x150bp paired end sequence data were generated, cleaned, trimmed and aligned to the reference genome (hg19) using bwa-mem. Somatic mutations were detected using Strelka and annotated using SnpEff. Mutational signatures were extracted using deconstructSigs. Differences on mutational profiles between BCP and case controls were assessed using Wilcoxon test for continuous variables and Fisher exact test for categorical variables.
Result
No difference in clinic-pathological features was observed between BCP and control patients. A median of 10084 and 13829 SNVs and of 26 and 21 indels were identified in the BCP and controls respectively, no significant difference between the two groups being observed (p = 0.703 and p = 0.851). Of interest, a significantly higher number of mutations was found in the BCP as compared to the control group when considering only mutations associated with a deleterious effect (median: 20 vs. 12, p = 0.027). As expected, TP53 and PIK3CA were the most frequently mutated genes both in BCP and control cases without any significant difference between the groups (34.3% vs. 22.2%, p = 0.53 and 20.0% vs. 16.7%, p = 1, respectively). Interestingly, there was a significant enrichment of non-silent mutations in the mucin genes family (MUC2, MUC4, MUC12, MUC16, MUC17, MUC20) in the BCP group: 45.7% of BCP vs. 11.1% of control cases had at least one such mutation (p = 0.015). A similar significant result (45.7% vs. 23.1%, p = 0.034) was found when comparing BCP with BC control cases from the TCGA dataset (selected to have similar age, ER and PR distribution, N = 56). When comparing the distribution of the twelve BC mutational signatures, a borderline significant enrichment with a signature depicting mismatch-repair deficiency (signature 20) was observed in the BCP patients (p = 0.059).
Conclusion
This is the first study reporting the mutational landscape of breast cancer diagnosed during pregnancy using WGS. We found that BCP are associated with a higher number of putative driver mutations including mutations in mucin genes, shown to be implicated in tumorigenesis. Furthermore, BCP were enriched with a mismatch-repair deficiency signature. These results could open new avenues for the development of targeted therapeutic approaches for patients diagnosed with breast cancer during pregnancy.
Citation Format: Nguyen B, Venet D, Desmedt C, Pruneri G, Peccatori F, Mardis ER, Azim HA, Rothé F, Sotiriou C. Whole genome sequencing reveals enrichment of mutations in mucin gene family in breast cancer diagnosed during pregnancy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-05-01.
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Affiliation(s)
- B Nguyen
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - D Venet
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - C Desmedt
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - G Pruneri
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - F Peccatori
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - ER Mardis
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - HA Azim
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - F Rothé
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
| | - C Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; European Institute of Oncology, Milan, Italy; McDonnell Genome Institute, Washington University School of Medicine, St. Louis, MO
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50
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Gingras I, Holmes E, De Azambuja E, Nguyen DHA, Izquierdo M, Anne Zujewski J, Inbar M, Naume B, Tomasello G, Gralow JR, Wolff AC, Harris L, Gnant M, Moreno-Aspitia A, Piccart MJ, Azim HA. Regional Nodal Irradiation After Breast Conserving Surgery for Early HER2-Positive Breast Cancer: Results of a Subanalysis From the ALTTO Trial. J Natl Cancer Inst 2017; 109:3064535. [PMID: 28376188 DOI: 10.1093/jnci/djw331] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2016] [Accepted: 12/21/2016] [Indexed: 01/18/2023] Open
Abstract
Background Two randomized trials recently demonstrated that regional nodal irradiation (RNI) could reduce the risk of recurrence in early breast cancer; however, these trials were conducted in the pretrastuzumab era. Whether these results are applicable to human epidermal growth factor receptor 2 (HER2)-positive breast cancer patients treated with anti-HER2-targeted therapy is unknown. Methods This retrospective analysis was performed on patients with node-positive breast cancer who were enrolled in the Adjuvant Lapatinib and/or Trastuzumab Treatment Optimization phase III adjuvant trial and subjected to BCS. The primary objective of the present study was to examine the effect of RNI on disease-free survival (DFS). A multivariable cox regression analysis adjusted for number of positive lymph nodes, tumor size, grade, age, hormone receptors status, presence of macrometastatis, treatment arm, and chemotherapy timing was carried out to investigate the relationship between RNI and DFS. Results One thousand six hundred sixty-four HER2-positive breast cancer patients were included, of whom 878 (52.8%) had received RNI to the axillary, supraclavicular, and/or internal mammary lymph nodes. Patients in the RNI group had higher nodal burden and more frequently had tumors larger than 2 cm. At a median follow-up of 4.5 years, DFS was 84.3% in the RNI group and 88.3% in the non-RNI group. No differences in regional recurrence (0.9 % vs 0.6 %) or in overall survival (93.6% vs 95.3%) were observed between the two groups. After adjustment in multivariable analysis, there was no statistically significant association between RNI and DFS (hazard ratio = 0.96, 95% confidence interval = 0.71 to 1.29). Conclusions Our analysis did not demonstrate a DFS benefit of RNI in HER2-positive, node-positive patients treated with adjuvant HER2-targeted therapy. The benefit of RNI in HER2-positive breast cancer needs further testing within randomized clinical trials.
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Affiliation(s)
- Isabelle Gingras
- Hematology/Oncology Department, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | | | - Evandro De Azambuja
- Breast Data Center, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - David H A Nguyen
- Radiation Oncology Department, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | | | | | - Moshe Inbar
- Oncology Division, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Bjorn Naume
- Department of Oncology, Division of Cancer, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | | | - Julie R Gralow
- Seattle Cancer Care Alliance, University of Washington, Seattle, WA, USA
| | - Antonio C Wolff
- Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Michael Gnant
- Department of Surgery and Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - Martine J Piccart
- Breast Data Center, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Hatem A Azim
- Breast Data Center, Department of Medicine, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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