1
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Donners R, Tunariu N, Tovey H, Hall E, Chua S, Cook G, Du Y, Blackledge MD, Parker CC, Koh DM. The value of baseline 18F-sodium fluoride and 18F-choline PET activity for identifying responders to radium-223 treatment in castration-resistant prostate cancer bone metastases. Eur Radiol 2024; 34:1146-1154. [PMID: 37615760 PMCID: PMC10853307 DOI: 10.1007/s00330-023-10172-7] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Revised: 06/27/2023] [Accepted: 07/15/2023] [Indexed: 08/25/2023]
Abstract
OBJECTIVES To investigate whether baseline 18F-sodium fluoride (NaF) and 18F-choline PET activity is associated with metastatic castration-resistant prostate cancer (mCRPC) global and individual bone metastases' DWI MR imaging response to radium-223 treatment. METHODS Thirty-six bone-only mCRPC patients were prospectively recruited from three centers. Whole-body (WB)-MRI with DWI and 18F-NaF and 18F-choline PET/CT were performed at therapy baseline and 8-week intervals. In each patient, bone disease median global (g)ADC change between baseline and follow-up was calculated. Additionally, up to five bone target lesions per patient were delineated and individual median ADC change recorded. An ADC increase > 30% defined response per-patient and per-lesion. For the same targets, baseline 18F-NaF and 18F-choline PET SUVmax were recorded. Mean SUVmax across patient targets was correlated with gADC change and lesion SUVmax with per-lesion ADC change. RESULTS A total of 133 lesions in 36 patients (14 responders) were analyzed. 18F-NaF PET per-patient mean SUVmax was significantly higher in responders (median = 56.0 versus 38.7 in non-responders; p = 0.008), with positive correlation between SUVmax and gADC increase (rho = 0.42; p = 0.015). A 48.7 SUVmax threshold identified responders with 77% sensitivity and 75% specificity. Baseline 18F-NaF PET per-lesion SUVmax was higher in responding metastases (median = 51.6 versus 31.8 in non-responding metastases; p = 0.001), with positive correlation between baseline lesion SUVmax and ADC increase (rho = 0.39; p < 0.001). A 36.8 SUVmax threshold yielded 72% sensitivity and 63% specificity. No significant association was found between baseline 18F-choline PET SUVmax and ADC response on a per-patient (p = 0.164) or per-lesion basis (p = 0.921). CONCLUSION 18F-NaF PET baseline SUVmax of target mCRPC bone disease showed significant association with response to radium-223 defined by ADC change. CLINICAL RELEVANCE STATEMENT 18F-sodium fluoride PET/CT baseline maximum SUV of castration-resistant prostate cancer bone metastases could be used as a predictive biomarker for response to radium-223 therapy. KEY POINTS • 18F-sodium fluoride PET baseline SUVmax of castration-resistant prostate cancer bone metastases showed significant association with response to radium-223. • Baseline 18F-sodium fluoride PET can improve patient selection for radium-223 therapy. • Change in whole-body DWI parameters can be used for response correlation with baseline 18F-sodium fluoride PET SUVmax in castration-resistant prostate cancer bone metastases.
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Affiliation(s)
- Ricardo Donners
- Department of Radiology, University Hospital Basel, Petersgraben 4, 4031, Basel, Switzerland.
| | - Nina Tunariu
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Holly Tovey
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Emma Hall
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
| | - Sue Chua
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Gary Cook
- King's College London and Guy's and St. Thomas' PET Centre, St. Thomas' Hospital, King's College London, Westminster Bridge Rd, London, UK
| | - Yong Du
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | | | - Christopher C Parker
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
| | - Dow-Mu Koh
- The Institute of Cancer Research, 15 Cotswold Road, Sutton, SM2 5NG, UK
- Royal Marsden Hospital, Downs Road, Sutton, SM2 5PT, UK
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2
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Guo C, Sharp A, Gurel B, Crespo M, Figueiredo I, Jain S, Vogl U, Rekowski J, Rouhifard M, Gallagher L, Yuan W, Carreira S, Chandran K, Paschalis A, Colombo I, Stathis A, Bertan C, Seed G, Goodall J, Raynaud F, Ruddle R, Swales KE, Malia J, Bogdan D, Tiu C, Caldwell R, Aversa C, Ferreira A, Neeb A, Tunariu N, Westaby D, Carmichael J, Fenor de la Maza MD, Yap C, Matthews R, Badham H, Prout T, Turner A, Parmar M, Tovey H, Riisnaes R, Flohr P, Gil J, Waugh D, Decordova S, Schlag A, Calì B, Alimonti A, de Bono JS. Targeting myeloid chemotaxis to reverse prostate cancer therapy resistance. Nature 2023; 623:1053-1061. [PMID: 37844613 PMCID: PMC10686834 DOI: 10.1038/s41586-023-06696-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2023] [Accepted: 09/28/2023] [Indexed: 10/18/2023]
Abstract
Inflammation is a hallmark of cancer1. In patients with cancer, peripheral blood myeloid expansion, indicated by a high neutrophil-to-lymphocyte ratio, associates with shorter survival and treatment resistance across malignancies and therapeutic modalities2-5. Whether myeloid inflammation drives progression of prostate cancer in humans remain unclear. Here we show that inhibition of myeloid chemotaxis can reduce tumour-elicited myeloid inflammation and reverse therapy resistance in a subset of patients with metastatic castration-resistant prostate cancer (CRPC). We show that a higher blood neutrophil-to-lymphocyte ratio reflects tumour myeloid infiltration and tumour expression of senescence-associated mRNA species, including those that encode myeloid-chemoattracting CXCR2 ligands. To determine whether myeloid cells fuel resistance to androgen receptor signalling inhibitors, and whether inhibiting CXCR2 to block myeloid chemotaxis reverses this, we conducted an investigator-initiated, proof-of-concept clinical trial of a CXCR2 inhibitor (AZD5069) plus enzalutamide in patients with metastatic CRPC that is resistant to androgen receptor signalling inhibitors. This combination was well tolerated without dose-limiting toxicity and it decreased circulating neutrophil levels, reduced intratumour CD11b+HLA-DRloCD15+CD14- myeloid cell infiltration and imparted durable clinical benefit with biochemical and radiological responses in a subset of patients with metastatic CRPC. This study provides clinical evidence that senescence-associated myeloid inflammation can fuel metastatic CRPC progression and resistance to androgen receptor blockade. Targeting myeloid chemotaxis merits broader evaluation in other cancers.
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Affiliation(s)
- Christina Guo
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Adam Sharp
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Bora Gurel
- The Institute of Cancer Research, London, UK
| | | | | | - Suneil Jain
- Northern Ireland Cancer Centre, Belfast, UK
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - Ursula Vogl
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | | | | | | | - Wei Yuan
- The Institute of Cancer Research, London, UK
| | | | - Khobe Chandran
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Alec Paschalis
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Ilaria Colombo
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
| | - Anastasios Stathis
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
| | | | - George Seed
- The Institute of Cancer Research, London, UK
| | | | | | - Ruth Ruddle
- The Institute of Cancer Research, London, UK
| | | | - Jason Malia
- The Institute of Cancer Research, London, UK
| | | | - Crescens Tiu
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | - Antje Neeb
- The Institute of Cancer Research, London, UK
| | - Nina Tunariu
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Daniel Westaby
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Juliet Carmichael
- The Institute of Cancer Research, London, UK
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | | | - Toby Prout
- The Institute of Cancer Research, London, UK
| | | | - Mona Parmar
- The Institute of Cancer Research, London, UK
| | - Holly Tovey
- The Institute of Cancer Research, London, UK
| | | | - Penny Flohr
- The Institute of Cancer Research, London, UK
| | - Jesus Gil
- MRC London Institute of Medical Sciences (LMS), London, UK
- Institute of Clinical Sciences (ICS), Faculty of Medicine, Imperial College London, London, UK
| | - David Waugh
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
- Centre for Cancer Biology, University of South Australia, Adelaide, South Australia, Australia
| | | | - Anna Schlag
- The Institute of Cancer Research, London, UK
| | - Bianca Calì
- Institute of Oncology Research, Bellinzona, Switzerland
| | - Andrea Alimonti
- Oncology Institute of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), Bellinzona, Switzerland
- Faculty of Biomedical Sciences, Università della Svizzera Italiana (USI), Lugano, Switzerland
- Institute of Oncology Research, Bellinzona, Switzerland
- Department of Health Sciences and Technology, Eidgenössische Technische Hochschule Zürich (ETH), Zurich, Switzerland
- Department of Medicine, Veneto Institute of Molecular Medicine, University of Padova, Padua, Italy
| | - Johann S de Bono
- The Institute of Cancer Research, London, UK.
- The Royal Marsden NHS Foundation Trust, London, UK.
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3
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Parker C, Tunariu N, Tovey H, Alonzi R, Blackledge MD, Cook GJR, Chua S, Du Y, Hafeez S, Murray I, Padhani AR, Staffurth J, Tree A, Stidwill H, Finch J, Curcean A, Chatfield P, Perry S, Koh DM, Hall E. Radium-223 in metastatic castration-resistant prostate cancer: whole-body diffusion-weighted magnetic resonance imaging scanning to assess response. JNCI Cancer Spectr 2023; 7:pkad077. [PMID: 37788117 PMCID: PMC10640884 DOI: 10.1093/jncics/pkad077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 07/10/2023] [Accepted: 07/17/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Radium-223 is a bone-seeking, ɑ-emitting radionuclide used to treat men with bone metastases from castration-resistant prostate cancer. Sclerotic bone lesions cannot be evaluated using Response Evaluation Criteria in Solid Tumors. Therefore, imaging response biomarkers are needed. METHODS We conducted a phase 2 randomized trial to assess disease response to radium-223. Men with metastatic castration-resistant prostate cancer and bone metastases were randomly allocated to 55 or 88 kBq/kg radium-223 every 4 weeks for 6 cycles. Whole-body diffusion-weighted magnetic resonance imaging (DWI) was performed at baseline, at cycles 2 and 4, and after treatment. The primary endpoint was defined as a 30% increase in global median apparent diffusion coefficient. RESULTS Disease response on DWI was seen in 14 of 36 evaluable patients (39%; 95% confidence interval = 23% to 56%), with marked interpatient and intrapatient heterogeneity of response. There was an association between prostate-specific antigen response and MRI response (odds ratio = 18.5, 95% confidence interval = 1.32 to 258, P = .013). Mean administered activity of radium-223 per cycle was not associated with global MRI response (P = .216) but was associated with DWI response using a 5-target-lesion evaluation (P = .007). In 26 of 36 (72%) patients, new bone metastases, not present at baseline, were seen on DWI scans during radium-223 treatment. CONCLUSIONS DWI is useful for assessment of disease response in bone. Response to radium-223 is heterogeneous, both between patients and between different metastases in the same patient. New bone metastases appear during radium-223 treatment.The REASURE trial is registered under ISRCTN17805587.
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Affiliation(s)
- Chris Parker
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Nina Tunariu
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Holly Tovey
- The Institute of Cancer Research, London, UK
| | | | | | - Gary J R Cook
- Cancer Imaging Department and King’s College London and Guy’s and St Thomas’ PET Centre, King’s College London, London, UK
| | - Sue Chua
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Yong Du
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Shaista Hafeez
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Iain Murray
- The Royal Marsden NHS Foundation Trust, London, UK
| | - Anwar R Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | | | - Alison Tree
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | | | | | - Andra Curcean
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | | | | | - Dow-Mu Koh
- The Royal Marsden NHS Foundation Trust, London, UK
- The Institute of Cancer Research, London, UK
| | - Emma Hall
- The Institute of Cancer Research, London, UK
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4
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Tovey H, Sipos O, Parker JS, Hoadley KA, Quist J, Kernaghan S, Kilburn L, Salgado R, Loi S, Kennedy RD, Roxanis I, Gazinska P, Pinder SE, Bliss J, Perou CM, Haider S, Grigoriadis A, Tutt A, Cheang MCU. Integrated Multimodal Analyses of DNA Damage Response and Immune Markers as Predictors of Response in Metastatic Triple-Negative Breast Cancer in the TNT Trial (NCT00532727). Clin Cancer Res 2023; 29:3691-3705. [PMID: 37574209 PMCID: PMC10502473 DOI: 10.1158/1078-0432.ccr-23-0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 05/23/2023] [Accepted: 07/24/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE The TNT trial (NCT00532727) showed no evidence of carboplatin superiority over docetaxel in metastatic triple-negative breast cancer (mTNBC), but carboplatin benefit was observed in the germline BRCA1/2 mutation subgroup. Broader response-predictive biomarkers are needed. We explored the predictive ability of DNA damage response (DDR) and immune markers. EXPERIMENTAL DESIGN Tumor-infiltrating lymphocytes were evaluated for 222 of 376 patients. Primary tumors (PT) from 186 TNT participants (13 matched recurrences) were profiled using total RNA sequencing. Four transcriptional DDR-related and 25 immune-related signatures were evaluated. We assessed their association with objective response rate (ORR) and progression-free survival (PFS). Conditional inference forest clustering was applied to integrate multimodal data. The biology of subgroups was characterized by 693 gene expression modules and other markers. RESULTS Transcriptional DDR-related biomarkers were not predictive of ORR to either treatment overall. Changes from PT to recurrence were demonstrated; in chemotherapy-naïve patients, transcriptional DDR markers separated carboplatin responders from nonresponders (P values = 0.017; 0.046). High immune infiltration was associated with docetaxel ORR (interaction P values < 0.05). Six subgroups were identified; the immune-enriched cluster had preferential docetaxel response [62.5% (D) vs. 29.4% (C); P = 0.016]. The immune-depleted cluster had preferential carboplatin response [8.0% (D) vs. 40.0% (C); P = 0.011]. DDR-related subgroups were too small to assess ORR. CONCLUSIONS High immune features predict docetaxel response, and high DDR signature scores predict carboplatin response in treatment-naïve mTNBC. Integrating multimodal DDR and immune-related markers identifies subgroups with differential treatment sensitivity. Treatment options for patients with immune-low and DDR-proficient tumors remains an outstanding need. Caution is needed using PT-derived transcriptional signatures to direct treatment in mTNBC, particularly DDR-related markers following prior chemotherapy.
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Affiliation(s)
- Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Orsolya Sipos
- Breast Cancer Now Toby Robinsons Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Joel S. Parker
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Katherine A. Hoadley
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jelmar Quist
- The Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Sarah Kernaghan
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Lucy Kilburn
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Roberto Salgado
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - Sherene Loi
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | | | - Ioannis Roxanis
- Breast Cancer Now Toby Robinsons Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Patrycja Gazinska
- Breast Cancer Now Toby Robinsons Research Centre, The Institute of Cancer Research, London, United Kingdom
- Biobank Research Group, Lukasiewicz Research Network – PORT Polish Center for Technology Development, Wroclaw, Poland
| | - Sarah E. Pinder
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Judith Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Charles M. Perou
- Department of Genetics, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Syed Haider
- Breast Cancer Now Toby Robinsons Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Anita Grigoriadis
- The Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Andrew Tutt
- Breast Cancer Now Toby Robinsons Research Centre, The Institute of Cancer Research, London, United Kingdom
- The Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, United Kingdom
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, United Kingdom
| | - Maggie Chon U. Cheang
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
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5
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Schuster EF, Lopez-Knowles E, Alataki A, Zabaglo L, Folkerd E, Evans D, Sidhu K, Cheang MCU, Tovey H, Salto-Tellez M, Maxwell P, Robertson J, Smith I, Bliss JM, Dowsett M. Molecular profiling of aromatase inhibitor sensitive and resistant ER+HER2- postmenopausal breast cancers. Nat Commun 2023; 14:4017. [PMID: 37419892 PMCID: PMC10328947 DOI: 10.1038/s41467-023-39613-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 06/15/2023] [Indexed: 07/09/2023] Open
Abstract
Aromatase inhibitors (AIs) reduce recurrences and mortality in postmenopausal patients with oestrogen receptor positive (ER+) breast cancer (BC), but >20% of patients will eventually relapse. Given the limited understanding of intrinsic resistance in these tumours, here we conduct a large-scale molecular analysis to identify features that impact on the response of ER + HER2- BC to AI. We compare the 15% of poorest responders (PRs, n = 177) as measured by proportional Ki67 changes after 2 weeks of neoadjuvant AI to good responders (GRs, n = 190) selected from the top 50% responders in the POETIC trial and matched for baseline Ki67 categories. In this work, low ESR1 levels are associated with poor response, high proliferation, high expression of growth factor pathways and non-luminal subtypes. PRs having high ESR1 expression have similar proportions of luminal subtypes to GRs but lower plasma estradiol levels, lower expression of estrogen response genes, higher levels of tumor infiltrating lymphocytes and immune markers, and more TP53 mutations.
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Affiliation(s)
- Eugene F Schuster
- The Breast Cancer Now Toby Robins Research Centre at the Institute of Cancer Research, London, UK.
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK.
| | - Elena Lopez-Knowles
- The Breast Cancer Now Toby Robins Research Centre at the Institute of Cancer Research, London, UK
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Anastasia Alataki
- The Breast Cancer Now Toby Robins Research Centre at the Institute of Cancer Research, London, UK
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | | | - Elizabeth Folkerd
- The Breast Cancer Now Toby Robins Research Centre at the Institute of Cancer Research, London, UK
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | | | | | - Maggie Chon U Cheang
- Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Holly Tovey
- Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Manuel Salto-Tellez
- Precision Medicine Centre of Excellence, The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
- Cellular Pathology, Belfast Health and Social Care Trust, Belfast City Hospital, Belfast, UK
- Division of Molecular Pathology, The Institute of Cancer Research, London, UK
| | - Perry Maxwell
- Precision Medicine Centre of Excellence, The Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - John Robertson
- Faculty of Medicine & Health Sciences, Queen's Medical Centre, Nottingham, UK
| | | | - Judith M Bliss
- Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
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6
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Bliss JM, Tovey H, Evans A, Holcombe C, Horgan K, Mallon E, Vidya R, Skene A, Dodson A, Hills M, Detre S, Zabaglo L, Banerji J, Kilburn L, Morden JP, Robertson JFR, Smith I, Dowsett M. Clinico-pathologic relationships with Ki67 and its change with short-term aromatase inhibitor treatment in primary ER + breast cancer: further results from the POETIC trial (CRUK/07/015). Breast Cancer Res 2023; 25:39. [PMID: 37046348 PMCID: PMC10099675 DOI: 10.1186/s13058-023-01626-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 02/27/2023] [Indexed: 04/14/2023] Open
Abstract
PURPOSE Ki67 assessed at diagnosis (Ki67baseline) is an important prognostic factor in primary oestrogen receptor-positive (ER +) breast cancer. Proportional change in Ki67 after 2 weeks (∆Ki672week) is associated with clinical benefit from endocrine therapies and residual Ki67 (Ki672week) with recurrence-free survival. The aim was to define the association between Ki67baseline and after aromatase inhibitor (AI) exposure ∆Ki672week and Ki672week with key prognostic and biologic factors utilising data from the POETIC study. PATIENTS AND METHODS In POETIC 4480 postmenopausal patients with primary ER and/or PgR + breast cancer were randomised 2:1 to 2 weeks' presurgical AI (anastrozole or letrozole) or no presurgical treatment (control). Ki67 was measured centrally in core-cut biopsies taken prior to AI and in core-cuts or the excision biopsy at surgery. Relationships between the Ki67 and biologic factors were explored using linear regression. RESULTS Established associations of Ki67baseline with biologic factors including PgR status, tumour grade, tumour size, histological subtype, nodal status, and vascular invasion were confirmed in the HER2- subpopulation. In the HER2 + subpopulation only grade and tumour size were significantly associated with Ki67baseline. In control group Ki672week was 18% lower than Ki67baseline (p < 0.001) when Ki672week was measured in excision biopsies but not when measured in core-cuts. Median suppression by AIs (∆Ki672week) was 79.3% (IQR: -89.9 to -54.6) and 53.7% (IQR: -78.9 to -21.1) for HER2-negative and HER2-positive cases, respectively. Significantly less suppression occurred in PgR- vs PgR + and HER2 + vs HER2- tumours which remained apparent after adjustment for 2-week sample type. CONCLUSIONS The magnitude of this study allowed characterisation of relationships between Ki67baseline, ∆Ki672week and Ki672week with high degrees of confidence providing a reference source for other studies. Lower values of Ki67 occur when measured on excision biopsies and could lead to apparent but artefactual decreases in Ki67: this should be considered when either ∆Ki672week or Ki672week is used in routine clinical practice to aid treatment decisions or in clinical trials assessing new drug therapies.
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Affiliation(s)
- Judith M Bliss
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK.
| | - Holly Tovey
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | | | | | - Kieran Horgan
- Department of Breast Surgery, St James's University Hospital, Leeds, UK
| | | | | | | | - Andrew Dodson
- UK NEQAS for Immunocytochemistry and In-Situ Hybridisation, London, UK
| | - Margaret Hills
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, and Breast Cancer Now Centre, The Institute of Cancer Research, London, UK
| | - Simone Detre
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, and Breast Cancer Now Centre, The Institute of Cancer Research, London, UK
| | - Lila Zabaglo
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, and Breast Cancer Now Centre, The Institute of Cancer Research, London, UK
| | - Jane Banerji
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - Lucy Kilburn
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | - James P Morden
- Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, London, UK
| | | | - Ian Smith
- Breast Unit, Royal Marsden Hospital, London, UK
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, and Breast Cancer Now Centre, The Institute of Cancer Research, London, UK
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7
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Alataki A, Schuster G, Zabaglo L, Maxwell P, López-Knowles E, Folkerd E, Evans D, Sidhu K, Tovey H, Turner N, Johnston S, Cheang MCU, Robertson J, Salto-Tellez M, Smith I, Bliss J, Dowsett M. Abstract PD10-08: PD10-08 Immune cell infiltration associated with poor anti-proliferative response to aromatase inhibitors in postmenopausal women with primary ER-positive HER2-negative breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd10-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Aromatase inhibitors (AIs) are one of the main treatment strategies for the clinical management of estrogen receptor-positive (ER+) breast cancer (BC). Despite prolonged time to recurrence and initial clinical responses, >20% of patients eventually relapse, and previous studies have shown an association of poor anti-proliferative response to AIs and worse outcome. High immune activity in ER+ tumors may be associated with worse outcome, in contrast to ER-negative BC where immune infiltration is a feature associated with better outcome. Our work focused on understanding the correlations between immune cell infiltration and response to AI. Methods: All patients with ER+ HER2- tumors within the bottom 15% of Ki67 anti-proliferative responders to AIs (poor responders [PRs]; n=177) were selected from the PeriOperative Endocrine Therapy for Individualizing Care (POETIC) trial and matched on baseline Ki67 levels to good responders (GRs) within the 50% showing the best response (n=190). Response to AI was measured by the Ki67 percentage change after 2 weeks of treatment. PRs were further divided into groups expressing high ESR1 (PRs ESR1HIGH; n=119) and low ESR1 (PRs ESR1LOW; n=58) levels to represent PR subgroups that showed partial or no response to AIs. The percentage of stromal tumor-infiltrating lymphocytes (TILs) was assessed. Multiple immunofluorescence was performed for ER, CD3, CD20, CD68, FOXP3, and CD3/FOXP3 in 15 baseline samples from each of the GR, PR ESR1HIGH, and PR ESR1LOW populations and immune cell density in stromal or tumor compartments was estimated. Spearman correlations of TILs with Consensus tumor microenvironment (TME) deconvolution and Molecular Signatures Database hallmark gene sets were conducted. The relationship between the immune markers’ density and genes, hallmark gene sets and Consensus TME was assessed. Results: The percentage of TILs was significantly higher in the PR ESR1HIGH and PR ESR1LOW compared to the GRs (adjusted p< 0.05). As expected, TILs were highly correlated with T cells (particularly T-regulatory cells) and immune hallmark gene sets. There was a tendency for higher density of each of the immune markers in PRs compared to GRs, with significant differences being observed in stromal B-cell marker CD20 density (p< 0.05). Analysis showed a significant correlation between TILs and stromal FOXP3 marker density (FDR< 0.05), and stromal biomarker density was highly correlated to the gene expression of the encoding genes of the same tumors (CD3/CD3D, FOXP3/FOXP3, and CD20/MS4A1) (FDRs< 0.05). There was also a strong and significant correlation between the stromal expression of CD20, CD3, FOXP3, and CD3/FOXP3 with the immune hallmark gene sets (FDRs< 0.05). Finally, the immune phenotyping showed the expected correlations with TME deconvolution, with particularly strong correlations of CD20 and CD3 with B- and T-cell gene signatures, respectively (FDRs< 0.05). Conclusions: Different immune features indicated a broad involvement of several immune cell types in PRs to AIs, suggesting that the immune system might be associated with resistance of ER+ breast tumors to AI treatment. Spatial gene expression profiling is ongoing to characterize these tumors further and investigate potential mechanisms of AI resistance.
Citation Format: Anastasia Alataki, Gene Schuster, Lila Zabaglo, Perry Maxwell, Elena López-Knowles, Elizabeth Folkerd, David Evans, Kally Sidhu, Holly Tovey, Nicholas Turner, Stephen Johnston, Maggie Chon U Cheang, John Robertson, Manuel Salto-Tellez, Ian Smith, Judith Bliss, Mitch Dowsett. PD10-08 Immune cell infiltration associated with poor anti-proliferative response to aromatase inhibitors in postmenopausal women with primary ER-positive HER2-negative breast cancer [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD10-08.
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Affiliation(s)
| | - Gene Schuster
- 2Breast Cancer Research, The Institute of Cancer Research, London
| | - Lila Zabaglo
- 3Breast Cancer Research, The Institute of Cancer Research
| | - Perry Maxwell
- 4School of Medicine, Dentistry and Biomedical Sciences Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast
| | | | | | | | | | - Holly Tovey
- 9Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | | | - Stephen Johnston
- 11Royal Marsden NHS Foundation Trust, Institute of Cancer Research
| | | | - John Robertson
- 13University of Nottingham, Nottingham, UK; University Hospitals of Derby and Burton, Derby, UK
| | - Manuel Salto-Tellez
- 14The Institute of Cancer Research, London; Queen’s University Belfast, Belfast
| | - Ian Smith
- 15The Royal Marsden NHS Foundation Trust, London
| | - Judith Bliss
- 16Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Mitch Dowsett
- 17The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
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Cheang MCU, Dewan M, Kilburn L, Morani G, Zabaglo L, Sidhu K, Tovey H, Zhu X, Holcombe C, Skene A, Smith I, Robertson J, Ring A, Turner N, Bliss J, Dowsett M. Abstract P2-03-07: Multi-parametric algorithm integrating on-treatment Ki67 value and standard clinicopathological variables to predict risk of recurrences for women > 70 years old with early ER+HER2- tumours in POETIC trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-03-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Prognosis in older patients with breast cancer (BC) is worse compared to younger patients. No robust and specific tool to predict the risk of recurrence (TTR) for women aged 70 and over is likely due to the lack of representation of this group in the data from clinical trials. In the POETIC trial, of estrogen receptor-positive (ER+) and mainly human epidermal growth factor receptor 2 negative (HER2-) BC (88%), peri-operative aromatase inhibitor (POAI) did not improve treatment outcome, but patients with low baseline Ki67 value (Ki67B) or low POAI-induced Ki67 value (Ki67_2wk) had good outcome with standard of care therapy (usually adjuvant endocrine therapy (adjET) with the addition of chemotherapy as clinically indicated). In this study, we sought to develop a multi-parametric algorithm, named Ki67Cal, by integrating Ki67_2wk value with tumour characteristics to predict TTR for patients > 70 years old (yr) with early ER+HER2- BC treated with adjET only.
Methods: Within POETIC, 39% (n=1744) of the randomised patients (n = 4480) were >70 years old. There were 813 patients aged > 70yr, with ER+HER2- BC, randomised to POAI treatment and treated with adjET only. A power calculation indicated that 811 such patients were sufficient to develop a prediction model that minimized overfitting, allowed up to 8 predictors, for predicting 5-years TTR with a median follow-up of 5.24 years and an overall event rate per 1000 person-years = 0.027, and provided an anticipated performance in terms of model fit R2 = 0.08 (Riley et al. BMJ 2020). A three-fold cross-validation approach was applied; an optimal list of features was selected in the training set (n = 538, events = 70); the agreement between expected and observed outcomes from the algorithm on the validation set (n = 275, events = 37) was evaluated by calibration plot. Multivariable Ridge Cox Regression model of significant parameters was built on the dataset merging training and validation datasets (n = 813) for precise estimates of the coefficients of parameters. A subset of post-POAI samples (n = 99) was gene expression profiled with Nanostring to allow pseudo-Oncotype, pseudo-EndoPredict, and RUO-Prosigna scores calculated (Buus et al. npj Breast cancer 2021). The risk groups classified by the Ki67Cal and gene-expression assays (GEP) were compared.
Results: Within this cohort, the 5-year TTR was 34.5% (C.I. 24.9-47.9) for those with a high Ki67_2wk (>=10%) and 12.3% (C.I. 9.1-16.7) in those with a high Ki67B that was suppressed to Ki672wk < 10%. The significant features were Ki67_2wk, sampling type (core vs. excision) at surgery, and pathological variables (tumour size, grade, and nodal status) for the final Ki67Cal algorithm. Stratifying patients into five groups (quintiles) by Ki67Cal identified 60% of patients with TTR of < 5% at 5yrs, and 20% of patients with TTR of > 30% at 5yrs.
As an exploratory analysis, the risk groups by Ki67Cal and GEP were compared (Table 1). To date, these assays are optimized to be used on untreated ER+HER2- samples; there were fairly good agreements between the high-risk group defined by Ki67Cal with pseudo-EndoPredict and RUO-Prosigna respectively, and low-risk groups by Ki67Cal with Prosigna probably because Prosigna scores are driven by proliferation score.
Conclusion: The relatively poor outcome of patients >70yrs in POETIC emphasizes the need for prognostic tools that identify patients who may be treated with endocrine therapy alone or conversely should be considered for additional therapy. Ki67Cal provides a simple tool that identified very low-risk and high-risk patients in 80% of patients with ER+HER2- BC.
Table 1: Comparison of the risk groups defined by Ki67Cal algorithm with the three commonly used gene-expression assays (pseudo-EndoPredict, pseudo-Oncotype and RUO-Prosigna) applied on the post-peri-operative aromatase inhibitor samples.
Citation Format: Maggie Chon U Cheang, Monisha Dewan, Lucy Kilburn, Gabriele Morani, Lila Zabaglo, Kally Sidhu, Holly Tovey, Xixuan Zhu, Chris Holcombe, Anthony Skene, Ian Smith, John Robertson, Alistair Ring, Nicholas Turner, Judith Bliss, Mitch Dowsett. Multi-parametric algorithm integrating on-treatment Ki67 value and standard clinicopathological variables to predict risk of recurrences for women > 70 years old with early ER+HER2- tumours in POETIC trial [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 P2-03-07.
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Affiliation(s)
| | - Monisha Dewan
- 2Institute of Cancer Research, Sutton, United Kingdom
| | - Lucy Kilburn
- 3Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | | | - Lila Zabaglo
- 5Breast Cancer Research, The Institute of Cancer Research
| | | | - Holly Tovey
- 7Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - Xixuan Zhu
- 8Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | | | - Anthony Skene
- 10Royal Bournemouth and Christchurch NHS Foundation Trust, Bournemouth, UK
| | - Ian Smith
- 11The Royal Marsden NHS Foundation Trust, London
| | - John Robertson
- 12University of Nottingham, Nottingham, UK; University Hospitals of Derby and Burton, Derby, UK
| | - Alistair Ring
- 13The Royal Marsden NHS Foundation Trust, Breast Unit - Department of Medicine, The Royal Marsden NHS Foundation Trust, London, UK/Breast Cancer Research Division – The Institute of Cancer Research, London, England, United Kingdom
| | | | - Judith Bliss
- 15Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Mitch Dowsett
- 16The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
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Schuster EF, López-Knowles E, Alataki A, Zabaglo L, Folkerd E, Evans D, Sidhu K, Tovey H, Maxwell P, Turner N, Johnston S, Salto-Tellez M, Cheang MCU, Robertson J, Smith I, Bliss J, Dowsett M. Abstract PD10-07: PD10-07 Low plasma estradiol, low expression of estrogen responsive genes and TP53 mutations are associated with poor anti-proliferative response to aromatase inhibitors. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd10-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Aromatase inhibitors (AIs) are highly effective at reducing recurrences and mortality in postmenopausal patients with estrogen receptor positive breast cancer (ER+ BC). Poor anti-proliferative (Ki67) response or ER+ BCs to AIs after 2 weeks is associated with worse long-term outcomes. Factors that relate to the degree of the response may identify markers and/or mechansims of resistance. Methods: The PeriOperative Endocrine Therapy for Individualizing Care (POETIC) trial randomized 4,480 with ER+ BC to 2 weeks’ AI before surgery or no presurgical treatment. All patients within the bottom 15% of Ki67 responders to AI (poor responders [PRs]; n=177 with RNA extracted) were selected from and matched to good responders (GRs) within the 50% showing the best response (n=190). Matching was based on baseline Ki67 levels as measured by immunohistochemistry (IHC). Response to AI was measured by the percentage change in Ki67 after 2 weeks’ treatment. PRs were further divided into groups expressing high ESR1 (PRs ESR1HIGH; n=119) and low ESR1 (PRs ESR1LOW; n=58) levels since there were very few GRs with low ESR1. RNAseq, targeted exome DNA sequencing of 87 BC/resistance related genes and measurement of plasma estradiol levels by mass spectrometry were performed to understand mechanisms of de novo resistance. Intrinsic subtypes were estimated from RNAseq data. Results: More than 90% of PRs ESR1LOW were non-luminal subtypes with low expression of estrogen-responsive genes. In contrast, 11% of PRs ESR1HIGH were non-luminal compared to 4% of GRs but only HER2-enriched subtypes were significantly higher in PR ESR1HIGH (p=0.05, Fisher exact). While AI treatment had limited impact on Ki67 IHC values in PRs ESR1HIGH, PGR expression was more than 2-fold lower after 2 weeks of AI. Gene-set enrichment analysis showed significantly lower expression of estrogen-response genes in PRs ESR1HIGH compared to GRs (FDR< 10-9) at baseline despite similar percentage of Luminal subtypes in PRs ESR1HIGH and GRs. Plasma estradiol levels were correlated with expression of estrogen-response genes (FDR=0.01) and levels were significantly lower in PRs ESR1HIGH compared to GRs (p=0.003, Mann Whitney). PRs ESR1HIGH had significantly more mutations in RB1, TP53, ARID1B and DNAH11 genes (p< 0.05, Fisher exact). TP53 mutations were significantly enriched in Luminal-A PRs ESR1HIGH compared to GRs (22% and 3% respectively; p=0.003, Fisher exact), but not in Luminal-B tumors (23% and 15% mutated respectively). Discussion and conclusions: In approximately 33% of PRs, de novo AI resistance was associated with and most likely due to low expression of ER/ESR1 and estrogen-responsive genes in non-luminal tumors. In the remaining tumors, AI treatment still impacted some estrogen responsive genes but had limited downstream impact on suppressing proliferation. This might be due to mutations including in TP53 that limit suppression of proliferation downstream of estrogen signaling. The proportion of Luminal tumors in GRs and PRs ESR1HIGH was similar, suggesting better outcome of Luminal-A tumors on AI is likely due to their better intrinsic prognosis rather than better response to endocrine therapy.
Citation Format: Eugene F. Schuster, Elena López-Knowles, Anastasia Alataki, Lila Zabaglo, Elizabeth Folkerd, David Evans, Kally Sidhu, Holly Tovey, Perry Maxwell, Nicholas Turner, Stephen Johnston, Manuel Salto-Tellez, Maggie Chon U Cheang, John Robertson, Ian Smith, Judith Bliss, Mitch Dowsett. PD10-07 Low plasma estradiol, low expression of estrogen responsive genes and TP53 mutations are associated with poor anti-proliferative response to aromatase inhibitors [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 PD10-07.
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Affiliation(s)
| | | | | | - Lila Zabaglo
- 4Breast Cancer Research, The Institute of Cancer Research
| | | | | | | | - Holly Tovey
- 8Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - Perry Maxwell
- 9School of Medicine, Dentistry and Biomedical Sciences Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast
| | | | - Stephen Johnston
- 11Royal Marsden NHS Foundation Trust, Institute of Cancer Research
| | - Manuel Salto-Tellez
- 12The Institute of Cancer Research, London; Queen’s University Belfast, Belfast
| | | | - John Robertson
- 14University of Nottingham, Nottingham, UK; University Hospitals of Derby and Burton, Derby, UK
| | - Ian Smith
- 15The Royal Marsden NHS Foundation Trust, London
| | - Judith Bliss
- 16Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Mitch Dowsett
- 17The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
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Tovey H, Sipos O, Hoadley KA, Parker JS, Quist J, Kernaghan S, Kilburn L, Salgado R, Loi S, Kennedy RD, Roxanis I, Gazinska P, Pinder SE, Bliss J, Perou CM, Haider S, Tutt A, Grigoriadis A, Cheang MCU. Abstract PD9-06: Histopathological and molecular immune landscape and DNA damage response signatures to predict response to carboplatin and docetaxel in TNT trial TNBC cohort. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd9-06] [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: 03/06/2023]
Abstract
Abstract
Background The TNT trial (NCT00532727) showed no evidence of carboplatin (C) superiority over docetaxel (D) overall in metastatic triple negative breast cancers (TNBC), but a C benefit was observed in the pre-specified sub-group analysis in patients with a gBRCA1/2 mutation (Tutt et al, Nat Med 2018). Given only ~30% of patients have a gBRCA1/2 mutation, broader predictive biomarkers of response are needed. In this cohort we previously found that DNA Damage Response (DDR) signatures were associated with improved C response in chemotherapy (CT) naïve patients only (Tovey et al, ASCO 2020). Since DDR activities influence tumour immune-microenvironment, we explored the predictive ability of immune cell markers and performed integrative analyses on multi-omics features to identify novel TNBC subgroups. Patients and Methods Tumour infiltrating lymphocytes (TILs) were evaluated on haematoxylin and eosin stained primary tumour (PT) slides for 222/376 TNT patients. Formalin-fixed paraffin-embedded PT tissues from 186/376 TNT patients were successfully profiled using total RNA-sequencing. Matched recurrence (REC) was also sequenced for 13 patients. Twenty-five immune signatures were assessed. Logistic regression and restricted mean progression free survival (PFS) were applied to delineate the relationship of these features with treatment outcomes. Random forest clustering of multi-omics DDR and immune biology markers, including gene expression signatures and mutation/methylation status, was applied to identify subgroups. We further molecularly characterised these clusters through supervised clustering of 693 gene expression “modules” (sets of co-expressed genes), immune cell deconvolution and genomic scars. Results Immune gene expression signatures and TILs were highly correlated. Average immune infiltration based on ConsensusTME was lower in mutated/methylated tumours compared with BRCA1 wildtype tumours (p=0.04). Immune signature score markers decreased from PT to REC, demonstrating a dynamic immune microenvironment. In the overall population and when restricting to prior CT treated patients, high immune infiltration (gene expression based & TILs) was associated with response to D while C response rates were not associated with immune scores (interaction p-values< 0.05). This did not translate to a PFS benefit. Multi-omics clustering identified 6 biological subgroups including immune enriched, immune depleted, DDR deficient and proficient clusters as well as 2 small clusters with no obvious distinguishing features. Immune enriched TNBC were predominantly basal-like immune activated with high B-cell/T-cell diversity. Immune depleted TNBC showed higher activity of proliferation and DDR pathway modules. DDR proficient tumours had low expression of immune markers and enrichment for ESR1/PGR expression, markers of extra cellular formation, cell structure, lipid metabolism and proliferation. The DDR deficient cluster was enriched for proliferation and demonstrated high number of TILs despite no apparent enrichment for gene expression-based immune modules. In the prior CT treated cohort, the immune enriched cluster had preferential response to D (62.5% (D) vs. 29.4% (C); p=0.02). The immune depleted cluster had preferential response to C (8.0% (D) vs. 40.0% (C); p=0.01). Numbers were too small to assess differential response within the other clusters or in the CT naïve cohort. Conclusions Tumours with high immune features have high response to D while those with low immune features have preferential response to C in advanced TNBC. Combining multi-omics markers of DDR deficiency and immune biology can identify clusters of patients with distinct biological profiles and differential treatment specific response rates.
Citation Format: Holly Tovey, Orsolya Sipos, Katherine A Hoadley, Joel S Parker, Jelmar Quist, Sarah Kernaghan, Lucy Kilburn, Roberto Salgado, Sherene Loi, Richard D Kennedy, Ioannis Roxanis, Patrycja Gazinska, Sarah E. Pinder, Judith Bliss, Charles M. Perou, Syed Haider, Andrew Tutt, Anita Grigoriadis, Maggie Chon U Cheang. Histopathological and molecular immune landscape and DNA damage response signatures to predict response to carboplatin and docetaxel in TNT trial TNBC cohort [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 PD9-06.
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Affiliation(s)
- Holly Tovey
- 1Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - Orsolya Sipos
- 2Breast Cancer Now Toby Robinsons Research Centre, The Institute of Cancer Research, London
| | - Katherine A Hoadley
- 3Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Joel S Parker
- 4Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC
| | - Jelmar Quist
- 5Breast Cancer Now Unit, King’s College London Faculty of Life Sciences and Medicine, London; School of Cancer and Pharmaceutical Sciences, King’s College London Faculty of Life Sciences and Medicine, London
| | - Sarah Kernaghan
- 6Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - Lucy Kilburn
- 7Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - Roberto Salgado
- 8GZA-ZNA-Hospitals, Antwerp, Belgium; Peter Mac Callum Cancer Centre, Melbourne, Australia
| | - Sherene Loi
- 9Peter MacCallum Cancer Centre, Melbourne, Australia, Australia
| | | | - Ioannis Roxanis
- 11Breast Cancer Now Toby Robinsons Research Centre, The Institute of Cancer Research, London
| | - Patrycja Gazinska
- 12Breast Cancer Now Toby Robinsons Research Centre, The Institute of Cancer Research, London; Biobank Research Group, Lukasiewicz Research Network – PORT Polish Center for Technology Development, Wroclaw, Poland
| | - Sarah E. Pinder
- 13School of Cancer and Pharmaceutical Sciences, King’s College London Faculty of Life Sciences and Medicine, London, London, England, United Kingdom
| | - Judith Bliss
- 14Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Charles M. Perou
- 15University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Syed Haider
- 16Breast Cancer Now Toby Robinsons Research Centre, The Institute of Cancer Research, London
| | - Andrew Tutt
- 17Institute of Cancer Research, London, United Kingdom
| | - Anita Grigoriadis
- 18Breast Cancer Now Unit, King’s College London Faculty of Life Sciences and Medicine, London; School of Cancer and Pharmaceutical Sciences, King’s College London Faculty of Life Sciences and Medicine, London
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Zhu X, Xiao H, López-Knowles E, Sirvén MAB, Alataki A, Maxwell P, Tovey H, Kilburn L, Holcombe C, Skene A, Smith I, Robertson J, Hoadley KA, Salgado R, Bliss J, Turner N, Salto-Tellez M, Schuster G, Dowsett M, Cheang MCU. Abstract P2-03-08: Deconstructing the molecular characteristics of ER+ HER2+ early breast cancer in the POETIC trial using multiplex immunofluorescence and gene expression profiles. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p2-03-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: POETIC was a phase III clinical trial, with patients randomised 2:1 to 2-week perioperative aromatase inhibitor (POAI) vs control for postmenopausal women with oestrogen receptor positive (ER+) early breast cancer (BC) (Smith et al., Lancet Oncology 2020). Our previous study on POETIC trial patients with ER+ human epidermal growth factor receptor 2 positive (HER2+) BC suggested both HER2 enriched subtype (HER2-E) and immune enrichment pre-POAI (baseline, B) are main drivers of poor early response to POAI (Bergamino et al., 2022). However, some patients with HER2-E or immune enriched BC at B still showed good response to POAI. In this study, we aim to further investigate a sub-cohort of ER+ HER2+ BC from the POETIC trial, including a subset of aforementioned HER2-E tumours, to further explore the multi-modal molecular characteristics of the tumours resistant to POAI.
Methods: Proliferation rate was assessed as percentage of cancer cells stained by Ki67. Patient POAI response was determined by Ki67 reduction at 2 weeks of treatment. A sub-cohort of 37 patients were selected based on response and classified as poor responders (PR, reduction < 30%, n=18), good responders (GR, reduction > 90%, n=11) and good responders with HER2-E BC at B (GR, reduction > 65%, n=8). Paired B and post-POAI (surgery, S) samples were taken from each patient of the sub-cohort. Multiplex immunofluorescence (mIF) was performed on these samples, measuring the immune cell densities in stroma and tumour compartments using five biomarkers: CD3 (all T cells), CD20 (B cells), CD68 (Macrophages), FOXP3 (regulatory T cells), and CD3 FOXP3 co-expression. The samples were also profiled using Breast Cancer 360TM (NanoString, BC360), covering the expressions of 758 genes and 46 biological signatures. Wilcoxon test, hierarchical clustering and spearman correlation test were performed to compare the tumour characteristics of GR and PR.
Results: In this study, two B and four S samples were not achievable for mIF experiments due to low tumour content. At B (n = 35), among the five mIF biomarker measurements in stroma and tumour, only the stromal CD3 density was significantly different between GR (median = 0.0013) and PR (median = 0.0003, p = 0.041). In GR, HER2-E BC at B were separated into immune-high and immune-low groups with mIF biomarkers at B; the immune-high group was more likely to change into luminal subtypes post-POAI, while the immune-low group remained HER2-E. After POAI, the density changes in five mIF biomarkers in stroma and CD68 in tumour were all significantly higher in PR than GR (Table 1, n of paired samples = 62). The BC360 signatures of BC p53 (p < 0.001), BC proliferation (p < 0.001), LumB (p < 0.001) and HER2-E correlation coefficients (p < 0.001) were significantly downregulated in GR after POAI, while LumA correlation coefficients (p < 0.001) were notably increased.
Conclusions: Our results suggest that for this sub-cohort, increased stromal immune response is associated with poor response to 2-week POAI in ER+ HER2+ early BC. HER2-E GR display visible immune heterogeneity at B. Lower-risk BC characteristics were exhibited in GR after the 2-week treatment. Further integrating mIF imaging data and additional digital spatial profiling are ongoing to reveal additional characteristics of ER+ HER2+ BC and tumour microenvironment predicting POAI resistance.
Table 1: List of medians of log2 fold changes in mIF biomarker densities between GR and PR among the 62 paired samples, and Wilcoxon test p-values.
Citation Format: Xixuan Zhu, Hui Xiao, Elena López-Knowles, Milana A. Bergamino Sirvén, Anastasia Alataki, Perry Maxwell, Holly Tovey, Lucy Kilburn, Chris Holcombe, Anthony Skene, Ian Smith, John Robertson, Katherine A Hoadley, Roberto Salgado, Judith Bliss, Nicholas Turner, Manuel Salto-Tellez, Gene Schuster, Mitch Dowsett, Maggie Chon U Cheang. Deconstructing the molecular characteristics of ER+ HER2+ early breast cancer in the POETIC trial using multiplex immunofluorescence and gene expression profiles [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 P2-03-08.
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Affiliation(s)
- Xixuan Zhu
- 1Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - Hui Xiao
- 2Clinical Trial and Statistics Unit, The Institute of Cancer Research, London
| | | | | | | | - Perry Maxwell
- 6School of Medicine, Dentistry and Biomedical Sciences Patrick G Johnston Centre for Cancer Research, Queen’s University Belfast, Belfast
| | - Holly Tovey
- 7Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - Lucy Kilburn
- 8Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | | | - Anthony Skene
- 10Royal Bournemouth and Christchurch NHS Foundation Trust, Bournemouth, UK
| | - Ian Smith
- 11The Royal Marsden NHS Foundation Trust, London
| | - John Robertson
- 12University of Nottingham, Nottingham, UK; University Hospitals of Derby and Burton, Derby, UK
| | - Katherine A Hoadley
- 13Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA
| | - Roberto Salgado
- 14GZA-ZNA-Hospitals, Antwerp, Belgium; Peter Mac Callum Cancer Centre, Melbourne, Australia
| | - Judith Bliss
- 15Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | - Manuel Salto-Tellez
- 17The Institute of Cancer Research, London; Queen’s University Belfast, Belfast
| | - Gene Schuster
- 18Breast Cancer Research, The Institute of Cancer Research, London
| | - Mitch Dowsett
- 19The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
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Wilkins A, Gusterson B, Tovey H, Griffin C, Stuttle C, Daley F, Corbishley CM, Dearnaley D, Hall E, Somaiah N. Multi-candidate immunohistochemical markers to assess radiation response and prognosis in prostate cancer: results from the CHHiP trial of radiotherapy fractionation. EBioMedicine 2023; 88:104436. [PMID: 36708693 PMCID: PMC9900483 DOI: 10.1016/j.ebiom.2023.104436] [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] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/20/2022] [Accepted: 12/25/2022] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND Protein markers of cellular proliferation, hypoxia, apoptosis, cell cycle checkpoints, growth factor signalling and inflammation in localised prostate tumours have previously shown prognostic ability. A translational substudy within the CHHiP trial of radiotherapy fractionation evaluated whether these could improve prediction of prognosis and assist treatment stratification following either conventional or hypofractionated radiotherapy. METHODS Using case:control methodology, patients with biochemical or clinical failure after radiotherapy (BCR) were matched to patients without recurrence according to established prognostic factors (Gleason score, presenting PSA, tumour-stage) and fractionation schedule. Immunohistochemical (IHC) staining of diagnostic biopsy sections was performed and scored for HIF1α, Bcl-2, Ki67, Geminin, p16, p53, p-chk1 and PTEN. Univariable and multivariable conditional logistic regression models, adjusted for matching strata and age, estimated the prognostic value of each IHC biomarker, including interaction terms to determine BCR prediction according to fractionation. FINDINGS IHC results were available for up to 336 tumours. PTEN, Geminin, mean Ki67 and max Ki67 were prognostic after adjusting for multiple comparisons and were fitted in a multivariable model (n = 212, 106 matched pairs). Here, PTEN and Geminin showed significant prediction of prognosis. No marker predicted BCR according to fractionation. INTERPRETATION Geminin or Ki67, and PTEN, predicted response to radiotherapy independently of established prognostic factors. These results provide essential independent external validation of previous findings and confirm a role for these markers in treatment stratification. FUNDING Cancer Research UK (BIDD) grant (A12518), Cancer Research UK (C8262/A7253), Department of Health, Prostate Cancer UK, Movember Foundation, NIHR Biomedical Research Centre at Royal Marsden/ICR.
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Affiliation(s)
- Anna Wilkins
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom.
| | - Barry Gusterson
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Clare Griffin
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Christine Stuttle
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - Frances Daley
- Division of Breast Cancer Research, The Institute of Cancer Research, London, United Kingdom
| | - Catherine M Corbishley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom
| | - David Dearnaley
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Navita Somaiah
- Division of Radiotherapy and Imaging, The Institute of Cancer Research, London, United Kingdom; Royal Marsden Hospital, Sutton, United Kingdom
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Lopez-Knowles E, Detre S, Hills M, Schuster EF, Cheang MCU, Tovey H, Kilburn LS, Bliss JM, Robertson J, Mallon E, Skene A, Evans A, Smith I, Dowsett M. Relationship between ER expression by IHC or mRNA with Ki67 response to aromatase inhibition: a POETIC study. Breast Cancer Res 2022; 24:61. [PMID: 36096872 PMCID: PMC9466340 DOI: 10.1186/s13058-022-01556-6] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 08/27/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In clinical practice, oestrogen receptor (ER) analysis is almost entirely by immunohistochemistry (IHC). ASCO/CAP recommends cut-offs of < 1% (negative) and 1-10% (low) cells positive. There is uncertainty whether patients with ER low tumours benefit from endocrine therapy. We aimed to assess IHC and mRNA cut-points for ER versus biological response of primary breast cancer to 2 weeks' aromatase inhibitor treatment as measured by change in Ki67. METHODS Cases were selected from the aromatase inhibitor treatment group of POETIC. We selected the 15% with the poorest Ki67 response (PR, < 40% Ki67 suppression, n = 230) and a random 30% of the remainder categorised as intermediate (IR, 40-79% Ki67 suppression, n = 150) and good-responders (GR, ≥ 80% Ki67 suppression, n = 230) from HER2 - group. All HER2 + cases available were selected irrespective of their response category (n = 317). ER expression was measured by IHC and qPCR. RESULTS ER IHC was available from 515 HER2 - and 186 HER2 + tumours and ER qPCR from 367 HER2 - and 171 HER2 + tumours. Ninety-one percentage of patients with ER IHC < 10% were PRs with similar rates in HER2 - and HER2 + cases. At or above ER IHC 10% substantial numbers of patients showed IR or GR. Similar proportions of patients were defined by cut-points of ER IHC < 10% and ER mRNA < 5 units. In addition, loss of PgR expression altered ER anti-proliferation response with 92% of PgR - cases with ER IHC < 40% being PRs. CONCLUSIONS There was little responsiveness at IHC < 10% and no distinction between < 1% and 1-10% cells positive. Similar separation of PRs from IR/GRs was achieved by IHC and mRNA.
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Affiliation(s)
- Elena Lopez-Knowles
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK.
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK.
| | - Simone Detre
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Margaret Hills
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Eugene F Schuster
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
| | - Maggie C U Cheang
- Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Holly Tovey
- Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Lucy S Kilburn
- Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Judith M Bliss
- Clinical Trials and Statistics Unit, Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - John Robertson
- Graduate Entry Medical School, Royal Derby Hospital, University of Nottingham, Uttoxeter Road, Derby, DE22 3DT, UK
| | | | - Anthony Skene
- University Hospitals Dorset (Royal Bournemouth), Bournemouth, UK
| | | | | | - Mitch Dowsett
- The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, UK
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Bergamino MA, López-Knowles E, Morani G, Tovey H, Kilburn L, Schuster EF, Alataki A, Hills M, Xiao H, Holcombe C, Skene A, Robertson JF, Smith IE, Bliss JM, Dowsett M, Cheang MCU. HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer. EBioMedicine 2022; 83:104205. [PMID: 35985932 PMCID: PMC9482930 DOI: 10.1016/j.ebiom.2022.104205] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Oestrogen receptor positive/ human epidermal growth factor receptor positive (ER+/HER2+) breast cancers (BCs) are less responsive to endocrine therapy than ER+/HER2- tumours. Mechanisms underpinning the differential behaviour of ER+HER2+ tumours are poorly characterised. Our aim was to identify biomarkers of response to 2 weeks' presurgical AI treatment in ER+/HER2+ BCs. METHODS All available ER+/HER2+ BC baseline tumours (n=342) in the POETIC trial were gene expression profiled using BC360™ (NanoString) covering intrinsic subtypes and 46 key biological signatures. Early response to AI was assessed by changes in Ki67 expression and residual Ki67 at 2 weeks (Ki672wk). Time-To-Recurrence (TTR) was estimated using Kaplan-Meier methods and Cox models adjusted for standard clinicopathological variables. New molecular subgroups (MS) were identified using consensus clustering. FINDINGS HER2-enriched (HER2-E) subtype BCs (44.7% of the total) showed poorer Ki67 response and higher Ki672wk (p<0.0001) than non-HER2-E BCs. High expression of ERBB2 expression, homologous recombination deficiency (HRD) and TP53 mutational score were associated with poor response and immune-related signatures with High Ki672wk. Five new MS that were associated with differential response to AI were identified. HER2-E had significantly poorer TTR compared to Luminal BCs (HR 2.55, 95% CI 1.14-5.69; p=0.0222). The new MS were independent predictors of TTR, adding significant value beyond intrinsic subtypes. INTERPRETATION Our results show HER2-E as a standardised biomarker associated with poor response to AI and worse outcome in ER+/HER2+. HRD, TP53 mutational score and immune-tumour tolerance are predictive biomarkers for poor response to AI. Lastly, novel MS identify additional non-HER2-E tumours not responding to AI with an increased risk of relapse. FUNDING Cancer Research UK (CRUK/07/015).
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Affiliation(s)
- Milana A Bergamino
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Elena López-Knowles
- Royal Marsden Hospital, London, UK; The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Gabriele Morani
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Holly Tovey
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Lucy Kilburn
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | - Eugene F Schuster
- Royal Marsden Hospital, London, UK; The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Anastasia Alataki
- Royal Marsden Hospital, London, UK; The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | | | - Hui Xiao
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, UK; Royal Marsden Hospital, London, UK
| | - Chris Holcombe
- Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | | | - John F Robertson
- Faculty of Medicine & Health Sciences, Queen's Medical Centre, Nottingham, UK
| | | | - Judith M Bliss
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, UK
| | | | - Maggie C U Cheang
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, UK.
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Kirwan C, Castle J, Pritchard S, Tovey H, Bundred N, Smith I, Robertson J, Bliss J, Dowsett M. PO-29: Coagulation and circulating tumour cells as pharmacodynamic biomarkers of response to aromatase inhibitors in breast cancer. Thromb Res 2022. [DOI: 10.1016/s0049-3848(22)00217-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bergamino MA, Morani G, Parker J, Schuster EF, Leal MF, López-Knowles E, Tovey H, Bliss JM, Robertson JF, Smith IE, Dowsett M, Cheang MC. Impact of Duration of Neoadjuvant Aromatase Inhibitors on Molecular Expression Profiles in Estrogen Receptor-positive Breast Cancers. Clin Cancer Res 2022; 28:1217-1228. [PMID: 34965950 PMCID: PMC7612503 DOI: 10.1158/1078-0432.ccr-21-2718] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 10/18/2021] [Accepted: 12/16/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE Aromatase inhibitor (AI) treatment is the standard of care for postmenopausal women with primary estrogen receptor-positive breast cancer. The impact of duration of neoadjuvant endocrine therapy (NET) on molecular characteristics is still unknown. We evaluated and compared changes of gene expression profiles under short-term (2-week) versus longer-term neoadjuvant AIs. EXPERIMENTAL DESIGN Global gene expression profiles from the PeriOperative Endocrine Therapy for Individualised Care (POETIC) trial (137 received 2 weeks of AIs and 47 received no treatment) and targeted gene expression from 80 patients with breast cancer treated with NET for more than 1 month (NeoAI) were assessed. Intrinsic subtyping, module scores covering different cancer pathways and immune-related genes were calculated for pretreated and posttreated tumors. RESULTS The differences in intrinsic subtypes after NET were comparable between the two cohorts, with most Luminal B (90.0% in the POETIC trial and 76.3% in NeoAI) and 50.0% of HER2 enriched at baseline reclassified as Luminal A or normal-like after NET. Downregulation of proliferative-related pathways was observed after 2 weeks of AIs. However, more changes in genes from cancer-signaling pathways such as MAPK and PI3K/AKT/mTOR and immune response/immune-checkpoint components that were associated with AI-resistant tumors and differential outcome were observed in the NeoAI study. CONCLUSIONS Tumor transcriptional profiles undergo bigger changes in response to longer NET. Changes in HER2-enriched and Luminal B subtypes are similar between the two cohorts, thus AI-sensitive intrinsic subtype tumors associated with good survival might be identified after 2 weeks of AI. The changes of immune-checkpoint component expression in early AI resistance and its impact on survival outcome warrants careful investigation in clinical trials.
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Affiliation(s)
- Milana A. Bergamino
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Gabriele Morani
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Joel Parker
- Department of Genetics, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | | | | | | | - Holly Tovey
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - Judith M. Bliss
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom
| | - John F.R. Robertson
- Faculty of Medicine & Health Sciences, Queen's Medical Centre, Nottingham, United Kingdom
| | | | - Mitch Dowsett
- Royal Marsden Hospital, London, United Kingdom.,Breast Cancer Now Research Centre, The Institute of Cancer Research, Sutton, London, United Kingdom
| | - Maggie C.U. Cheang
- Clinical Trials and Statistics Unit (ICR-CTSU)- Division of Clinical Studies, The Institute of Cancer Research, London, United Kingdom.,Corresponding Author: Maggie C.U. Cheang, Clinical Trials and Statistics Unit (ICR-CTSU), The Institute of Cancer Research, 15 Cotswold Rd, Sutton SM2 5NG, United Kingdom. Phone: 4420-8722-4552; E-mail:
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Macpherson I, McIntosh S, Kilburn L, Tovey H, Kernaghan S, Goddard K, Bhattacharya I, Boyd C, Coles C, Kirwan C, Mackenzie M, O’Brien C, Ring A, Snowdon C, Stobart H, Wheatley D, Wardley A, Shaaban A, Hall P, Cameron D, Bliss J. Abstract OT2-05-01: The HER2-RADiCAL study (Response ADaptive CAre pLan) - Tailoring treatment for HER2 positive early breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-05-01] [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 The presence or absence of residual disease following neoadjuvant systemic anti-cancer therapy (neoSACT) for HER2-positive early breast cancer (HER2+ EBC) provides powerful prognostic information that may guide subsequent adjuvant treatment for the individual patient. Pathological complete response (pCR) following neoSACT identifies a population with excellent outcomes in whom the balance of toxicity associated with the current treatment pathway may be disproportionate to the absolute clinical benefit. Aims HER2-RADiCAL seeks to reduce the burden of toxicity and healthcare costs of treating HER2+ EBC by testing the hypothesis that pCR can be used as a functional response biomarker to select patients who can safely receive less intensive therapy, including avoiding anthracyclines, with minimal or no loss of efficacy in the population. Trial design and eligibility criteria HER2-RADiCAL is a response-directed interventional cohort (single-arm) study embedded within a real-world data driven clinical pathway model. Participants will be registered within 6 weeks of completion of breast cancer surgery. The main eligibility criteria include clinical stage T1N1 or T2N0-1 at diagnosis and locally-determined pCR (ypT0/Tis ypN0) after standard of care taxane-based (non-anthracycline) neoadjuvant chemotherapy, trastuzumab and pertuzumab. After registration participants will continue to receive trastuzumab to complete a total of 9 cycles including those (neo-)adjuvant cycles administered prior to study entry. Participants will receive no further pertuzumab nor any adjuvant chemotherapy. Statistical methods The primary clinical endpoint is relapse free interval. Recruitment of 720 participants over 3 years will provide 90% power to exclude an event rate >6.5% at 3 years. Secondary endpoints include relapse-free survival, invasive breast cancer-free survival, invasive disease-free survival, distant recurrence-free interval, breast cancer-free interval, treatment pathway adherence and cost-effectiveness. Real-world data driven clinical pathway model Health economic modelling will compare the protocol-driven study cohort with two comparator pathways: a non-response adapted maximum therapy pathway (the standard clinical pathway prior to the study) and a real-world representative pathway taken from 4-nation UK National Health Service data at the beginning and end of the study. Patient and public involvement Patient advocates have shaped the research by confirming that the main outcomes being evaluated are important to patients and that the interventional cohort design, with power to exclude an absolute risk of recurrence outwith a 2-3% margin of historical control data, is acceptable and preferable to a randomised controlled trial, which would take longer to get answers and need many more patients to be included. They have been involved in protocol design, including methodology, sample collection and patient follow-up, and their input has shaped the patient information materials and consent forms. Patient advocates will have an ongoing key role in overseeing the progress of the study as members of the Trial Management Group, and they will also have an important role in communicating the study results to patients and the public. Current status HER2-RADiCAL is planned to open at ~40 UK sites commencing in September 2021.
Citation Format: Iain Macpherson, Stuart McIntosh, Lucy Kilburn, Holly Tovey, Sarah Kernaghan, Katie Goddard, Indrani Bhattacharya, Clinton Boyd, Charlotte Coles, Cliona Kirwan, Mairead Mackenzie, Ciara O’Brien, Alistair Ring, Claire Snowdon, Hilary Stobart, Duncan Wheatley, Andrew Wardley, Abeer Shaaban, Peter Hall, David Cameron, Judith Bliss. The HER2-RADiCAL study (Response ADaptive CAre pLan) - Tailoring treatment for HER2 positive early 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 OT2-05-01.
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Affiliation(s)
| | | | - Lucy Kilburn
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Sarah Kernaghan
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Katie Goddard
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | | | - Clinton Boyd
- Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - Charlotte Coles
- Department of Oncology, University of Cambridge, Cambridge, United Kingdom
| | - Cliona Kirwan
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | | | - Ciara O’Brien
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Alistair Ring
- The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Claire Snowdon
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
| | - Hilary Stobart
- Independent Cancer Patients' Voice, London, United Kingdom
| | | | - Andrew Wardley
- Outreach Research & Innovation Group and AstraZeneca, Manchester, United Kingdom
| | - Abeer Shaaban
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, United Kingdom
| | - Peter Hall
- The University of Edinburgh, Edinburgh, United Kingdom
| | - David Cameron
- The University of Edinburgh, Edinburgh, United Kingdom
| | - Judith Bliss
- Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom
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Sirvén MAB, López-Knowles E, Morani G, Tovey H, Kilburn L, Holcombe C, Skene A, Smith I, Robertson J, Schuster G, Bliss JM, Dowsett M, Cheang MCU. Abstract PD15-02: HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd15-02] [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: Approximately 10% of estrogen receptor positive (ER+) early breast cancers (EBC) are human epidermal growth factor positive/overexpressed (HER2+). Resistance to aromatase inhibitors (AIs) is poorly understood among ER+HER2+ BC. We aimed to identify biomarkers of response and resistance using the HER2+ tumours in the POETIC trial. Methods: POETIC was a phase III trial of post-menopausal women with ER+ EBC randomized 2:1 to 2-weeks of peri-surgical AI vs control, followed by standard-of-care. Baseline formalin-fixed paraffin-embedded samples from 342 ER+HER2+ BC (237 treated/105 controls) were gene expression profiled using Breast cancer 360™ panel (NanoString) covering intrinsic subtypes and 40 key biological signatures. New molecular subgroups were identified using consensus clustering (CC).Proliferation rate was estimated as percentage of cancer-cells staining for Ki67. Ki67 response was defined by percentage-changes from baseline to surgery: poor (PR; reduction <50%), intermediate (IR; 50-75%) and good (GR; >75%). Residual Ki67 at 2 weeks timepoint (Ki672w) was defined as High (H) (≥ 10%) vs Low (L) (<10%). Association of molecular features with Ki67 response was assessed using logistic regression models and with time to recurrence (TTR) using multivariable Cox regression models adjusted for post-surgery clinicopathological variables: grade, tumour size, nodal status and age. Results: Ki672w was measured for all treated samples (n = 227, 48% H, 52% L) and a fraction of controls (n = 50, 96% H, 4% L). At baseline, 45% of tumours were HER2-enriched (HER2-E), 53% Luminal A/B and 2% Basal-Like. HER2-E associated with high Ki672W (84% H, 16% L) compared to non-HER2-E (29% H, 71% L, p<0.001). Amongst the 40 BC360 signatures, 9 were significantly associated with Ki67 response (Table).
High expression of endocrine-related and apoptosis signatures associated with GR while HRD and TP53 with PR. These features were also related to Ki672W, with additional signatures involved in immune-checkpoint component and immune-enrichment (IM) (IDO1, PD-L1, IFN-gamma and T-reg) associated with high Ki672W.. Using CC, 4 molecular subgroups predicting differential response to AI were identified. Cluster (C) 1 was characterized by overexpression of IM features and low ER signaling (42%); C2 low IM but highest ERBB2 expression (15%); C3 ESR1 high and PgR low (4%) and C4 high endocrine signaling and lowest ERBB2 expression (39%). Distribution of Intrinsic subtypes varied across these molecular subgroups with the majority of C1 being HER2-E (62%) and Luminal B (27%); C2 HER2-E (74%); C3 Luminal B (64%) and C4 Luminal B (55%) and Luminal A (30%). HER2-E had significantly poorer TTR (HR 2.14; 95%CI1.11-4.17; p=0.0224) compared to Luminal tumours, remaining significant (HR 2.55, 95%CI1.14-5.69; p=0.0222) in the multivariable analysis. C2 (HR 4.67, 95%CI 1.90-11.51; p<0.001) and C4 (HR 2.42, 95%CI1.05-4.5.58; p=0.0385) were independent predictors of shorter TTR compared to C1, adding significant value beyond intrinsic subtypes (Likelihood ratio test, p=0.00429). Conclusions: Our results confirm that HER2-E, TP53 mutation, HRD and IM features are the main components driving poor early response to AI in ER+/HER2+ EBC. Novel molecular subgroups identify additional non-HER-E tumours not responding to AI with an increased risk of relapse. The appropriate additional treatment warrants further investigation.
List of significant gene expression signatures associated with response as defined by reduction of Ki67. Odds ratio (OR) were determined by ordinal logistic regression analyses. OR: <1 indicating associated with good response and > 1.0 associated with worse response.Odds Ratiop-valuep-adjusted (False Discovery Rate)ESR10.65< 0.001< 0.001Estrogen Receptor Signaling0.44< 0.001< 0.001ERBB21.52< 0.001< 0.001TP53 mutant signature2.65< 0.001< 0.001FOXA10.42< 0.001< 0.001Apoptosis0.26< 0.0010.00228Homologous Recombination Deficiency (HRD)2.33< 0.0010.00349PgR0.820.001480.00737Hypoxia2.180.001660.00737
Citation Format: Milana A Bergamino Sirvén, Elena López-Knowles, Gabriele Morani, Holly Tovey, Lucy Kilburn, Chris Holcombe, Anthony Skene, Ian Smith, John Robertson, Gene Schuster, Judith M Bliss, Mitch Dowsett, Maggie CU Cheang, POETIC investigators. HER2-enriched subtype and novel molecular subgroups drive aromatase inhibitor resistance and an increased risk of relapse in early ER+/HER2+ 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 PD15-02.
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Affiliation(s)
| | | | | | - Holly Tovey
- The Institute of Cancer Research, London, United Kingdom
| | - Lucy Kilburn
- The Institute of Cancer Research, London, United Kingdom
| | - Chris Holcombe
- Liverpool University Hospitals, Liverpool, United Kingdom
| | - Anthony Skene
- Birmingham's Women and Children, Birmingham, United Kingdom
| | - Ian Smith
- Royal Marsden Hospital, London, United Kingdom
| | - John Robertson
- The University of Nottingham, Nottingham, United Kingdom
| | - Gene Schuster
- The Institute of Cancer Research, London, United Kingdom
| | - Judith M Bliss
- The Institute of Cancer Research, London, United Kingdom
| | - Mitch Dowsett
- The Institute of Cancer Research, London, United Kingdom
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Jervoise N Andreyev H, Matthews J, Adams C, Gothard L, Lucy C, Tovey H, Boyle S, Anbalagan S, Musallam A, Yarnold J, Abraham D, Bliss J, Ahmed Abdi B, Taylor A, Hauer-Jensen M. Randomised single centre double-blind placebo controlled phase II trial of Tocovid SupraBio in combination with pentoxifylline in patients suffering long-term gastrointestinal adverse effects of radiotherapy for pelvic cancer: the PPALM study. Radiother Oncol 2022; 168:130-137. [DOI: 10.1016/j.radonc.2022.01.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 01/13/2022] [Accepted: 01/16/2022] [Indexed: 02/07/2023]
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Nicholson S, Tovey H, Elliott T, Burnett SM, Cruickshank C, Bahl A, Kirkbride P, Mitra AV, Thomson AH, Vasudev N, Venugopal B, Slade R, Tregellas L, Morgan B, Hassall A, Hall E, Pickering LM. VinCaP: a phase II trial of vinflunine in locally advanced and metastatic squamous carcinoma of the penis. Br J Cancer 2022; 126:34-41. [PMID: 34671131 PMCID: PMC8727613 DOI: 10.1038/s41416-021-01574-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 08/31/2021] [Accepted: 09/30/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We investigated the first-line activity of vinflunine in patients with penis cancer. Cisplatin-based combinations are commonly used, but survival is not prolonged; many patients are unfit for such treatment or experience toxicity that outweighs clinical benefit. METHODS Twenty-five patients with inoperable squamous carcinoma of the penis were recruited to a single-arm, Fleming-A'Hern exact phase II trial. Treatment comprised 4 cycles of vinflunine 320 mg/m2, given every 21 days. Primary endpoint was clinical benefit rate (CBR: objective responses plus stable disease) assessed after 4 cycles. Seven or more objective responses or disease stabilisations observed in 22 evaluable participants would exclude a CBR of <15%, with a true CBR of >40% being probable. RESULTS Twenty-two participants were evaluable. Ten objective responses or disease stabilisations were confirmed. CBR was 45.5%, meeting the primary endpoint; partial response rate was 27.3%. Seven patients received >4 cycles of vinflunine. Dose reduction or treatment delay was required for 20% of cycles. In all, 68% of patients experienced at least one grade 3 adverse event. Two deaths on treatment were not caused by disease progression. CONCLUSIONS Pre-specified clinical activity threshold was exceeded. Toxicity was in keeping with experience in other tumours. Vinflunine merits further study in this disease. TRIAL REGISTRATION NCT02057913.
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Affiliation(s)
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Tony Elliott
- The Christie Hospital NHS Foundation Trust, Manchester, UK
| | - Stephanie M Burnett
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Clare Cruickshank
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Anita V Mitra
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | | | | | - Rachel Slade
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Lucy Tregellas
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Bruno Morgan
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | | | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Lisa M Pickering
- St. Georges University Hospitals Foundation Trust and The Royal Marsden Foundation Trust, London, UK
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21
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Hijab A, Curcean S, Tunariu N, Tovey H, Alonzi R, Staffurth J, Blackledge M, Padhani A, Tree A, Stidwill H, Finch J, Chatfield P, Perry S, Mu Koh D, Hall E, Parker C. Fracture Risk in Men with Metastatic Prostate Cancer Treated With Radium-223. Clin Genitourin Cancer 2021; 19:e299-e305. [PMID: 33958296 PMCID: PMC8514085 DOI: 10.1016/j.clgc.2021.03.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 03/17/2021] [Accepted: 03/27/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Radium-223 is a bone-seeking, alpha-emitting radionuclide used in metastatic castration-resistant prostate cancer (mCRPC). Radium-223 increases the risk of fracture when used in combination with abiraterone and prednisolone. The risk of fracture in men receiving radium-223 monotherapy is unclear. PATIENTS AND METHODS This was a prospective, multicenter phase II study of radium-223 in 36 men with mCRPC and a reference cohort (n = 36) matched for fracture risk and not treated with radium-223. Bone fractures were assessed using whole-body magnetic resonance imaging. The primary outcome was risk of new fractures. RESULTS Thirty-six patients were treated with up to six 4-week cycles of radium-223. With a median follow-up of 16.3 months, 74 new fractures were identified in 20 patients. Freedom from fracture was 56% (95% confidence interval, 35.3-71.6) at 12 months. On multivariate analysis, prior corticosteroid use was associated with risk of fracture. In the reference cohort (n = 36), 16 new fractures were identified in 12 patients over a median follow-up of 24 months. Across both cohorts, 67% of all fractures occurred at uninvolved bone. CONCLUSIONS Men with mCRPC, and particularly those treated with radium-223, are at risk of fracture. They should receive a bone health agent to reduce the risk of fragility fractures.
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Affiliation(s)
- Adham Hijab
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | - Nina Tunariu
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Holly Tovey
- The Institute of Cancer Research, London, UK
| | | | | | | | - Anwar Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, Northwood, UK
| | - Alison Tree
- The Royal Marsden NHS Foundation Trust, London, UK
| | | | | | | | | | - Dow Mu Koh
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Emma Hall
- The Institute of Cancer Research, London, UK
| | - Chris Parker
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
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22
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Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Borley A, Schmidt M, Rautenberg B, Kunze CA, Rhein U, Mehta K, Mousa K, Dibble T, Lu XL, von Minckwitz G, Bliss JM. Effect of Celecoxib vs Placebo as Adjuvant Therapy on Disease-Free Survival Among Patients With Breast Cancer: The REACT Randomized Clinical Trial. JAMA Oncol 2021; 7:1291-1301. [PMID: 34264305 PMCID: PMC8283666 DOI: 10.1001/jamaoncol.2021.2193] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 02/04/2021] [Accepted: 04/26/2021] [Indexed: 01/04/2023]
Abstract
IMPORTANCE Patients with breast cancer remain at risk of relapse after adjuvant therapy. Celecoxib has shown antitumor effects in preclinical models of human breast cancer, but clinical evidence is lacking. OBJECTIVE To evaluate the role of celecoxib as an addition to conventional therapy for women with ERBB2 (formerly HER2)-negative primary breast cancer. DESIGN, SETTING, AND PARTICIPANTS The Randomized European Celecoxib Trial (REACT) was a phase 3, randomized, double-blind study conducted in 160 centers across the UK and Germany testing 2 years of adjuvant celecoxib vs placebo among 2639 patients recruited between January 19, 2007, and November 1, 2012, with follow-up 10 years after treatment completion. Eligible patients had completely resected breast cancer with local and systemic therapy according to local practice. Patients with ERBB2-positive or node-negative and T1, grade 1 tumors were not eligible. Randomization was in a 2:1 ratio between celecoxib or placebo. Statistical analysis was performed from May 5, 2019, to March 5, 2020. INTERVENTIONS Patients received celecoxib, 400 mg, or placebo once daily for 2 years. MAIN OUTCOMES AND MEASURES The primary end point was disease-free survival (DFS), analyzed in the intention-to-treat population using Cox proportional hazards regression and log-rank analysis. Follow-up is complete. RESULTS A total of 2639 patients (median age, 55.2 years [range, 26.8-86.0 years]) were recruited; 1763 received celecoxib, and 876 received placebo. Most patients' tumors (1930 [73%]) were estrogen receptor positive or progesterone receptor positive and ERBB2 negative. A total of 1265 patients (48%) had node-positive disease, and 1111 (42%) had grade 3 tumors. At a median follow-up of 74.3 months (interquartile range, 61.4-93.6 years), DFS events had been reported for 487 patients (19%): 18% for those who received celecoxib (n = 323; 5-year DFS rate = 84%) vs 19% for those who received placebo (n = 164; 5-year DFS rate = 83%); the unadjusted hazard ratio was 0.97 (95% CI, 0.80-1.17; log-rank P = .75). Rates of toxic effects were low across both treatment groups, with no evidence of a difference. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, patients showed no evidence of a DFS benefit for 2 years' treatment with celecoxib compared with placebo as adjuvant treatment of ERBB2-negative breast cancer. Longer-term treatment or use of a higher dose of celecoxib may lead to a DFS benefit, but further studies would be required to test this possibility. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02429427 and isrctn.org Identifier: ISRCTN48254013.
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Affiliation(s)
- R. Charles Coombes
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Digestion, Metabolism and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Lucy Kilburn
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Janine Mansi
- Guy’s and St Thomas’ National Health Service Foundation Trust and Biomedical Research Centre, King’s College, London, United Kingdom
| | - Carlo Palmieri
- University of Liverpool and Clatterbridge Cancer Centre, Liverpool, United Kingdom
| | - John Bartlett
- Ontario Institute for Cancer Research, Toronto, Ontario, Canada
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Jonathan Hicks
- National Health Service Lanarkshire, Lanarkshire, United Kingdom
| | | | - Abigail Evans
- Breast Unit, Poole Hospital National Health Service Foundation Trust, Poole, United Kingdom
| | | | - Carsten Denkert
- Charité University Hospital and German Cancer Consortium, Berlin, Germany
| | - Elisabeth Murray
- United Lincolnshire Hospitals National Health Service Trust, Lincolnshire, United Kingdom
| | - Robert Grieve
- University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, United Kingdom
| | | | | | | | | | | | - Uwe Rhein
- Stiftung Rehabilitation Heidelberg, Zentralkilikum Suhl GmbH, Suhl, Germany
| | | | - Kelly Mousa
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Digestion, Metabolism and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Tessa Dibble
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Digestion, Metabolism and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Xiao Lou Lu
- Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Department of Digestion, Metabolism and Reproduction, Faculty of Medicine, Imperial College London, London, United Kingdom
| | | | - Judith M. Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
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23
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Alataki A, Zabaglo L, Tovey H, Dodson A, Dowsett M. A simple digital image analysis system for automated Ki67 assessment in primary breast cancer. Histopathology 2021; 79:200-209. [PMID: 33590538 DOI: 10.1111/his.14355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 01/16/2021] [Accepted: 02/14/2021] [Indexed: 10/22/2022]
Abstract
AIMS Ki67 is a well-established immunohistochemical marker associated with cell proliferation that has prognostic and predictive value in breast cancer. Quantitative evaluation of Ki67 is traditionally performed by assessing stained tissue slides with light microscopy. Automated image analysis systems have become available and, if validated, could provide greater standardisation and improved precision of Ki67 scoring. Here, we aimed to evaluate the use of the Cognition Master Professional Suite (CogM) image analysis software, which is a simple system for scoring Ki67 in primary breast cancer samples. METHODS AND RESULTS Sections from 94 core-cut biopsies, 20 excision specimens and 29 pairs of core-cut biopsies and excision specimens were stained for Ki67 with MIB1 antibody and the Dako EnVision FLEX Detection System. Stained slides were scanned to convert them to digital data. Computer-based Ki67 scoring was performed with CogM. Manual Ki67 scoring assessment was conducted on previously stained sections from the same biopsies with a clinically validated system that had been calibrated against the risk of recurrence. A high correlation between manual and digital scores was observed [rCores = 0.92, 95% confidence interval (CI) 0.87-0.94, P < 0.0001; rExcisions = 0.95, 95% CI 0.86-0.98, P < 0.0001] and there was no significant bias between them (P = 0.45). There was also a high correlation of Ki67 scores between paired core-cut biopsies and excision specimens when CogM was used (r = 0.78, 95% CI 0.59-0.89, P < 0.0001). CONCLUSIONS CogM image analysis allows for standardised automated Ki67 scoring that accurately replicates previously clinically validated and calibrated manual scores.
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Affiliation(s)
- Anastasia Alataki
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK.,The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Lila Zabaglo
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK.,The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Andrew Dodson
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital and The Institute of Cancer Research, London, UK.,The Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
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24
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Serra Elizalde V, Llop-Guevara A, Pearson A, Cruz C, Castroviejo-Bermejo M, Chopra N, Tovey H, Toms C, Kriplani D, Gevensleben H, Roylance R, Chan S, Tutt A, Skene A, Evans A, Davies H, Bliss J, Nik-Zainal S, Balmaña J, Turner N. 1O Detection of homologous recombination repair deficiency (HRD) in treatment-naive early triple-negative breast cancer (TNBC) by RAD51 foci and comparison with DNA-based tests. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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25
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Sipos O, Tovey H, Quist J, Haider S, Nowinski S, Gazinska P, Kernaghan S, Toms C, Maguire S, Orr N, Linn SC, Owen J, Gillett C, Pinder SE, Bliss JM, Tutt A, Cheang MCU, Grigoriadis A. Assessment of structural chromosomal instability phenotypes as biomarkers of carboplatin response in triple negative breast cancer: the TNT trial. Ann Oncol 2021; 32:58-65. [PMID: 33098992 PMCID: PMC7784666 DOI: 10.1016/j.annonc.2020.10.475] [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] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/05/2020] [Accepted: 10/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In the TNT trial of triple negative breast cancer (NCT00532727), germline BRCA1/2 mutations were present in 28% of carboplatin responders. We assessed quantitative measures of structural chromosomal instability (CIN) to identify a wider patient subgroup within TNT with preferential benefit from carboplatin over docetaxel. PATIENTS AND METHODS Copy number aberrations (CNAs) were established from 135 formalin-fixed paraffin-embedded primary carcinomas using Illumina OmniExpress SNP-arrays. Seven published [allelic imbalanced CNA (AiCNA); allelic balanced CNA (AbCNA); copy number neutral loss of heterozygosity (CnLOH); number of telomeric allelic imbalances (NtAI); BRCA1-like status; percentage of genome altered (PGA); homologous recombination deficiency (HRD) scores] and two novel [Shannon diversity index (SI); high-level amplifications (HLAMP)] CIN-measurements were derived. HLAMP was defined based on the presence of at least one of the top 5% amplified cytobands located on 1q, 8q and 10p. Continuous CIN-measurements were divided into tertiles. All nine CIN-measurements were used to analyse objective response rate (ORR) and progression-free survival (PFS). RESULTS Patients with tumours without HLAMP had a numerically higher ORR and significantly longer PFS in the carboplatin (C) than in the docetaxel (D) arm [56% (C) versus 29% (D), PHLAMP,quiet = 0.085; PFS 6.1 months (C) versus 4.1 months (D), Pinteraction/HLAMP = 0.047]. In the carboplatin arm, patients with tumours showing intermediate telomeric NtAI and AiCNA had higher ORR [54% (C) versus 20% (D), PNtAI,intermediate = 0.03; 62% (C) versus 33% (D), PAiCNA,intermediate = 0.076]. Patients with high AiCNA and PGA had shorter PFS in the carboplatin arm [3.4 months (high) versus 5.7 months (low/intermediate); and 3.8 months (high) versus 5.6 months (low/intermediate), respectively; Pinteraction/AiCNA = 0.027, Padj.interaction/AiCNA = 0.125 and Pinteraction/PGA = 0.053, Padj.interaction/PGA = 0.176], whilst no difference was observed in the docetaxel arm. CONCLUSIONS Patients with tumours lacking HLAMP and demonstrating intermediate CIN-measurements formed a subgroup benefitting from carboplatin relative to docetaxel treatment within the TNT trial. This suggests a complex and paradoxical relationship between the extent of genomic instability in primary tumours and treatment response in the metastatic setting.
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Affiliation(s)
- O Sipos
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - H Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - J Quist
- Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - S Haider
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Nowinski
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - P Gazinska
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Kernaghan
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - C Toms
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - S Maguire
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - N Orr
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - S C Linn
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - J Owen
- King's Health Partners Cancer Biobank, London, UK
| | - C Gillett
- King's Health Partners Cancer Biobank, London, UK
| | - S E Pinder
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - J M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - A Tutt
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK; Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - M C U Cheang
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - A Grigoriadis
- Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK.
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26
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Banerjee S, Tovey H, Bowen R, Folkerd E, Kilburn L, McLachlan J, Hall M, Tunariu N, Attygalle A, Lima JPDSN, Perry S, Chatfield P, Hills M, Kaye S, Attard G, Dowsett M, Bliss JM. Abiraterone in patients with recurrent epithelial ovarian cancer: principal results of the phase II Cancer of the Ovary Abiraterone (CORAL) trial (CRUK - A16037). Ther Adv Med Oncol 2020; 12:1758835920975352. [PMID: 33854564 PMCID: PMC8013695 DOI: 10.1177/1758835920975352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/29/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Recurrent epithelial ovarian cancer (EOC) remains difficult to treat, with an urgent need for more therapy options. Androgens bind to the androgen receptor (AR), commonly expressed in EOC. CYP17 inhibitor abiraterone irreversibly inhibits androgen biosynthesis. The Cancer of the Ovary Abiraterone (CORAL) trial was designed to evaluate the clinical activity of abiraterone in EOC. PATIENTS & METHODS CORAL was a multi-centre, open-label, non-randomised, 2-stage phase II clinical trial. Eligible patients had progression within 12 months of last systemic therapy and no prior hormonal anti-cancer agents. Patients received abiraterone 1000 mg daily plus 5 mg prednisone until progression. The primary endpoint was objective response rate (ORR) according to combined Response Evaluation Criteria in Solid Tumours/Gynaecological Cancer Intergroup (RECIST/GCIG) criteria at 12 weeks. Secondary endpoints included clinical benefit rate (CBR) at 12 weeks. RESULTS A total of 42 patients were recruited; median age 65 (range 34-85) years; 37 (88.1%) had high-grade serous tumours; 20 (48%) had at least three prior lines of therapy; 29/40 (72.5%) were AR+. In stage 1, 1/26 response was observed (in an AR+, low-grade serous EOC); response lasted 47 weeks. Overall, 12 week ORR was 1/42 (2%), CBR was 11/42 (26%) (8/29 (28%) in AR+ patients). Disease control was ⩾6 months for 4/29 (14%). One patient (AR+, low-grade serous) had a RECIST response at 82 weeks. Four (10%) had grade ⩾3 hypokalaemia; 11 (26%) had dose delays. CONCLUSIONS CORAL represents the first trial of an AR targeted agent in ovarian cancer. While responses were rare, a subset of patients achieved sustained clinical benefit. Targeting AR in EOC including low-grade serous cancer warrants further investigation. TRIAL REGISTRATION CORAL is registered on the ISRCTN registry: ISRCTN63407050; http://www.isrctn.com/ISRCTN63407050.
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Affiliation(s)
- Susana Banerjee
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, Downs Road, Sutton, SM2 5PT, UK
- The Institute of Cancer Research, London, UK
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Rebecca Bowen
- Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | | | - Lucy Kilburn
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Jennifer McLachlan
- Department of Medical Oncology, Christchurch Hospital, Christchurch, New Zealand
| | - Marcia Hall
- Medical Oncology, Mount Vernon Cancer Centre, Northwood, UK
| | - Nina Tunariu
- Radiology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Ayoma Attygalle
- Histopathology, The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - Sophie Perry
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Peter Chatfield
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - Margaret Hills
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Stan Kaye
- Gynaecology Unit, The Royal Marsden NHS Foundation Trust, London, UK
| | - Gert Attard
- UCL Cancer Institute, University College London, London, UK
| | | | - Judith M. Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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27
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Chopra N, Tovey H, Pearson A, Cutts R, Toms C, Proszek P, Hubank M, Dowsett M, Dodson A, Daley F, Kriplani D, Gevensleben H, Davies HR, Degasperi A, Roylance R, Chan S, Tutt A, Skene A, Evans A, Bliss JM, Nik-Zainal S, Turner NC. Homologous recombination DNA repair deficiency and PARP inhibition activity in primary triple negative breast cancer. Nat Commun 2020; 11:2662. [PMID: 32471999 PMCID: PMC7260192 DOI: 10.1038/s41467-020-16142-7] [Citation(s) in RCA: 136] [Impact Index Per Article: 34.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 04/03/2020] [Indexed: 12/17/2022] Open
Abstract
Triple negative breast cancer (TNBC) encompasses molecularly different subgroups, with a subgroup harboring evidence of defective homologous recombination (HR) DNA repair. Here, within a phase 2 window clinical trial, RIO trial (EudraCT 2014-003319-12), we investigate the activity of PARP inhibitors in 43 patients with untreated TNBC. The primary end point, decreased Ki67, occured in 12% of TNBC. In secondary end point analyses, HR deficiency was identified in 69% of TNBC with the mutational-signature-based HRDetect assay. Cancers with HRDetect mutational signatures of HR deficiency had a functional defect in HR, assessed by impaired RAD51 foci formation on end of treatment biopsy. Following rucaparib treatment there was no association of Ki67 change with HR deficiency. In contrast, early circulating tumor DNA dynamics identified activity of rucaparib, with end of treatment ctDNA levels suppressed by rucaparib in mutation-signature HR-deficient cancers. In ad hoc analysis, rucaparib induced expression of interferon response genes in HR-deficient cancers. The majority of TNBCs have a defect in DNA repair, identifiable by mutational signature analysis, that may be targetable with PARP inhibitors.
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Affiliation(s)
- Neha Chopra
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, CB2 0XZ, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Alex Pearson
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, CB2 0XZ, United Kingdom
| | - Ros Cutts
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, CB2 0XZ, United Kingdom
| | - Christy Toms
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Paula Proszek
- The Centre for Molecular Pathology, The Royal Marsden Hospital, 15 Cotswold Road, Sutton, SM2 5NG, Surrey, United Kingdom
| | - Michael Hubank
- The Centre for Molecular Pathology, The Royal Marsden Hospital, 15 Cotswold Road, Sutton, SM2 5NG, Surrey, United Kingdom
| | - Mitch Dowsett
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, CB2 0XZ, United Kingdom
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, United Kingdom
| | - Andrew Dodson
- Ralph Lauren Centre for Breast Cancer Research, Royal Marsden Hospital, London, United Kingdom
| | - Frances Daley
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, CB2 0XZ, United Kingdom
| | - Divya Kriplani
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, CB2 0XZ, United Kingdom
| | - Heidi Gevensleben
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, CB2 0XZ, United Kingdom
| | - Helen Ruth Davies
- Department of Medical Genetics, The Clinical School, Box 238, Level 6 Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197, Cambridge Biomedical Campus, Cambridge, CB2 0XZ, United Kingdom
| | - Andrea Degasperi
- Department of Medical Genetics, The Clinical School, Box 238, Level 6 Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197, Cambridge Biomedical Campus, Cambridge, CB2 0XZ, United Kingdom
| | - Rebecca Roylance
- University College London Hospitals NHS Foundation Trust, NIHR University College London Hospitals Biomedical Research Centre, London, United Kingdom
| | - Stephen Chan
- Nottingham University Hospital Trust (City Campus), Nottingham, United Kingdom
| | - Andrew Tutt
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, CB2 0XZ, United Kingdom
- Breast Cancer Now Research Unit, Cancer Centre, Guy's Hospital, King's College London, London, United Kingdom
| | - Anthony Skene
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Abigail Evans
- Poole Hospital NHS Foundation Trust, Poole, United Kingdom
| | - Judith M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Serena Nik-Zainal
- Department of Medical Genetics, The Clinical School, Box 238, Level 6 Addenbrooke's Treatment Centre, Cambridge Biomedical Campus, Cambridge, CB2 0QQ, United Kingdom
- MRC Cancer Unit, Hutchison/MRC Research Centre, University of Cambridge, Box 197, Cambridge Biomedical Campus, Cambridge, CB2 0XZ, United Kingdom
| | - Nicholas C Turner
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, CB2 0XZ, United Kingdom.
- Breast Unit, The Royal Marsden Hospital, Fulham Road, London, United Kingdom.
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Tovey H, Parker JS, Hoadley KA, Kennedy RD, Sipos O, Kilburn L, Kernaghan S, Gazinska P, Haider S, Pinder SE, Bliss J, Perou CM, Grigoriadis A, Tutt A, Cheang MCU. Evaluation of DNA repair biology signatures to predict specific carboplatin (C) versus docetaxel (D) benefit in advanced triple-negative breast cancer (aTNBC). J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.1074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1074 Background: In the Triple Negative Trial we observed no improved response rate (RR) to C over D in aTNBC [Tutt et al, Nat Med 2018], but we did in BRCA1/2 mutated (mut) patients (pts). We hypothesise tumors with other aberrant DNA damage response (DDR) characteristics having higher RR to DNA damage inducing C than D. Methods: We tested the predictive value of DDR process related gene expression signatures (PARPi7, chromosomal instability CIN70, TP53 & DDR Deficiency (DDRD)) on 192 treatment naïve primary tumours (PT) by total RNA-sequencing. Odds ratio (OR) for RR are reported. Paired PT & recurrent (REC) signature scores were compared. Results: Unexpectedly, high DDRD and PARPi7 were associated with higher RR to D than C ( p =0.01 & 0.06). No effect was observed for CIN70 or TP53 signature. To assess whether the unexpected results were due to biological changes 12 PT-REC pairs were available from pts who received chemotherapy (CT) between PT & REC. CIN70 increased from PT to REC, DDRD (non-significantly) & PARPi7 decreased. 4/5 TP53 wildtype classified PT samples classified as mut in REC. The BRCA1/2 & DDRD-treatment interactions only held in pts who received CT before trial entry (table). The PARPi7-treatment interaction only held in CT naïve pts. In CT naïve pts, high CIN70 tumors suggested higher C RR as hypothesized. Restricted to the 149 PAM50 basal-like pts, results were non-significant but similar trends seen. Conclusions: In this trial of aTNBC, DDRD high pts with prior CT had better RR to D than C. A possible explanation for this unexpected result is selective pressure of adjuvant DNA damaging CT and selection for relative taxane sensitivity in those who recur despite a high DDRD score. The hypothesised CIN70 treatment interaction was observed in CT naïve pts. Our results suggest care is required in application of signatures to initial diagnostic material when predicting response to DNA damaging agents at REC particularly in pts with prior CT. [Table: see text]
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Affiliation(s)
- Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Joel S. Parker
- UNC Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Katherine A. Hoadley
- Lineberger Comprehensive Center, Department of Genetics, University of North Carolina, Chapel Hill, NC
| | | | - Orsolya Sipos
- The Breast Cancer Now Toby Robins Breast Cancer Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Lucy Kilburn
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom
| | - Sarah Kernaghan
- Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), London, United Kingdom
| | | | - Syed Haider
- The Institute of Cancer Research, London, United Kingdom
| | | | - Judith Bliss
- Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), London, United Kingdom
| | - Charles M. Perou
- The University of North Carolina at Chapel Hill, Chapel Hill, NC
| | | | - Andrew Tutt
- King's College London School of Medicine, London, United Kingdom
| | - Maggie Chon U Cheang
- Institute of Cancer Research Clinical Trials and Statistics Unit (ICR-CTSU), London, United Kingdom
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Kolinsky MP, Rescigno P, Bianchini D, Zafeiriou Z, Mehra N, Mateo J, Michalarea V, Riisnaes R, Crespo M, Figueiredo I, Miranda S, Nava Rodrigues D, Flohr P, Tunariu N, Banerji U, Ruddle R, Sharp A, Welti J, Lambros M, Carreira S, Raynaud FI, Swales KE, Plymate S, Luo J, Tovey H, Porta N, Slade R, Leonard L, Hall E, de Bono JS. A phase I dose-escalation study of enzalutamide in combination with the AKT inhibitor AZD5363 (capivasertib) in patients with metastatic castration-resistant prostate cancer. Ann Oncol 2020; 31:619-625. [PMID: 32205016 PMCID: PMC7217345 DOI: 10.1016/j.annonc.2020.01.074] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 01/16/2020] [Accepted: 01/29/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Activation of the PI3K/AKT/mTOR pathway through loss of phosphatase and tensin homolog (PTEN) occurs in approximately 50% of patients with metastatic castration-resistant prostate cancer (mCRPC). Recent evidence suggests that combined inhibition of the androgen receptor (AR) and AKT may be beneficial in mCRPC with PTEN loss. PATIENTS AND METHODS mCRPC patients who previously failed abiraterone and/or enzalutamide, received escalating doses of AZD5363 (capivasertib) starting at 320 mg twice daily (b.i.d.) given 4 days on and 3 days off, in combination with enzalutamide 160 mg daily. The co-primary endpoints were safety/tolerability and determining the maximum tolerated dose and recommended phase II dose; pharmacokinetics, antitumour activity, and exploratory biomarker analysis were also evaluated. RESULTS Sixteen patients were enrolled, 15 received study treatment and 13 were assessable for dose-limiting toxicities (DLTs). Patients were treated at 320, 400, and 480 mg b.i.d. dose levels of capivasertib. The recommended phase II dose identified for capivasertib was 400 mg b.i.d. with 1/6 patients experiencing a DLT (maculopapular rash) at this level. The most common grade ≥3 adverse events were hyperglycemia (26.7%) and rash (20%). Concomitant administration of enzalutamide significantly decreased plasma exposure of capivasertib, though this did not appear to impact pharmacodynamics. Three patients met the criteria for response (defined as prostate-specific antigen decline ≥50%, circulating tumour cell conversion, and/or radiological response). Responses were seen in patients with PTEN loss or activating mutations in AKT, low or absent AR-V7 expression, as well as those with an increase in phosphorylated extracellular signal-regulated kinase (pERK) in post-exposure samples. CONCLUSIONS The combination of capivasertib and enzalutamide is tolerable and has antitumour activity, with all responding patients harbouring aberrations in the PI3K/AKT/mTOR pathway. CLINICAL TRIAL NUMBER NCT02525068.
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Affiliation(s)
- M P Kolinsky
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK; Cross Cancer Institute, Edmonton, Canada
| | - P Rescigno
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK; Department of Clinical Medicine and Surgery, Department of Translational Medical Sciences, AOU Federico II, Naples, Italy
| | - D Bianchini
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Z Zafeiriou
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - N Mehra
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - J Mateo
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - V Michalarea
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - R Riisnaes
- The Institute of Cancer Research, London, UK
| | - M Crespo
- The Institute of Cancer Research, London, UK
| | | | - S Miranda
- The Institute of Cancer Research, London, UK
| | | | - P Flohr
- The Institute of Cancer Research, London, UK
| | - N Tunariu
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - U Banerji
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - R Ruddle
- The Institute of Cancer Research, London, UK
| | - A Sharp
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - J Welti
- The Institute of Cancer Research, London, UK
| | - M Lambros
- The Institute of Cancer Research, London, UK
| | - S Carreira
- The Institute of Cancer Research, London, UK
| | - F I Raynaud
- The Institute of Cancer Research, London, UK
| | - K E Swales
- The Institute of Cancer Research, London, UK
| | - S Plymate
- University of Washington School of Medicine, Seattle, USA
| | - J Luo
- Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, USA
| | - H Tovey
- The Institute of Cancer Research, London, UK
| | - N Porta
- The Institute of Cancer Research, London, UK
| | - R Slade
- The Institute of Cancer Research, London, UK
| | - L Leonard
- The Institute of Cancer Research, London, UK
| | - E Hall
- The Institute of Cancer Research, London, UK
| | - J S de Bono
- The Royal Marsden NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
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Tovey H, Cheang MCU. Identifying Biomarkers to Pair with Targeting Treatments within Triple Negative Breast Cancer for Improved Patient Stratification. Cancers (Basel) 2019; 11:E1864. [PMID: 31769425 PMCID: PMC6966447 DOI: 10.3390/cancers11121864] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 11/07/2019] [Accepted: 11/18/2019] [Indexed: 12/24/2022] Open
Abstract
The concept of precision medicine has been around for many years and recent advances in high-throughput sequencing techniques are enabling this to become reality. Within the field of breast cancer, a number of signatures have been developed to molecularly sub-classify tumours. Notable examples recently approved by National Institute for Health and Care Excellence in the UK to guide treatment decisions for oestrogen receptors (ER)+ human epidermal growth factor receptor 2 (HER2)- patients include Prosigna test, EndoPredict, and Oncotype DX. However, a population of still unmet need are those with triple negative breast cancer (TNBC). Accounting for 15-20% of patients, this population has comparatively poor prognosis and as yet no targeted treatment options. Studies have shown that some patients with TNBC respond favourably to DNA damaging drugs (carboplatin) or agents which inhibit DNA damage response (poly ADP ribose polymerase (PARP) inhibitors). Known to be a heterogeneous population, there is a need to identify further TNBC patients who may benefit from these treatments. A number of signatures have been identified based on association with treatment response or specific genetic features/pathways however many of these were not restricted to TNBC patients and as of yet are not common practice in the clinic.
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Affiliation(s)
- Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London SM2 5NG, UK
| | - Maggie Chon U. Cheang
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London SM2 5NG, UK
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31
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Garcia-Murillas I, Chopra N, Comino-Méndez I, Beaney M, Tovey H, Cutts RJ, Swift C, Kriplani D, Afentakis M, Hrebien S, Walsh-Crestani G, Barry P, Johnston SRD, Ring A, Bliss J, Russell S, Evans A, Skene A, Wheatley D, Dowsett M, Smith IE, Turner NC. Assessment of Molecular Relapse Detection in Early-Stage Breast Cancer. JAMA Oncol 2019; 5:1473-1478. [PMID: 31369045 PMCID: PMC6681568 DOI: 10.1001/jamaoncol.2019.1838] [Citation(s) in RCA: 198] [Impact Index Per Article: 39.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 04/08/2019] [Indexed: 01/04/2023]
Abstract
Importance Current treatment cures most cases of early-stage, primary breast cancer. However, better techniques are required to identify which patients are at risk of relapse. Objective To assess the clinical validity of molecular relapse detection with circulating tumor DNA (ctDNA) analysis in early-stage breast cancer. Design, Setting, and Participants This prospective, multicenter, sample collection, validation study conducted at 5 United Kingdom medical centers from November 24, 2011, to October 18, 2016, assessed patients with early-stage breast cancer irrespective of hormone receptor and ERBB2 (formerly HER2 or HER2/neu) status who were receiving neoadjuvant chemotherapy followed by surgery or surgery before adjuvant chemotherapy. The study recruited 170 women, with mutations identified in 101 patients forming the main cohort. Secondary analyses were conducted on a combined cohort of 144 patients, including 43 patients previously analyzed in a proof of principle study. Interventions Primary tumor was sequenced to identify somatic mutations, and personalized tumor-specific digital polymerase chain reaction assays were used to monitor these mutations in serial plasma samples taken every 3 months for the first year of follow-up and subsequently every 6 months. Main Outcomes and Measures The primary end point was relapse-free survival analyzed with Cox proportional hazards regression models. Results In the main cohort of 101 female patients (mean [SD] age, 54 [11] years) with a median follow-up of 35.5 months (interquartile range, 27.9-43.0 months), detection of ctDNA during follow-up was associated with relapse (hazard ratio, 25.2; 95% CI, 6.7-95.6; P < .001). Detection of ctDNA at diagnosis, before any treatment, was also associated with relapse-free survival (hazard ratio, 5.8; 95% CI, 1.2-27.1; P = .01). In the combined cohort, ctDNA detection had a median lead time of 10.7 months (95% CI, 8.1-19.1 months) compared with clinical relapse and was associated with relapse in all breast cancer subtypes. Distant extracranial metastatic relapse was detected by ctDNA in 22 of 23 patients (96%). Brain-only metastasis was less commonly detected by ctDNA (1 of 6 patients [17%]), suggesting relapse sites less readily detectable by ctDNA analysis. Conclusions and Relevance The findings suggest that detection of ctDNA during follow-up is associated with a high risk of future relapse of early-stage breast cancer. Prospective studies are needed to assess the potential of molecular relapse detection to guide adjuvant therapy.
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Affiliation(s)
- Isaac Garcia-Murillas
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Neha Chopra
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Iñaki Comino-Méndez
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Matthew Beaney
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Rosalind J. Cutts
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Claire Swift
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Divya Kriplani
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Maria Afentakis
- Ralph Lauren Centre for Breast Cancer Research, London, United Kingdom
| | - Sarah Hrebien
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Giselle Walsh-Crestani
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
| | - Peter Barry
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
| | | | - Alistair Ring
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
| | - Judith Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | | | - Anthony Skene
- Royal Bournemouth Hospital, Bournemouth, United Kingdom
| | - Duncan Wheatley
- Department of Oncology, Royal Cornwall Hospitals National Health Service Trust, Truro, United Kingdom
| | - Mitch Dowsett
- Ralph Lauren Centre for Breast Cancer Research, London, United Kingdom
| | - Ian E. Smith
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
| | - Nicholas C. Turner
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, United Kingdom
- Breast Unit, Royal Marsden Hospital, London, United Kingdom
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Alonzi R, Parker CC, Tunariu N, Koh DM, Staffurth J, Blackledge MD, Padhani AR, Tree A, Stidwill H, Finch J, Chatfield P, Perry S, Tovey H, Hall E. Fracture risk after radium-223 (Ra-223) in metastatic castration resistant prostate cancer (mCRPC). J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e16513] [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: 11/20/2022] Open
Abstract
e16513 Background: Ra-223 improves overall survival in patients with mCRPC, but is associated with increased risk of fracture when used in combination with abiraterone and prednisolone. We have assessed time to first new fracture in men with mCRPC receiving Ra-223 monotherapy, imaged using whole body MRI. Methods: In a prospective phase II study, patients with chemotherapy-naïve, bone mCRPC were randomised (1:1) to receive Ra-223 at 55 or 88 kBq/kg for 6 cycles, at 4-week intervals (REASURE; ISRCTN17805587). Whole body MRI was done at baseline, at cycles 2 and 4, and 1 month post-treatment. Subsequent imaging was done as clinically indicated. All scans were centrally reviewed to describe the time to first new fracture and characteristics of fractures. Time to new fracture was analysed using Kaplan Meier methods; comparisons of time to fracture between groups were based on log-rank tests. Results: 36 evaluable patients received a median of 6 cycles of Ra-223; scans were available for 35 patients. For these 35 patients, median age was 75 years (IQR: 73-80). 3 (9%) were receiving bone health agents at trial entry; 8 (23%) had received prior abiraterone or enzalutamide. 21 (60%) patients developed new fractures between randomisation and 2 years after completing treatment with radium-223. The spine was the most common location for fractures (14 patients). Median time to new fracture from randomisation was 10.8 months (95% CI: 6.2-18.2). Freedom from new fracture at 2 years post-randomisation was 21% (95% CI: 7 – 39%). Time to first new fracture was not associated with Ra-223 dose (55 kBq/kg: 10/18 patients experienced a fracture vs 88kBq/kg: 11/17; p = 0.93) or baseline use of bone health agents (3/3 vs 18/32; p = 0.09). Patients with Extent of Disease (EOD) ≥2 (defined as ≥6 metastatic sites/superscan) had earlier time to first new fracture compared to patients with EOD 1 (defined as < 6 metastatic sites) (11/18 vs 10/17; hazard ratio = 2.7, 95% confidence interval = 1.0 – 6.8; p = 0.04). Conclusions: New fractures are commonly seen on imaging in men with mCRPC during and after treatment with Ra-223 monotherapy. This observation supports treatment guidelines that recommend the use of bone health agents in men with mCRPC. Clinical trial information: ISRCTN17805587.
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Affiliation(s)
| | - Chris C. Parker
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Nina Tunariu
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Dow-Mu Koh
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | | | - Matthew D. Blackledge
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Anwar R. Padhani
- Paul Strickland Scanner Centre, Mount Vernon Cancer Centre, London, United Kingdom
| | - Alison Tree
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Helen Stidwill
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Jessica Finch
- Mount Vernon Cancer Centre, Northwood, United Kingdom
| | - Peter Chatfield
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Sophie Perry
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
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33
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Turner N, Garcia-Murillas I, Chopra N, Comino-Mendez I, Beaney M, Tovey H, Cutts R, Swift C, Kriplani D, Afentakis M, Hrebien S, Walsh G, Johnston S, Ring A, Russell S, Evans A, Skene A, Wheatley D, Dowsett M, Smith I. Abstract P4-01-01: Molecular residual disease detection with circulating tumor DNA analysis predicts relapse in patients with early stage breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p4-01-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Detection of circulating tumor DNA (ctDNA) after treatment of early stage breast cancer may identify molecular residual disease. In a prior proof-of-principle study we demonstrated that detection of ctDNA predicted relapse with high accuracy (Garcia-Murillas et al Science Trans Med 2015). We conducted an independent, prospective, multi-centre validation study.
Methods. In this validation study, a cohort of 170 early stage breast cancer patients were recruited from five hospitals into two prospective sample collection studies. Patients were scheduled to receive standard chemotherapy, surgery +/- radiotherapy, adjuvant endocrine therapy and HER2 antibodies as appropriate. Plasma samples were collected for ctDNA analysis at baseline, post-surgery, three monthly for the first year of follow-up, and six monthly thereafter and shipped to a central lab for processing. Using previously established criteria, tumor was sequenced to identify somatic mutations that were tracked by digital PCR in DNA extracted from 4mls of plasma at all available time points. Buffy coat DNA was analysed at all time-points to control for clonal haematopoesis of indeterminate potential (CHIP) detection. The primary endpoint was to compare invasive disease free survival between patients with and without detection of ctDNA after treatment. A combined analysis of this validation study, and the prior proof-of-principle study, was also conducted to analyse secondary endpoints.
Results. After tumor sequencing, 101 patients from the validation study had at least one mutation to track. At median 35.5 months follow-up, ctDNA was detected in plasma of 15.8% (16/101) patients. Detection of ctDNA strongly predicted relapse, hazard ratio 24.5 (95% CI 6.5 to 93.2, P<0.001 time-dependent Cox model), and was predictive of relapse in all tumor subtypes.
In the combined analysis (N=144), lead-time between ctDNA detection and relapse was 10.7 months (95% CI 7.7-17.0). Six patients had a clinical relapse that was not detected by ctDNA prior to relapse. These patients had a distinct pattern of oligo-metastatic relapse, 3 patients with brain-only metastases (P=0.0068), 1 ovarian oligo-metastasis and 2 local disease recurrence. The level of ctDNA in baseline plasma, prior to treatment, was associated with tumor subtype, highest in triple negative breast cancer (P=0.0036).
Conclusion. Detection of ctDNA after treatment is associated with a high risk of future relapse in early-stage breast cancer. Prospective studies are required to assess the potential of molecular residual disease detection to guide adjuvant therapy.
Citation Format: Turner N, Garcia-Murillas I, Chopra N, Comino-Mendez I, Beaney M, Tovey H, Cutts R, Swift C, Kriplani D, Afentakis M, Hrebien S, Walsh G, Johnston S, Ring A, Russell S, Evans A, Skene A, Wheatley D, Dowsett M, Smith I. Molecular residual disease detection with circulating tumor DNA analysis predicts relapse in patients with early stage breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P4-01-01.
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Affiliation(s)
- N Turner
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - I Garcia-Murillas
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - N Chopra
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - I Comino-Mendez
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - M Beaney
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - H Tovey
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - R Cutts
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - C Swift
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - D Kriplani
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - M Afentakis
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - S Hrebien
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - G Walsh
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - S Johnston
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - A Ring
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - S Russell
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - A Evans
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - A Skene
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - D Wheatley
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - M Dowsett
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
| | - I Smith
- The Institute of Cancer Research, Lomdon, United Kingdom; The Royal Marsden Hospital, London, United Kingdom; Hinchingbrooke Hospital, Hungtindon, United Kingdom; Poole General Hospital, Poole, United Kingdom; Royal Bournemouth Hospital, Bournemouth, United Kingdom; Royal Cornwall Hospitals NHS Trust, Truro, United Kingdom
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Sipos O, Tovey H, Quist J, Haider S, Nowinski S, Gazinska P, Kernaghan S, Toms C, Timms KM, Lanchbury JS, Linn SC, Pinder SE, Bliss JM, Tutt A, Cheang MC, Grigoriadis A. Abstract P1-06-07: Characterization of chromosomal instability in the TNT trial: A randomized phase III trial of carboplatin compared with docetaxel for patients with metastatic or recurrent locally advanced triple negative or BRCA1/2 breast cancer (CRUK/07/012). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-06-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
A distinctive trait of triple negative breast cancer (TNBC) is the acquisition of genome wide highly aberrant copy number states, which is more evident in metastatic settings. The level of copy number alterations can be characterized by quantitative estimates of chromosomal instability, such as allelic imbalanced copy number aberrations, telomeric allelic imbalance (NtAI), homologous recombination deficiency (HRD) score, referred here as genomic scars. Several of these scars are reported as being indicative of BRCAness and potential predictive and/or prognostic biomarkers of chemotherapy response, currently mostly demonstrated in neoadjuvant settings in TNBC.
Aims
Using several genomic scar measures, we aim to capture chromosomal instability and test their predictive and prognostic value in metastatic or recurrent locally advanced triple negative or BRCA1/2 mutated breast cancer in the TNT trial.
Methods
Patients recruited to TNT (n=376) had ER-/PR-/Her2- breast cancer or were germline BRCA mutation carriers. Genome-wide copy numbers (CN) were derived from FFPE samples including primary tumours and positive lymph nodes (n=183, docetaxel=93, carboplatin=90; BRCA1 mut=25). Genomic scars were generated using ASCAT (Van loo et al., PNAS 2010) CN profiles. HRD scores were established by Myriad Genetics, Inc. assay (n=272). BRCA1-like classifier was applied as described in Schouten et al., Mol Onc 2015. Shannon diversity index was calculated using ASCAT raw CN profiles. Association of genomic scars with PAM50 subtypes and BRCA1 deficiency status were evaluated using Kruskal-Wallis test; p-values were adjusted for multiple comparisons (Dunn's test). Statistical significance was defined as p<0.05. Association of genomic scars with objective tumour response rate (ORR) and Progression Free Survival (PFS) was assessed using logistic regression and restricted mean survival analysis, respectively.
Results
HRD and NtAI scores were higher in basal like samples compared to non-basal like (median diff. HRD=11.5, p=0.005; NtAI=3, p=0.04). HRD (p=2e-14) and NtAI (p=0.003) scores were also higher in BRCA1 deficient (BRCA1 germline/somatic mutant or BRCA1 methylated) samples compared to non-deficient. Using the BRCA1-like classifier, 42 out of 50 BRCA1 deficient samples and 93 out of 133 BRCA1 non-deficient/undetermined samples were identified as BRCA1-like. The Shannon diversity index, measuring CN heterogeneity, clustered samples into 3 groups. Analysis of ORR showed non-significant trends to preferential response rates with docetaxel in cluster 1 and 3. Membership of cluster 2 predicted higher ORR to carboplatin over docetaxel (interaction p=0.017). PFS indicated a treatment effect in cluster 2, but not in cluster 1 or 3; there was no evidence of interaction between subgroups and treatment (p=0.15).
Conclusions
Our results suggest that the overall heterogeneity of the copy number landscape is a promising area for seeking predictive/prognostic biomarkers in metastatic TNBC, and combined with other modalities of high-dimensional omics data could provide essential treatment response information.
Citation Format: Sipos O, Tovey H, Quist J, Haider S, Nowinski S, Gazinska P, Kernaghan S, Toms C, Timms KM, Lanchbury JS, Linn SC, Pinder SE, Bliss JM, Tutt A, Cheang MC, Grigoriadis A, On behalf of the TNT Trial Management Group and Investigators. Characterization of chromosomal instability in the TNT trial: A randomized phase III trial of carboplatin compared with docetaxel for patients with metastatic or recurrent locally advanced triple negative or BRCA1/2 breast cancer (CRUK/07/012) [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 P1-06-07.
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Affiliation(s)
- O Sipos
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - H Tovey
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - J Quist
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - S Haider
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - S Nowinski
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - P Gazinska
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - S Kernaghan
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - C Toms
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - KM Timms
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - JS Lanchbury
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - SC Linn
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - SE Pinder
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - JM Bliss
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - A Tutt
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - MC Cheang
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - A Grigoriadis
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
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Basu B, Krebs MG, Sundar R, Wilson RH, Spicer J, Jones R, Brada M, Talbot DC, Steele N, Ingles Garces AH, Brugger W, Harrington EA, Evans J, Hall E, Tovey H, de Oliveira FM, Carreira S, Swales K, Ruddle R, Raynaud FI, Purchase B, Dawes JC, Parmar M, Turner AJ, Tunariu N, Banerjee S, de Bono JS, Banerji U. Vistusertib (dual m-TORC1/2 inhibitor) in combination with paclitaxel in patients with high-grade serous ovarian and squamous non-small-cell lung cancer. Ann Oncol 2018; 29:1918-1925. [PMID: 30016392 PMCID: PMC6158767 DOI: 10.1093/annonc/mdy245] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Background We have previously shown that raised p-S6K levels correlate with resistance to chemotherapy in ovarian cancer. We hypothesised that inhibiting p-S6K signalling with the dual m-TORC1/2 inhibitor in patients receiving weekly paclitaxel could improve outcomes in such patients. Patients and methods In dose escalation, weekly paclitaxel (80 mg/m2) was given 6/7 weeks in combination with two intermittent schedules of vistusertib (dosing starting on the day of paclitaxel): schedule A, vistusertib dosed bd for 3 consecutive days per week (3/7 days) and schedule B, vistusertib dosed bd for 2 consecutive days per week (2/7 days). After establishing a recommended phase II dose (RP2D), expansion cohorts in high-grade serous ovarian cancer (HGSOC) and squamous non-small-cell lung cancer (sqNSCLC) were explored in 25 and 40 patients, respectively. Results The dose-escalation arms comprised 22 patients with advanced solid tumours. The dose-limiting toxicities were fatigue and mucositis in schedule A and rash in schedule B. On the basis of toxicity and pharmacokinetic (PK) and pharmacodynamic (PD) evaluations, the RP2D was established as 80 mg/m2 paclitaxel with 50 mg vistusertib bd 3/7 days for 6/7 weeks. In the HGSOC expansion, RECIST and GCIG CA125 response rates were 13/25 (52%) and 16/25 (64%), respectively, with median progression-free survival (mPFS) of 5.8 months (95% CI: 3.28-18.54). The RP2D was not well tolerated in the SqNSCLC expansion, but toxicities were manageable after the daily vistusertib dose was reduced to 25 mg bd for the following 23 patients. The RECIST response rate in this group was 8/23 (35%), and the mPFS was 5.8 months (95% CI: 2.76-21.25). Discussion In this phase I trial, we report a highly active and well-tolerated combination of vistusertib, administered as an intermittent schedule with weekly paclitaxel, in patients with HGSOC and SqNSCLC. Clinical trial registration ClinicialTrials.gov identifier: CNCT02193633.
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Affiliation(s)
- B Basu
- Department of Oncology, University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge
| | - M G Krebs
- Manchester Academic Health Science Centre, The University of Manchester and The Christie NHS Foundation Trust, Manchester
| | - R Sundar
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Department of Haematology-Oncology, National University Health System, Singapore
| | - R H Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast and Belfast City Hospital, Belfast
| | - J Spicer
- School of Cancer and Pharmaceutical Sciences, King's College London and Guy's and St Thomas' NHS Foundation Trust, London
| | - R Jones
- Cardiff University and Velindre Cancer Centre, Cardiff
| | - M Brada
- University of Liverpool and Clatterbridge Cancer Centre NHS Foundation Trust, Wirral
| | - D C Talbot
- Department of Oncology, Oxford University Hospitals NHS Foundation Trust, Oxford
| | - N Steele
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow
| | - A H Ingles Garces
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - W Brugger
- Oncology, IMED Biotech Unit AstraZeneca, Cambridge
| | | | - J Evans
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow
| | - E Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - H Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London
| | - F M de Oliveira
- Division of Clinical Studies, The Institute of Cancer Research, London
| | - S Carreira
- Division of Clinical Studies, The Institute of Cancer Research, London
| | - K Swales
- Division of Cancer Therapeutics, The Institute of Cancer Research, London
| | - R Ruddle
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, London
| | - F I Raynaud
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Division of Cancer Therapeutics, The Institute of Cancer Research, London
| | - B Purchase
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - J C Dawes
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - M Parmar
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - A J Turner
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - N Tunariu
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK
| | - S Banerjee
- Department of Gynae-Oncology, The Royal Marsden, London, UK
| | - J S de Bono
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London
| | - U Banerji
- Drug Development Unit, The Institute of Cancer Research and The Royal Marsden, London, UK; Division of Clinical Studies, The Institute of Cancer Research, London; Division of Cancer Therapeutics, The Institute of Cancer Research, London.
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Pickering LM, Tovey H, Elliott T, Burnett SM, Cruickshank C, Bahl A, Kirkbride P, Mitra A, Thomson AH, Vasudev N, Venugopal B, Slade R, Tregellas L, Morgan B, Hassall A, Hall E, Nicholson S. VinCaP: A phase II trial of vinflunine chemotherapy in locally-advanced and metastatic carcinoma of the penis (CRUK/12/021). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.4514] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [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)
- Lisa M. Pickering
- St. Georges University Hospitals Foundation Trust and The Royal Marsden Foundation Trust, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Tony Elliott
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Stephanie M. Burnett
- Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, United Kingdom
| | - Clare Cruickshank
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Peter Kirkbride
- Clatterbridge Cancer Centre, Wirral, Merseyside, United Kingdom
| | - Anita Mitra
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | | | - Rachel Slade
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Lucy Tregellas
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Bruno Morgan
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
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Pickering LM, Tovey H, Elliott T, Burnett SM, Bahl A, Kirkbride P, Mitra A, Thomson AH, Vasudev N, Slade R, Tregellas L, Morgan B, Hassall A, Hall E, Nicholson S. VinCaP: A phase II trial of vinflunine chemotherapy in locally-advanced and metastatic carcinoma of the penis (CRUK/12/021). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.6_suppl.547] [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: 11/20/2022] Open
Abstract
547 Background: Platinum-based combination chemotherapy regimens are used in the treatment of carcinoma of the penis, but toxicity limits their value for patients with metastatic disease. This trial aims to define both the toxicity and the rate of disease control for the non-platinum cytotoxic agent Vinflunine. Methods: A phase II single-arm trial was designed to demonstrate a clinical benefit rate of at least 40% and to exclude a rate of less than 15% (p0 = 0.15, p1 = 0.40, α = 0.05, β = 0.80, Fleming-A’hern exact design). 22 evaluable patients were required. Key eligibility criteria included measurable, histologically-proven squamous cell carcinoma of the penis staged as M1; or M0, Tx, N3; or M0, Tx, N2 and deemed inoperable by multidisciplinary team; or M0, T4 any N. Patients were required to have ECOG performance status of 0, 1 or 2 and adequate hepatic and renal function. Treatment comprised four 21-day cycles of vinflunine (320mg/m2) with RECIST v1.1 restaging following cycle 4 (response primary endpoint). Patients deemed to be benefitting from treatment were permitted to continue vinflunine at the discretion of the treating clinician until progression or unacceptable toxicity. Results: 25 patients were recruited from 8 UK centres between June 2014 and May 2017. Median age was 68 years; 19 patients had metastatic (M1) disease. All patients have completed trial treatment and primary endpoint assessment. Data cleaning for the primary analysis is currently in progress, with the snapshot for the primary analysis due in October 2017 and primary analysis to be presented to the trial oversight committees in November 2017. Conclusions: It is hoped that single-agent vinflunine will be associated with a favourable toxicity profile combined with meaningful clinical responses. The results will be available for presentation at the meeting. Clinical trial information: NCT02057913.
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Affiliation(s)
- Lisa M. Pickering
- St. Georges University Hospitals Foundation Trust and The Royal Marsden Foundation Trust, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Tony Elliott
- Christie Hospital NHS Foundation Trust, Manchester, United Kingdom
| | - Stephanie M. Burnett
- Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, United Kingdom
| | - Amit Bahl
- University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Peter Kirkbride
- Clatterbridge Cancer Centre, Wirral, Merseyside, United Kingdom
| | - Anita Mitra
- University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | | | | | - Rachel Slade
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Lucy Tregellas
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Bruno Morgan
- University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | | | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
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Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Schmidt M, Klare P, Rezai M, Rautenberg B, Klutinus N, Rhein U, Mousa K, Ricardo-Vitorino S, von Minckwitz G, Bliss J. Abstract GS3-03: A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib trial). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs3-03] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Inhibition of COX-2 has been shown to attenuate the metastatic process in pre-clinical models of human breast cancer (BC). The primary aim of this study was to assess the effect of 2 years adjuvant therapy with the COX-2 inhibitor celecoxib compared with placebo in HER2-ve primary BC patients.
Patients & Methods
Patients were randomised in a 2:1 ratio to receive celecoxib 400mg once daily or placebo for 2 years. Patients had to have completely resected BC with prior local and systemic adjuvant treatment according to local practice. Concurrent radiotherapy was permitted and hormone receptor +ve patients received endocrine therapy according to local practice. Patients with HER2+ or node negative, T1 and grade 1 disease were excluded. Median age of patients was 55 years (IQR: 49-63). 50% of patients had tumours >2cm; 42% were grade 3; 48% had node +ve disease. According to local assessment 73% were ER/PgR +ve. Primary endpoint was Disease Free Survival (DFS); defined as time from randomisation to date of first event, with events contributing to analysis defined as recurrence (distant/local), new primary BC (ipsilateral/contralateral) and death. Secondary endpoints included Overall Survival (OS), toxicity, cardiovascular mortality and incidence of second primaries. Subgroup analysis by hormone receptor status was pre-planned. Survival endpoints are analysed using Cox-proportional hazards and log-rank tests; restricted mean survival is used where proportional hazards do not hold.
Results
Between January 2007 and November 2012, 2639 patients were randomised (1763 celecoxib; 876 placebo) from 181 centres across the UK and Germany. At 13th April 2017, median follow up was 60 months (IQR: 48-72) with 428 DFS events reported. Unadjusted survival analysis results are presented below, with hazard ratio<1 favouring celecoxib:
5 year survival estimate (95% CI)Hazard ratio (95% CI)p-valueDFS (all patients) Celecoxib83% (81, 85)1.02 (0.83 – 1.24)0.88Placebo83% (80, 86)1- DFS within ER+ Celecoxib87% (85, 89)0.89 (0.69 – 1.16)0.40Placebo86% (83, 89)1- DFS within ER- Celecoxib72% (68, 76)1.17 (0.85 – 1.61)0.33Placebo75% (69, 80)1- OS (all patients) Celecoxib90% (88, 91)0.97 (0.75 – 1.25)0.81Placebo90% (88, 92)1-
The interaction between ER status and treatment was not significant; p=0.36.
In the celecoxib and placebo groups there were 17 and 8 deaths respectively in patients who had not relapsed. These were due to cardiac (n=3; 2) and other (n=14; 6) in the celecoxib and placebo groups respectively; none were GI related. In total 304 serious adverse events were observed in 265 patients (186/1763 celecoxib; 79/876 placebo). In the celecoxib and placebo groups respectively these were related to cardiac (n=12; 7), GI (n=9; 2) and other (n=193; 81). Work is ongoing to determine whether a subset of ER+ patients whose primary tumours show the characteristics of a COX-2 signature receive greater benefit from celecoxib.
Conclusions
There is no benefit of celecoxib in the ITT population. Further exploratory studies focussing on the ER+ subpopulation are ongoing. Celecoxib treatment is not associated with significant toxicity when compared to placebo in this population of BC patients.
Citation Format: Coombes RC, Tovey H, Kilburn L, Mansi J, Palmieri C, Bartlett J, Hicks J, Makris A, Evans A, Loibl S, Denkert C, Murray E, Grieve R, Coleman R, Schmidt M, Klare P, Rezai M, Rautenberg B, Klutinus N, Rhein U, Mousa K, Ricardo-Vitorino S, von Minckwitz G, Bliss J. A phase III multicentre double blind randomised trial of celecoxib versus placebo in primary breast cancer patients (REACT – Randomised EuropeAn celecoxib trial) [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 GS3-03.
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Affiliation(s)
- RC Coombes
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - H Tovey
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - L Kilburn
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Mansi
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - C Palmieri
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Bartlett
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Hicks
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - A Makris
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - A Evans
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - S Loibl
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - C Denkert
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - E Murray
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - R Grieve
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - R Coleman
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - M Schmidt
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - P Klare
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - M Rezai
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - B Rautenberg
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - N Klutinus
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - U Rhein
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - K Mousa
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - S Ricardo-Vitorino
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - G von Minckwitz
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
| | - J Bliss
- Imperial College London, UK; Institute of Cancer Research - Clinical Trials and Statistics Unit, UK; Guys' & St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, UK; University of Liverpool and Clatterbridge Cancer Centre, UK; Ontario Institute for Cancer Research, Toronto, Canada; NHS Lanarkshire, UK; Mount Vernon Cancer Centre, UK; Poole Hospital NHS Foundation Trust, UK; German Breast Group, Neu-Isenburg, Germany; Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany; United Lincolnshire Hospitals NHS Foundation Trust, UK; University Hospitals Coventry and Warwickshire NHS Trust, UK; University of Sheffield. Sheffield, UK; Praxisklinik Krebsheilkunde, Berlin, Germany; Luisenkrankenhaus Düsseldorf, Germany; Universitätsklinikum Freiburg, Germany; Klinikum Pforzheim GmbH, Germany; SRH Zentralklinikum Suhl GmbH, Germany; Universitatsmedizin Mainz, Germany
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Lim JSJ, Asghar US, Diamantis N, Ward SE, Parmar M, Purchase B, Raynaud FI, Swales KE, Hrebien S, Hall E, Tovey H, Bye H, Proszek P, Lopez JS, Turner AJ, De Bono JS, Banerji U, Yap TA, Turner NC. A phase I trial of selective PI3K inhibitor taselisib (tas) plus palbociclib (palb) with and without endocrine therapy incorporating pharmacodynamic (PD) studies in patients (pts) with advanced cancers. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2573] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2573 Background: The phosphatidylinositol 3-kinase (PI3K) pathway is commonly mutated in cancer. Tas is a selective β-isoform-sparing PI3K inhibitor with improved therapeutic index compared to pan-PI3K inhibitors. Palb is a CDK4/6 inhibitor now standard of care in combination with endocrine therapy (ET) in hormone receptor positive breast cancer. Combination of Tas, Palb and ET is synergistic in preclinical models. Methods: This investigator-initiated study investigated safety and tolerability, pharmacokinetics (PK), PD and antitumor activity of Tas+Palb, with addition of ET in dose expansion. Pts were enrolled in 3+3 dose escalation design. Tas was given continuously or 3-weeks-on, 1-week-off (3/1), Palb was given on 3/1 schedule. PD studies included analyses of platelet-rich plasma (PRP) (n = 20) and paired tumor biopsies (n = 5). Serial circulating tumor DNA was monitored in pts with PIK3CA mutations. Results: 24 pts were treated, 22 with Tas+Palb, 2 with Tas+Palb+fulvestrant(ful); M/F 11/13, median lines prior therapy 4. Treatment was well tolerated with mainly G1-2 toxicities. Most frequent G3 toxicities were neutropenia (5/24), thrombocytopenia (5/24) and rash (5/24), with no G4/5 toxicities. Two pts had dose-limiting toxicities (DLT) at DL2. No DLTs were observed at DL4, although pts experienced delayed neutrophil recovery. PK was linear and comparable with monotherapy. At 125mg Palb, significant decreases in pAKT and pGSK3β in PRP confirmed PI3K target inhibition. Two pts with PI3KCA H1047R mutant breast cancers have ongoing RECIST partial response; 1 pt with PIK3CA E542K colorectal cancer had stable disease for 20 weeks. Conclusions: Tas+Palb is well tolerated with evidence of PD and antitumor activity. Dose expansion including recruitment to triplet Tas+Palb+ful and Tas+Palb+letrozole is ongoing with continuous Tas 2mg QD, and Palb 100mg QD on 3/1 schedule, increasing to 125mg after cycle 1 in absence of myelosuppression. Clinical trial information: NCT02389842. [Table: see text]
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Affiliation(s)
| | | | | | | | - Mona Parmar
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Beth Purchase
- The Institute of Cancer Research, London, United Kingdom
| | - Florence I. Raynaud
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Karen E Swales
- The Institute of Cancer Research, London, United Kingdom
| | - Sarah Hrebien
- Royal Marsden Hospital, The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Hannah Bye
- Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Paula Proszek
- The Institute of Cancer Research, London, United Kingdom
| | | | | | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
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40
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Chenard-Poirier M, Kaiser M, Boyd K, Sriskandarajah P, Constantinidou A, Harris SJ, Serrano Fandos S, Ryan A, Witt K, Dawes JC, Parmar M, Turner AJ, Tovey H, Hall E, Perez Lopez R, Tunariu N, Lopez JS, De Bono JS, Banerji U. Results from the biomarker-driven basket trial of RO5126766 (CH5127566), a potent RAF/MEK inhibitor, in RAS- or RAF-mutated malignancies including multiple myeloma. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2506] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2506 Background: RO5126766 is a potent RAF and MEK inhibitor with activity in xenografts models of RAS and RAF-mutated cancers. We present data from the RAS/RAF-mutated advanced solid tumor cohort and the initial results for the multiple myeloma (MM) cohort. Methods: Patients with KRAS, NRAS or BRAF-mutant tumours were treated with RO5127566 using a novel schedule:4mg twice weekly in 4-week cycles. For MM patients, it was given 3 weeks out of 4 and co-administration of weekly dexamethasone was authorised. Response assessment was completed using RECIST 1.1 criteria for solid tumours and the International Myeloma Working Group (IMWG) criteria were used for MM. Results: A total of 20 patients with solid tumours (10 NSCLC, 5 gynaecological cancers and 5 miscellaneous cancers) and 1 MM patients were evaluable. Among the 10 KRAS-mutant NSCLC patients, tumour regression was seen in 6/10 (60 %), of which 3/10 (30 %) were partial responses. Two of these patients had maintained response for over 1 year and one patient is still on study after 30 cycles. Of the gynaecological cancers, 3/5 patients (60%) achieved a partial response ( KRAS-mutant endometrial and ovarian cancer and BRAF-mutant ovarian). Of these patients, 1 of the KRAS mutants had received 2 previous lines of MEK inhibitors and the BRAF mutant had previously received a BRAF inhibitor. In the miscellaneous group, 4 patients with colorectal cancer (2 BRAF and 2 NRAS) and 1 patient with NRAS-mutant melanoma were treated and none responded. Two patients with MM have been treated so far (1 KRAS, 1 KRAS+NRAS). The one evaluable patient has had an IMWG partial response (PR) after 1 cycle (FLC-λ from 324 mg/L to 161mg/L, ratio 0.03 to 0.08) without concomittant dexamethasone. This patient was previously treated with an immunomodulatory drug, a proteasome inhibitor and two ASCTs. Conclusions: RO5126766 has shown exciting preliminary activity across a wide range of RAS- and RAF-mutated malignancies, with significant response rates in lung and gynaecological cancers. To our knowledge, the PR seen in our MM patient represents one of the first responses to a single-agent RAF/MEK inhibitor in multiple myeloma in a trial context. Clinical trial information: NCT02407509.
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Affiliation(s)
| | - Martin Kaiser
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Kevin Boyd
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Priya Sriskandarajah
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | | | - Samuel John Harris
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Sonia Serrano Fandos
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Alison Ryan
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Karolina Witt
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Joanna C Dawes
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Mona Parmar
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Alison Joanne Turner
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Raquel Perez Lopez
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Nina Tunariu
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | | | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
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Sundar R, Basu B, Wilson RH, Spicer JF, Jones RH, Krebs M, Brada M, Talbot DC, Steele N, Hall E, Tovey H, Carreira S, de Oliveira FM, Swales KE, Balarajah G, Dawes JC, Parmar M, De Bono JS, Banerji U. TAX-TORC: A phase I trial of vistusertib (AZD2014) in combination with weekly paclitaxel with integrated pharmacodynamic (PD) and molecular characterization (MC) studies. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.15_suppl.2571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
2571 Background: In ovarian cells isolated from ascites, p-S6K levels were found to correlate with resistance to chemotherapy. We hypothesised that inhibiting p-S6K signalling with dual m-TORC1/2 inhibitor vistusertib (V) in addition to paclitaxel (P) would improve outcomes of patients with high-grade serous ovarian cancer (HGSOC). Methods: In the dose escalation part, weekly P 80mg/m2IV (6/7 weeks) was evaluated in combination with two schedules of V; Schedule A: V (25, 50 or 75mg) BID PO on day(D) 1-3/week and Schedule B: V (75 or 100mg) BID PO D1-2/week. This was followed by an expansion cohort in 25 HGSOC patients. Results: Dose limiting toxicities in Schedule A were fatigue and mucositis and in Schedule B were diarrhoea, rash and fatigue. The AUC, Cmax and half-life of V in the 50mg-cohort were 2821ng.hr/ml, 926ng/ml and 3hrs, comparable to single agent studies. PD analysis (from six 50mg-cohort patients) in platelet-rich plasma showed increased phosphorylation of Ser473 AKT following P induction (1.4 fold, p = 0.1378). Following addition of V to P, phosphorylation levels 4hrs post-treatment with V fell significantly to 53% of pre-dose levels (p = 0.0495). This was 61% lower than the corresponding time point following P alone. Based on toxicity, pharmacokinetic and PD evaluation, recommended phase 2 dose was established as P 80mg/m2 D1 and V 50mg BID D1-3 for 6/7 weeks. In the HGSOC expansion, 96% of patients had relapsed within 12 months of last platinum therapy and 100% had received previous paclitaxel, with a median of 3 previous lines of treatments. RECIST and GCIG CA125 response rates were 13/25 (52%) and 15/25 (60%) respectively, with median progression free survival of 5.5 months. MC was performed on archival tumor tissue of 24/25 HGSOC expansion cohort patients, with the most common mutations occurring in p53 (100%), BRCA (17%), and MUC16 (17%). ATM mutations occurred in 17% (n = 4), 3 of whom had a response. Conclusions: We report a highly active combination of paclitaxel with an intermittent schedule of vistusertib in patients with HGSOC. This combination is now being evaluated in a randomised controlled trial for this indication. Clinical trial information: NCT02193633.
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Affiliation(s)
- Raghav Sundar
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Bristi Basu
- University of Cambridge and Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Richard H. Wilson
- Centre for Cancer Research and Cell Biology, Queen's University Belfast, Belfast, United Kingdom
| | | | - Robert Hugh Jones
- Cardiff University and Velindre Cancer Centre, Cardiff, United Kingdom
| | - Matthew Krebs
- The Christie NHS Foundation Trust and The University of Manchester, Manchester, United Kingdom
| | | | | | - Nicola Steele
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
| | | | | | - Karen E Swales
- The Institute of Cancer Research, London, United Kingdom
| | | | - Joanna C Dawes
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Mona Parmar
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Johann S. De Bono
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
| | - Udai Banerji
- The Institute of Cancer Research and The Royal Marsden Hospital, London, United Kingdom
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Kolinsky MP, Rescigno P, Bianchini D, Zafeiriou Z, Mehra N, Mateo J, Riisnaes R, Crespo M, Figueiredo I, Flohr P, Tunariu N, Banerji U, Raynaud FI, Swales KE, Tovey H, Porta N, Slade R, Leonard L, Hall E, De Bono JS. A phase I dose-escalation study of enzalutamide in combination with the AKT inhibitor AZD5363 in patients with mCRPC. J Clin Oncol 2017. [DOI: 10.1200/jco.2017.35.6_suppl.135] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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
135 Background: Activation of the PI3K/AKT/mTOR pathway may contribute to resistance to androgen receptor targeted therapies in metastatic CRPC (mCRPC). The phase I/II RE-AKT trial (NCT02525068) investigates the safety and activity of enzalutamide (enza) in combination with the AKT inhibitor, AZD5363, in patients (pts) with mCRPC. Results of the phase I run-in are reported. Methods: mCRPC pts progressing after 1-2 lines of taxane chemotherapy and at least 12 weeks (wks) of abiraterone or enza were treated with enza (160mg od) and AZD5363 bid 4-days on, 3-days off, in a 3+3 dose escalation design. Co-primary endpoints were to assess toxicity (CTCAE), and identify the recommended phase II dose (RP2D) of AZD5363; antitumour activity and pharmacokinetics (PK) were secondary endpoints. Response was assessed by PSA, RECIST v1.1 and circulating tumor cell (CTC) conversion. Pts were considered evaluable for response if they completed 12 wks of treatment. Results: 16 pts were enrolled between 12/2014 & 04/2016 with 15 receiving treatment. At the AZD5363 320mg dose 3 pts were treated with no dose limiting toxicity (DLT). At the AZD5363 480mg dose, 5 pts were treated with 2 DLTs of grade (G) 3 maculopapular rash (MPR) related to AZD5363. An intermediate dose level of AZD5363 400mg was selected with 7 pts treated. 1 pt withdrew consent prior to completing the DLT window. 1 DLT of G3 MPR occurred and this dose was selected as the RP2D. Non-DLT treatment related (TR) G3/4 adverse events (AEs) were hyperglycaemia (n = 4, 26.7%), neutropenia (n = 1, 6.7%) & diarrhea (n = 1, 6.7%). All other TR AEs were G1 or G2, with diarrhea (n = 9, 60%), anorexia (n = 8, 53.3%) & nausea (n = 7, 46.7%) being most common. Of the 10 pts who completed 12 wks of treatment, 3 met at least one of the criteria for response. 1 pt (AZD5363 320mg) who had previously progressed on enza exhibited RECIST v1.1 partial response, > 50% PSA response, and CTC conversion by wk 13. Enza decreased AZD5363 PK exposure; robust modulation of pS6, pGSK3b and pPRAS40 was demonstrated. Conclusions: AZD5363 at the RP2D of 400mg bid 4 days on, 3 days off combined with enza 160mg od is safe and tolerable. Antitumor activity is reported, suggesting that AZD5363 may be able to overcome resistance to enza. Clinical trial information: NCT02525068.
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Affiliation(s)
- Michael Paul Kolinsky
- The Institute of Cancer Research, The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Pasquale Rescigno
- Institute of Cancer Research and The Royal Marsden NHS Trust Foundation, Sutton, United Kingdom
| | - Diletta Bianchini
- The Institute of Cancer Research & The Royal Marsden, London, United Kingdom
| | - Zafeiris Zafeiriou
- The Institute of Cancer Research & The Royal Marsden, London, United Kingdom
| | - Niven Mehra
- Institute of Cancer Research, London, United Kingdom
| | - Joaquin Mateo
- Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | - Ruth Riisnaes
- Cancer Biomarkers Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Mateus Crespo
- The Institute of Cancer Research and The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - Ines Figueiredo
- Cancer Biomarkers Laboratory, The Institute of Cancer Research, London, United Kingdom
| | - Penelope Flohr
- The Institute of Cancer Research & The Royal Marsden, London, United Kingdom
| | - Nina Tunariu
- Drug Development Unit, Royal Marsden Hospital and The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, Sutton, United Kingdom
| | - Florence I. Raynaud
- The Institute of Cancer Research and The Royal Marsden, London, United Kingdom
| | - Karen E Swales
- The Institute of Cancer Research, London, United Kingdom
| | - Holly Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Nuria Porta
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Rachel Slade
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Lorna Leonard
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, Sutton, United Kingdom
| | - Emma Hall
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, United Kingdom
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Krebs M, Spicer J, Steele N, Talbot D, Brada M, Wilson R, Jones R, Basu B, Dawes J, Parmar M, Purchase B, Turner A, Hall E, Tovey H, Banerji U, Yap T. P3.02c-003 TAX-TORC: The Novel Combination of Weekly Paclitaxel and the Dual mTORC1/2 Inhibitor AZD2014 for the Treatment of Squamous NSCLC. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2016.11.1798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Banerjee S, Kilburn L, Bowen R, Tovey H, Hall M, Kaye S, Rustin G, Gore M, McLachlan J, Attygalle A, Tunariu N, Lima J, Chatfield P, Jeffs L, Folkerd E, Hills M, Perry S, Attard G, Dowsett M, Bliss J. Principal results of the cancer of the ovary abiraterone trial (CORAL): A phase II study of abiraterone in patients with recurrent epithelial ovarian cancer (CRUKE/12/052). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw435.27] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Harris SJ, de Miguel Luken MJ, Roda Perez D, Perez Lopez R, Parmar M, Prathapan V, Hassam H, Turner AJ, Serrano Fandos S, Hall E, Tovey H, Tunariu N, Lopez JS, Yap TA, De Bono JS, Banerji U. Updated efficacy and safety results from the phase I study of intermittent dosing of the dual MEK/RAF inhibitor, RO5126766 in patients (pts) with RAS/RAF mutated advanced solid tumours. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.2582] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [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)
| | | | | | | | - Mona Parmar
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | - Hasina Hassam
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | | | - Emma Hall
- The Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, United Kingdom
| | - Holly Tovey
- The Institute of Cancer Research Clinical Trials and Statistics Unit, Sutton, United Kingdom
| | - Nina Tunariu
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
| | | | | | - Johann S. De Bono
- The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, United Kingdom
| | - Udai Banerji
- The Royal Marsden/Institute of Cancer Research, London, United Kingdom
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Tovey H, Bliss J, Tutt A, Morden J, Jarman K, Martin S, Kernaghan S, Toms C, Kilburn L. Managing non-proportionality of hazards (PH) within TNT: a randomised phase III trial of carboplatin compared to docetaxel for patients with metastatic or recurrent locally advanced triple negative (TN) or brca1/2 breast cancer (BC). Trials 2015. [PMCID: PMC4660070 DOI: 10.1186/1745-6215-16-s2-p150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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47
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Cheang MCU, Bliss J, Dowsett M, Kilburn L, Grigoriadis A, Gillett C, Pinder S, Gazinska P, Haynes B, Kernaghan S, Tovey H, Owen J, Harries M, Ellis PA, Tutt ANJ. Concordance of intrinsic subtyping and risk of recurrence (ROR) scores between matched primary and metastatic tissue from Triple Negative Breast Cancer Trial (TNT). J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.1019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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)
- Maggie Chon U Cheang
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom
| | - Judith Bliss
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom
| | - Mitch Dowsett
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
| | - Lucy Kilburn
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom
| | | | - Cheryl Gillett
- King's College London School of Medicine, London, United Kingdom
| | - Sarah Pinder
- King's College London School of Medicine, London, United Kingdom
| | - Patrycja Gazinska
- Breakthrough Breast Cancer Research Unit, Guys & St Thomas NHS Trust, Kings College London, London, United Kingdom
| | - Ben Haynes
- The Institute of Cancer Research, London, United Kingdom
| | - Sarah Kernaghan
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom
| | - Holly Tovey
- Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom
| | - Julie Owen
- King's College London School of Medicine, London, United Kingdom
| | - Mark Harries
- Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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Glendenning J, Barrington S, Tovey H, Parikh J, Dunn J, Tutt A. Repeatability evaluation of PET/CT imaging using [18F]fluorothymidine (FLT) and [18F]fluorodeoxyglucose (FDG) in primary triple negative breast cancer (TNBC). Ann Oncol 2015. [DOI: 10.1093/annonc/mdv119.02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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