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Turner NC, Swift C, Jenkins B, Kilburn L, Coakley M, Beaney M, Fox L, Goddard K, Garcia-Murillas I, Proszek P, Hall P, Harper-Wynne C, Hickish T, Kernaghan S, Macpherson IR, Okines AFC, Palmieri C, Perry S, Randle K, Snowdon C, Stobart H, Wardley AM, Wheatley D, Waters S, Winter MC, Hubank M, Allen SD, Bliss JM. Results of the c-TRAK TN trial: a clinical trial utilising ctDNA mutation tracking to detect molecular residual disease and trigger intervention in patients with moderate- and high-risk early-stage triple-negative breast cancer. Ann Oncol 2023; 34:200-211. [PMID: 36423745 DOI: 10.1016/j.annonc.2022.11.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Post-treatment detection of circulating tumour DNA (ctDNA) in early-stage triple-negative breast cancer (TNBC) patients predicts high risk of relapse. c-TRAK TN assessed the utility of prospective ctDNA surveillance in TNBC and the activity of pembrolizumab in patients with ctDNA detected [ctDNA positive (ctDNA+)]. PATIENTS AND METHODS c-TRAK TN, a multicentre phase II trial, with integrated prospective ctDNA surveillance by digital PCR, enrolled patients with early-stage TNBC and residual disease following neoadjuvant chemotherapy, or stage II/III with adjuvant chemotherapy. ctDNA surveillance comprised three-monthly blood sampling to 12 months (18 months if samples were missed due to coronavirus disease), and ctDNA+ patients were randomised 2 : 1 to intervention : observation. ctDNA results were blinded unless patients were allocated to intervention, when staging scans were done and those free of recurrence were offered pembrolizumab. A protocol amendment (16 September 2020) closed the observation group; all subsequent ctDNA+ patients were allocated to intervention. Co-primary endpoints were (i) ctDNA detection rate and (ii) sustained ctDNA clearance rate on pembrolizumab (NCT03145961). RESULTS Two hundred and eight patients registered between 30 January 2018 and 06 December 2019, 185 had tumour sequenced, 171 (92.4%) had trackable mutations, and 161 entered ctDNA surveillance. Rate of ctDNA detection by 12 months was 27.3% (44/161, 95% confidence interval 20.6% to 34.9%). Seven patients relapsed without prior ctDNA detection. Forty-five patients entered the therapeutic component (intervention n = 31; observation n = 14; one observation patient was re-allocated to intervention following protocol amendment). Of patients allocated to intervention, 72% (23/32) had metastases on staging at the time of ctDNA+, and 4 patients declined pembrolizumab. Of the five patients who commenced pembrolizumab, none achieved sustained ctDNA clearance. CONCLUSIONS c-TRAK TN is the first prospective study to assess whether ctDNA assays have clinical utility in guiding therapy in TNBC. Patients had a high rate of metastatic disease on ctDNA detection. Findings have implications for future trial design, emphasising the importance of commencing ctDNA testing early, with more sensitive and/or frequent ctDNA testing regimes.
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Affiliation(s)
- N C Turner
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK; Breast Unit, The Royal Marsden Hospital, London, UK.
| | - C Swift
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - B Jenkins
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - L Kilburn
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - M Coakley
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - M Beaney
- The Institute of Cancer Research, London, UK
| | - L Fox
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - K Goddard
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - P Proszek
- NIHR Centre for Molecular Pathology, Royal Marsden Hospital, London, UK
| | - P Hall
- University of Edinburgh, Edinburgh, UK
| | - C Harper-Wynne
- Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - T Hickish
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - S Kernaghan
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - A F C Okines
- Breast Unit, The Royal Marsden Hospital, London, UK
| | - C Palmieri
- Clatterbridge Cancer Centre NHS Trust, Liverpool, Wirral, UK
| | - S Perry
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - K Randle
- Independent Cancer Patients' Voice, London, UK
| | - C Snowdon
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - H Stobart
- Independent Cancer Patients' Voice, London, UK
| | - A M Wardley
- Outreach Research & Innovation Group Ltd, Manchester, UK
| | - D Wheatley
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - S Waters
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, UK
| | - M C Winter
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - M Hubank
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - S D Allen
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - J M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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Coombes RC, Badman PD, Lozano-Kuehne JP, Liu X, Macpherson IR, Zubairi I, Baird RD, Rosenfeld N, Garcia-Corbacho J, Cresti N, Plummer R, Armstrong A, Allerton R, Landers D, Nicholas H, McLellan L, Lim A, Mouliere F, Pardo OE, Ferguson V, Seckl MJ. Author Correction: Results of the phase IIa RADICAL trial of the FGFR inhibitor AZD4547 in endocrine resistant breast cancer. Nat Commun 2023; 14:260. [PMID: 36650166 PMCID: PMC9845345 DOI: 10.1038/s41467-023-35969-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Affiliation(s)
- R C Coombes
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - P D Badman
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - J P Lozano-Kuehne
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - X Liu
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - I R Macpherson
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - I Zubairi
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R D Baird
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - N Rosenfeld
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - J Garcia-Corbacho
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - N Cresti
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - R Plummer
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - A Armstrong
- Breast Research Office, The Christie NHS Foundation Trust, Christie Hospital, Manchester, UK
| | - R Allerton
- C8 Admin Offices, Russell's Hall Hospital, Russells Hall, UK
| | | | - H Nicholas
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - L McLellan
- ECMC Programme Office, Research and Innovation, Cancer Research UK, London, UK
| | - A Lim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - F Mouliere
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - O E Pardo
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - V Ferguson
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M J Seckl
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Coombes RC, Badman PD, Lozano-Kuehne JP, Liu X, Macpherson IR, Zubairi I, Baird RD, Rosenfeld N, Garcia-Corbacho J, Cresti N, Plummer R, Armstrong A, Allerton R, Landers D, Nicholas H, McLellan L, Lim A, Mouliere F, Pardo OE, Ferguson V, Seckl MJ. Results of the phase IIa RADICAL trial of the FGFR inhibitor AZD4547 in endocrine resistant breast cancer. Nat Commun 2022; 13:3246. [PMID: 35688802 PMCID: PMC9187670 DOI: 10.1038/s41467-022-30666-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [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: 09/21/2021] [Accepted: 05/12/2022] [Indexed: 01/21/2023] Open
Abstract
We conducted a phase IIa, multi-centre, open label, single arm study (RADICAL; NCT01791985) of AZD4547 (a potent and selective inhibitor of Fibroblast Growth Factor Receptor (FGFR)-1, 2 and 3 receptor tyrosine kinases) administered with anastrozole or letrozole in estrogen receptor positive metastatic breast cancer patients who had become resistant to aromatase inhibitors. After a safety run-in study to assess safety and tolerability, we recruited 52 patients. The primary endpoint was change in tumour size at 12 weeks, and secondary endpoints were to assess response at 6 weeks, 20 weeks and every 8 weeks thereafter and tolerability of the combined treatment. Two partial responses (PR) and 19 stable disease (SD) patients were observed at the 12-week time point. At 28 weeks, according to centrally reviewed Response Evaluation Criteria in Solid Tumours (RECIST) criteria, five PR and 8 SD patients were observed in 50 assessable cases. Overall, objective response rate (5 PR) was of 10%, meeting the pre-specified endpoint. Fourteen patients discontinued due to adverse events. Eleven patients had retinal pigment epithelial detachments which was asymptomatic and reversible in all but one patient. Exploratory ribonucleic acid sequencing (RNA-Seq) analysis was done on patients' samples: 6 differentially-expressed-genes could distinguish those who benefited from the addition of AZD4547.
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Affiliation(s)
- R C Coombes
- Department of Surgery and Cancer, Imperial College London, London, UK.
| | - P D Badman
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - J P Lozano-Kuehne
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - X Liu
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - I R Macpherson
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - I Zubairi
- Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - R D Baird
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - N Rosenfeld
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - J Garcia-Corbacho
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
| | - N Cresti
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - R Plummer
- Sir Bobby Robson Cancer Trials Research Centre, Northern Centre for Cancer Care, Freeman Hospital, Newcastle, UK
| | - A Armstrong
- Breast Research Office, The Christie NHS Foundation Trust, Christie Hospital, Manchester, UK
| | - R Allerton
- C8 Admin Offices, Russell's Hall Hospital, Russells Hall, UK
| | | | - H Nicholas
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - L McLellan
- ECMC Programme Office, Research and Innovation, Cancer Research UK, London, UK
| | - A Lim
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - F Mouliere
- Medical Oncology, Addenbrooke's Hospital, Breast Cancer Research Unit, Cancer Research UK Cambridge Centre, Cambridge, UK
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Pathology, Cancer Centre Amsterdam, Amsterdam, The Netherlands
| | - O E Pardo
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - V Ferguson
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M J Seckl
- Department of Surgery and Cancer, Imperial College London, London, UK.
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Palmieri C, Macpherson IR. A review of the evidence base for utilizing Child-Pugh criteria for guiding dosing of anticancer drugs in patients with cancer and liver impairment. ESMO Open 2021; 6:100162. [PMID: 34098229 PMCID: PMC8190488 DOI: 10.1016/j.esmoop.2021.100162] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Revised: 04/12/2021] [Accepted: 05/05/2021] [Indexed: 12/24/2022] Open
Abstract
As the liver is vital for the metabolism of many anticancer drugs, determining the correct starting doses in cancer patients with liver impairment is key to safe prescription and prevention of unnecessary adverse effects. Clinicians typically use liver function tests when evaluating patients; however, prescribing information and summaries of product characteristics often suggest dosing of anticancer drugs in patients with liver impairment based on the Child-Pugh criteria, even though the criteria were not developed for this purpose. In this review, we assessed all the oncological small molecule and cytotoxic drugs approved by the United States Food and Drug Administration (FDA) over a 5-year period from 2014 to 2018. The various entry criteria related to these drugs—with respect to hepatic function—in key pivotal studies were compared with their approved dosing recommendations found in prescribing information and summaries of product characteristics. We found that 46% of drugs have dosing recommendations based on Child-Pugh criteria alone, despite the fact that only 8% of these drugs were tested within studies that used the Child-Pugh criteria as entry criteria. Moreover, we note that the data used to make recommendations based on Child-Pugh criteria are typically from small studies that may lack an appropriate patient population. We propose that these findings, along with details surrounding the development of the Child-Pugh criteria, call into question the validity and appropriateness of using Child-Pugh criteria for dosing recommendations of anticancer drugs. Dosing information for anticancer drugs in patients with liver impairment is often based on the Child-Pugh criteria. Clinical trials and clinicians typically use liver function tests when evaluating patients. Of the 39 oncologic drugs examined, almost half (46%) had dosing recommendations based on Child-Pugh criteria alone. We question whether using Child-Pugh criteria for dosing recommendations of anticancer drugs is the best approach.
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Affiliation(s)
- C Palmieri
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, UK; Academic Department of Medical Oncology, The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK.
| | - I R Macpherson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
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5
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Tzolos E, Adamson PD, Hall PS, Macpherson IR, Oikonomidou O, MacLean M, Lewis SC, McVicars H, Newby DE, Mills NL, Lang NN, Henriksen PA. Dynamic Changes in High-Sensitivity Cardiac Troponin I in Response to Anthracycline-Based Chemotherapy. Clin Oncol (R Coll Radiol) 2019; 32:292-297. [PMID: 31813662 PMCID: PMC7139216 DOI: 10.1016/j.clon.2019.11.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 10/22/2019] [Accepted: 11/04/2019] [Indexed: 10/25/2022]
Abstract
AIMS Treatment advances have improved cancer-related outcomes and shifted interest towards minimising long-term iatrogenic complications, particularly chemotherapy-related cardiotoxicity. High-sensitivity cardiac troponin I (hs-cTnI) assays accurately quantify very low concentrations of plasma troponin and enable early detection of cardiomyocyte injury prior to the development of myocardial dysfunction. The profile of hs-cTnI in response to anthracycline-based treatment has not previously been described. MATERIALS AND METHODS This was a multicentre prospective observational cohort study. Female patients with newly diagnosed invasive breast cancer scheduled to receive anthracycline-based (epirubicin) chemotherapy were recruited. Blood sampling was carried out before and 24 h after each cycle. Hs-cTnI concentrations were measured using the Abbott ARCHITECTSTAT assay. RESULTS We recruited 78 women with a median (interquartile range) age of 52 (49-61) years. The median baseline troponin concentration was 1 (1-4) ng/l and the median cumulative epirubicin dose was 394 (300-405) mg/m2. Following an initial 33% fall 24 h after anthracycline dosing (P < 0.001), hs-cTnI concentrations increased by a median of 50% (P < 0.001) with each successive treatment cycle. In total, 45 patients had troponin measured immediately before the sixth treatment cycle, 21 (46.6%) of whom had hs-cTnI concentrations ≥16 ng/l, indicating myocardial injury. Plasma hs-cTnI concentrations before the second treatment cycle were a strong predictor of subsequent myocardial injury. CONCLUSIONS Cardiotoxicity arising from anthracycline therapy is detectable in the earliest stages of breast cancer treatment and is cumulative with each treatment cycle. This injury is most reliably determined from blood sampling carried out before rather than after each treatment cycle.
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Affiliation(s)
- E Tzolos
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK.
| | - P D Adamson
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK; Christchurch Heart Institute, University of Otago, Christchurch, New Zealand
| | - P S Hall
- Cancer Research UK, Edinburgh Centre, MRC Institute Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - I R Macpherson
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - O Oikonomidou
- Cancer Research UK, Edinburgh Centre, MRC Institute Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - M MacLean
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK
| | - S C Lewis
- Edinburgh Clinical Trials Unit, University of Edinburgh, Edinburgh, UK; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - H McVicars
- Cancer Research UK, Edinburgh Centre, MRC Institute Genetics and Molecular Medicine, University of Edinburgh, Edinburgh, UK
| | - D E Newby
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
| | - N L Mills
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK; Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK
| | - N N Lang
- Department of Cardiology, Queen Elizabeth University Hospital, Glasgow, UK
| | - P A Henriksen
- BHF Centre for Cardiovascular Sciences, University of Edinburgh, Edinburgh, UK
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6
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Stein RC, Hughes-Davies L, Makris A, Macpherson IR, Conefrey C, Rooshenas L, Pinder SE, Thomas J, Hall PS, Cameron DA, Earl HM, Naume B, Poole CJ, Rea DW, MacIntosh SA, Harmer V, Morgan A, Hulme C, McCabe C, Stallard N, Higgins H, Donovan JL, Bartlett JM, Marshall A, Dunn JA. Abstract OT1-05-02: OPTIMA: A prospective randomized trial to validate the clinical utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in high clinical risk early breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-05-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Multi-parameter tumour gene expression assays (MPAs) are widely used to estimate individual patient residual risk and to guide chemotherapy use in hormone-sensitive, HER2-negative early breast cancer. The TAILORx trial supports MPA use in a node-negative population. Evidence for MPA use in node-positive breast cancer is limited. OPTIMA (Optimal Personalised Treatment of early breast cancer usIng Multi-parameter Analysis) (ISRCTN42400492) aims to validate MPAs as predictors of chemotherapy sensitivity in a largely node-positive breast cancer population where prospective RCT (Randomised Controlled Trial) evidence is lacking.
Methods: OPTIMA is a partially blinded multi-center RCT with an adaptive two-stage design. The main eligibility criteria are women and men age 40 or older with resected ER-positive, HER2-negative invasive breast cancer and up to 9 involved axillary lymph nodes. Randomisation is to standard management (chemotherapy and endocrine therapy) or to MPA-directed treatment using the Prosigna (PAM50) test. Those with a Prosigna tumour score (ROR_PT) >60 receive standard management whilst those with a low score (≤60) are treated with endocrine therapy alone. Endocrine therapy for pre-menopausal women includes ovarian suppression. The co-primary outcomes are (1) Invasive Disease Free Survival (IDFS) and (2) cost-effectiveness of test-directed treatment. Secondary outcomes include IDFS in patients with low-score tumours and quality of life. An integrated qualitative recruitment study addresses challenges to consent and recruitment and will build on experience from the feasibility study that a multidisciplinary approach at sites is important for recruitment success. Tumour blocks will be banked to allow evaluation of additional MPA technologies. Recruitment of 4500 patients over 5 years will permit demonstration of 3% non-inferiority of test-directed treatment, assuming 5-year IDFS of 85% with standard management, equivalent to a HR of 1.22. Inclusion of patients from the feasibility study will increase the power to test for non-inferiority.
Results: The OPTIMA main trial opened in January 2017. Overall recruitment (including the feasibility study) will reach 1000 in August 2018. Recruitment in Norway will commence in July 2018. Characteristics of the OPTIMA main participants recruited to 31st May 2018 are shown in the table.
Main study patient characteristicsCharacteristic %Median age in years (range)57 (40-80) Menopause statusPre34 Post66 Male1Tumour size<30mm58 >=30mm42Node statuspN04 pN1mi(sn)7 pN1(sn)20 pN155 pN214Historic grade16 258 336
Conclusion: OPTIMA is one of two large scale prospective trials validating the use of test-guided chemotherapy decisions in node-positive early breast cancer. It is expected to have a global impact on breast cancer treatment. Experience from the preliminary study and close engagement with centres will aid trial success.
Funding: OPTIMA is funded by the UK NIHR HTA Programme (10/34/501). Views expressed are those of the authors and not those of the HTA Programme, NIHR, NHS or the DoH.
Citation Format: Stein RC, Hughes-Davies L, Makris A, Macpherson IR, Conefrey C, Rooshenas L, Pinder SE, Thomas J, Hall PS, Cameron DA, Earl HM, Naume B, Poole CJ, Rea DW, MacIntosh SA, Harmer V, Morgan A, Hulme C, McCabe C, Stallard N, Higgins H, Donovan JL, Bartlett JM, Marshall A, Dunn JA. OPTIMA: A prospective randomized trial to validate the clinical utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in high clinical risk early 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 OT1-05-02.
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Affiliation(s)
- RC Stein
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - L Hughes-Davies
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - A Makris
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - IR Macpherson
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - C Conefrey
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - L Rooshenas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - SE Pinder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - J Thomas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - PS Hall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - DA Cameron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - HM Earl
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - B Naume
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - CJ Poole
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - DW Rea
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - SA MacIntosh
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - V Harmer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - A Morgan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - C Hulme
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - C McCabe
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - N Stallard
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - H Higgins
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - JL Donovan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - JM Bartlett
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - A Marshall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
| | - JA Dunn
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Mount Vernon Cancer Centre, Northwood, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; University of Bristol, Bristol, United Kingdom; Kings College London, London, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; Oslo University Hospital HF, Radiumhospitalet, Postboks 4953 Nydalen, Oslo, Norway; University Hosptial Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; In
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Copson E, Shaaban AM, Maishman T, Moseley PM, McKenzie H, Bradbury J, Borley A, Brzezinska M, Chan SYT, Ching J, Cutress RI, Danial I, Dall B, Kerin M, Lowery AJ, Macpherson IR, Romics L, Sawyer E, Sharmat N, Sircar T, Vidya R, Pan Y, Rea D, Jones L, Eccles DM, Berditchevski F. The presentation, management and outcome of inflammatory breast cancer cases in the UK: Data from a multi-centre retrospective review. Breast 2018; 42:133-141. [PMID: 30278369 DOI: 10.1016/j.breast.2018.09.003] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2018] [Revised: 08/22/2018] [Accepted: 09/10/2018] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES Inflammatory Breast cancer (IBC) is a rare but aggressive form of breast cancer. Its incidence and behaviour in the UK is poorly characterised. We collected retrospective data from hospitals in the UK and Ireland to describe the presentation, pathology, treatment and clinical course of IBC in the UK. MATERIALS AND METHODS Patients with IBC diagnosed between 1997-2014 at fourteen UK and Irish hospitals were identified from local breast unit databases. Patient characteristics, tumour pathology and stage, and details of surgical, systemic and radiotherapy treatment and follow-up data were collected from electronic patient records and medical notes. RESULT This retrospective review identified 445 patients with IBC accounting for 0.4-1.8% of invasive breast cancer cases. Median follow-up was 4.2 years. 53.2% of tumours were grade 3, 56.2% were oestrogen receptor positive, 31.3% were HER2 positive and 25.1% were triple negative. 20.7% of patients had distant metastases at presentation. Despite trimodality treatment in 86.4%, 40.1% of stage III patients developed distant metastases. Five-year overall survival (OS) was 61.0% for stage III and 21.4% for stage IV patients. CONCLUSIONS This is the largest series of UK IBC patients reported to date. It indicates a lower incidence than in American series, but confirms that IBC has a high risk of recurrence with poor survival despite contemporary multi-modality therapy. A national strategy is required to facilitate translational research into this aggressive disease.
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Affiliation(s)
- E Copson
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK.
| | - A M Shaaban
- Department of Histopathology and University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B152GW, UK
| | - T Maishman
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - P M Moseley
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - H McKenzie
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - J Bradbury
- Department of Oncology, Salisbury NHS Foundation Trust, Salisbury District Hospital, Odstock Road, Salisbury, Wiltshire, SP2 8BJ, UK
| | - A Borley
- Velindre Cancer Centre, Whitchurch, Cardiff, CF14 2TL, UK
| | - M Brzezinska
- Edinburgh Breast Unit, Western General Hospital, Edinburgh, Crewe Road South Edinburgh, EH4 2XU, UK
| | - S Y T Chan
- Clinical Oncology Department, Nottingham University Hospitals NHS Trust, Nottingham, NG5 1PB, UK
| | - J Ching
- Poole Hospital NHS Foundation Trust, Longfleet Road, Poole, BH15 2JB, UK
| | - R I Cutress
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - I Danial
- Department of Histopathology and University of Birmingham, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Mindelsohn Way, Edgbaston, Birmingham, B152GW, UK
| | - B Dall
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Leeds Teaching Hospitals NHS Trust, Becket Street, Leeds, LS9 7TF, UK
| | - M Kerin
- The Lambe Institute for Translational Research, National University of Ireland & University Hospital Galway, Galway, Ireland
| | - A J Lowery
- The Lambe Institute for Translational Research, National University of Ireland & University Hospital Galway, Galway, Ireland
| | - I R Macpherson
- Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1QH, UK
| | - L Romics
- Wolfson Wohl Cancer Research Centre, University of Glasgow, Glasgow, G61 1QH, UK
| | - E Sawyer
- Research Oncology, Division of Cancer Studies, Guy's Hospital, King's College London, London, SE1 9RT, UK
| | - N Sharmat
- Breast Unit, Level 1 Chancellor Wing, St James Hospital, Leeds Teaching Hospitals NHS Trust, Becket Street, Leeds, LS9 7TF, UK
| | - T Sircar
- Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - R Vidya
- Royal Wolverhampton NHS Trust, New Cross Hospital, Wolverhampton Road, Wolverhampton, WV10 0QP, UK
| | - Y Pan
- Centre for Computational Biology, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK; Institute of Immunology and Immunotherapy, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - D Rea
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - L Jones
- Barts NHS Trust and Barts Cancer Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, EC1M 6BQ, UK
| | - D M Eccles
- Cancer Sciences Academic Unit and Southampton Clinical Trials Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, UK
| | - F Berditchevski
- Institute of Cancer and Genomic Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Stein RC, Makris A, Hughes-Davies L, Macpherson IR, Hall PS, Cameron DA, Earl HM, Pinder SE, Poole CJ, Rea DW, McIntosh S, Harmer V, Morgan A, Rooshenas L, Conefrey C, Donovan JL, Hulme C, McCabe C, Stallard N, Campbell A, Higgins H, Bartlett JMS, Marshall A, Dunn JA. Abstract OT1-06-01: OPTIMA: A prospective randomized trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in early breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-06-01] [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: Multi-parameter gene expression assays (MPAs) are widely used to estimate individual patient residual risk in hormone-sensitive HER2-negative node-negative early breast cancer, allowing patients with low risk to safely avoid chemotherapy. Evidence for MPA use in node-positive breast cancer is limited. OPTIMA (Optimal Personalised Treatment of early breast cancer usIng Multi-parameter Analysis) aims to validate MPA's as predictors of chemotherapy sensitivity in a largely node-positive breast cancer population.
Methods: OPTIMA is a partially blinded multi-center, phase 3 randomized controlled trial with an adaptive two-stage design. The main eligibility criteria are women or men aged 40 or older with resected ER-positive, HER2-negative breast cancer and up to 9 involved axillary lymph nodes. Randomization is to standard management (chemotherapy and endocrine therapy) or to MPA-directed treatment. Those with a “high risk” tumor MPA score receive standard management whilst those at “low risk” are treated with endocrine therapy alone. The preliminary phase (OPTIMA prelim) evaluated the performance of several MPAs to select a test to be used in the main efficacy trial based on economic analysis, and assessed the feasibility and acceptability of a large UK trial. OPTIMA prelim used Oncotype DX as the primary discriminator; the main trial will use Prosigna (PAM50) with Prosigna Score ≤60 defined as “low-risk”. The co-primary outcomes are (1) Invasive Disease Free Survival (IDFS) and (2) cost-effectiveness of test-directed therapy. Secondary outcomes include IDFS in “low-risk” patients, quality of life and additional survival measures. An integrated qualitative recruitment study will identify and address challenges to recruitment and informed consent. Tumor blocks from all consenting participants will be banked allowing the performance of alternative MPA technologies to be evaluated. Recruitment of 4500 patients will permit demonstration of 3% non-inferiority of test-directed treatment, with 5% significance and 85% power, assuming 3 years follow-up and a control arm 5-year IDFS of at least 85%. The addition of patients from OPTIMA prelim will allow non-inferiority to be assessed with 2.5% significance.
Results: OPTIMA-prelim recruited 412 patients in 23 months from 35 sites with a 47% acceptance rate. The main study opened in January 2017. Early progress indicates that the recruitment target is achievable in the intended 46-month timescale through the participation of >100 sites
Conclusion: OPTIMA, as one of two large scale prospective trials validating the use of test-guided chemotherapy decisions in node-positive early breast cancer, is expected to have a global impact on breast cancer treatment. Experience from OPTIMA prelim showed that patient advocate support and close engagement with sites will aid trial success.
Funding: The project is funded in the UK by the NIHR HTA Programme (10/34/501). Views expressed are those of the authors and not those of the HTA Programme, NIHR, NHS or the DoH.
Citation Format: Stein RC, Makris A, Hughes-Davies L, Macpherson IR, Hall PS, Cameron DA, Earl HM, Pinder SE, Poole CJ, Rea DW, McIntosh S, Harmer V, Morgan A, Rooshenas L, Conefrey C, Donovan JL, Hulme C, McCabe C, Stallard N, Campbell A, Higgins H, Bartlett JMS, Marshall A, Dunn JA. OPTIMA: A prospective randomized trial to validate the predictive utility and cost-effectiveness of gene expression test-directed chemotherapy decisions in early breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-06-01.
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Affiliation(s)
- RC Stein
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Makris
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - L Hughes-Davies
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - IR Macpherson
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - PS Hall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - DA Cameron
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - HM Earl
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - SE Pinder
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - CJ Poole
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - DW Rea
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - S McIntosh
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - V Harmer
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Morgan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - L Rooshenas
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - C Conefrey
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - JL Donovan
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - C Hulme
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - C McCabe
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - N Stallard
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Campbell
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - H Higgins
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - JMS Bartlett
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - A Marshall
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
| | - JA Dunn
- National Institute for Health Research University College London Hospitals Biomedical Research Centre, London, United Kingdom; Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, Northwood, United Kingdom; Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; Institute of Cancer Sciences, University of Glasgow, Glasgow, United Kingdom; Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, United Kingdom; University of Cambridge and NIHR Cambridge Biomedical Research Centre, Cambridge, United Kingdom; King's College London, London, United Kingdom; University Hospitals Coventry and Warwickshire NHS Trust, Coventry, United Kingdom; Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, United Kingdom; Queen's University Belfast, Belfast, United Kingdom; Imperial College Healthcare NHS Trust, London, United Kingdom; Independent Cancer Patients' Voice, United Kingdom; University of Bristol, Bristol, United K
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Macpherson IR, Dornier E, Rabas N, Rainero E, Norman JC. Abstract P6-01-06: Glutamine metabolism drives breast cancer invasion by providing a source of extracellular glutamate to activate the GRM3 metabotropic glutamate receptor. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-01-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Glutamine metabolism is well-established to contribute to cancer cell growth and proliferation by providing a source of nitrogen for nucleotide and amino acid biosynthesis as well as TCA cycle intermediates. There is also accumulating evidence that glutamine metabolism may contribute to metastasis although mechanistic links to tumour cell migration and invasion remain unclear. We have generated a number of highly invasive primary cell lines from the polyoma middle-T genetically engineered mouse model of breast cancer (MMTV-PyMT) and found that withdrawal of glutamine from these cells reduces not only their proliferation, but also their invasive migration into 'stroma-like' preparations of fibroblast-derived extracellular matrix. Our metabolomic analyses indicate that invasive MMTV-PyMT cells actively secrete glutamate, a product of glutamine metabolism, into the extracellular milieu. Moreover, addition of glutamate is sufficient to restore invasiveness (but not cell growth or proliferation) to glutamine-starved MMTV-PyMT cells. We have pursued these findings by investigating the role played by plasma membrane receptors for glutamate in cell migration and invasion in PyMT cells and in MDA-MB-231 triple negative breast cancer cells. We provide evidence that glutamate generated within the cell by deamidation of glutamine leaves the cell via the xCT antiporter to activate the GRM3 metabotropic glutamate receptor at the cell surface. This, in turn, suppresses adenylate cyclase activity to prevent protein kinase A activation and to drive an invasive programme. Indeed, knocking out GRM3 with CRISPR technology or inhibition using a selective GRM3 antagonist (LY341495) is sufficient to oppose invasiveness without compromising proliferation. Conversely, a specific GRM3 agonist (LY354740) drives invasiveness without increasing proliferation. Consistently, treatment with LY341495 was sufficient to abrogate lung colonisation following tail vein injection whilst tumour growth after orthotopic injection was unaffected. Our results provide a mechanistic link between glutamine metabolism and invasion and identify GRM3 as a potential therapeutic target in breast cancer.
Citation Format: Macpherson IR, Dornier E, Rabas N, Rainero E, Norman JC. Glutamine metabolism drives breast cancer invasion by providing a source of extracellular glutamate to activate the GRM3 metabotropic glutamate receptor [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P6-01-06.
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Affiliation(s)
- IR Macpherson
- University of Glasgow, Glasgow, United Kingdom; CRUK Beatson Institute, Glasgow, United Kingdom; University of Sheffield, Sheffield, United Kingdom
| | - E Dornier
- University of Glasgow, Glasgow, United Kingdom; CRUK Beatson Institute, Glasgow, United Kingdom; University of Sheffield, Sheffield, United Kingdom
| | - N Rabas
- University of Glasgow, Glasgow, United Kingdom; CRUK Beatson Institute, Glasgow, United Kingdom; University of Sheffield, Sheffield, United Kingdom
| | - E Rainero
- University of Glasgow, Glasgow, United Kingdom; CRUK Beatson Institute, Glasgow, United Kingdom; University of Sheffield, Sheffield, United Kingdom
| | - JC Norman
- University of Glasgow, Glasgow, United Kingdom; CRUK Beatson Institute, Glasgow, United Kingdom; University of Sheffield, Sheffield, United Kingdom
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Marshall-McKenna R, Morrison A, Stirling L, Hutchison C, Rice AM, Hewitt C, Paul L, Rodger M, Macpherson IR, McCartney E. A randomised trial of the cool pad pillow topper versus standard care for sleep disturbance and hot flushes in women on endocrine therapy for breast cancer. Support Care Cancer 2016; 24:1821-9. [PMID: 26446702 DOI: 10.1007/s00520-015-2967-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 01/21/2015] [Accepted: 09/28/2015] [Indexed: 01/15/2023]
Abstract
PURPOSE Quality of life in women receiving adjuvant endocrine therapy for breast cancer (BC) may be impaired by hot flushes and night sweats. The cool pad pillow topper (CPPT) is a commercial product, promoted to improve quality of sleep disrupted by hot flushes. This study aimed to identify if the CPPT reduces severity of sleep disturbance by minimising effects of hot flushes. METHODS This randomised phase II trial, recruited women with BC, on adjuvant endocrine therapy, experiencing hot flushes and insomnia. Participants were randomised (stratified by baseline sleep efficiency score (SES) and menopausal status) to the intervention arm (CPPT + standard care) or control arm (standard care). Participants completed Hospital Anxiety and Depression Scale and Functional Assessment of Cancer Therapy-Breast (FACT-B) questionnaires and fortnightly sleep/hot flush diaries (where responses were averaged over 2-week periods). The primary endpoint was change in average SES from -2 to 0 weeks to 2 to 4 weeks. RESULTS Seventy-four pre- (68.9 %) and post-menopausal (31.1 %) women were recruited. Median age was 49.5 years. Endocrine therapies included tamoxifen (93.2 %). Median SES at weeks 2 to 4 improved in both arms but the increase on the intervention arm was almost twice that on the control arm (p = 0.024). There were significantly greater reductions in hot flushes and HADS depression in the intervention arm (p = 0.09 and p = 0.036, respectively). There were no significant differences in FACT-B or HADS anxiety. CONCLUSION This study supports the use of the CPPT as an aid to reduce sleep disturbance and the frequency/severity of hot flushes.
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Affiliation(s)
- R Marshall-McKenna
- Nursing & Health Care School, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK.
| | - A Morrison
- The Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - L Stirling
- The Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - C Hutchison
- The Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - A M Rice
- Nursing & Health Care School, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK
| | - C Hewitt
- The Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - L Paul
- Nursing & Health Care School, University of Glasgow, 59 Oakfield Avenue, Glasgow, G12 8LL, UK
| | - M Rodger
- CRUK CTU Glasgow, Institute of Cancer Sciences, The Beatson West of Scotland Cancer Centre, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - I R Macpherson
- The Beatson West of Scotland Cancer Centre, Gartnavel General Hospital, 1053 Great Western Road, Glasgow, G12 0YN, UK
| | - E McCartney
- CRUK CTU Glasgow, Institute of Cancer Sciences, The Beatson West of Scotland Cancer Centre, University of Glasgow, 1053 Great Western Road, Glasgow, G12 0YN, UK
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Macpherson IR, Dozynkiewicz M, Kalna G, Speirs C, Chaudhary S, Edwards J, Timpson P, Norman J. Abstract P1-05-13: CLIC3 is associated with invasive behaviour and poorer prognosis in estrogen receptor-negative breast cancer. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p1-05-13] [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: We previously described a Chloride Intracellular Channel-3 (CLIC3)-dependent recycling pathway which trafficked active integrins from late endosomes to the cell surface and which was required for the migratory and invasive behaviour of A2780 ovarian cancer cells in vitro. We also demonstrated that elevated expression of CLIC3 was associated with poor prognosis in pancreatic cancer. We therefore set out to investigate the role of CLIC3 in breast cancer.
Materials and Methods: CLIC3 expression was assessed by immunohistochemistry and the weighted histoscore method in a tissue microarray (TMA) consisting of triplicate cores from 141 patients diagnosed with invasive estrogen receptor (ER)-negative early breast carcinoma between 1995 and 1998. Full clinicopathological and follow-up data were available. Further data were obtained from publicly available gene expression datasets (Desmedt, GSE7390) and Oncomine™. Knockdown of CLIC3 in the ER-ve MDA-MB231 breast cancer cell line was achieved by nucleofection of 2 different siRNA sequences (Dharmacon). Inverse invasion assays measured invasion into a plug of matrigel supplemented with fibronectin over 72 hours whilst organotypic invasion assays measured invasion into a fibroblast-containing collagen matrix over 6 days.
Results: CLIC3 mRNA expression was significantly elevated in breast cancer in comparison to normal breast tissue in two independent data sets. High CLIC3 protein levels were associated with significantly shorter breast cancer specific survival (p = 0.026) in a TMA of 141 ER-ve patients. This finding was corroborated by the observation that high CLIC3 mRNA levels were associated with shorter overall survival in 198 patients in the Desmedt dataset (p = 0.038). Transient silencing of CLIC3 expression using two independent siRNA sequences had no effect on proliferation of MDA-MB231 cells but significantly reduced their invasiveness by 46% and 93% respectively in an inverse invasion assay and by 36% and 42% respectively in an organotypic invasion assay. CLIC3 was found to co-localise with Rab7 and LAMP1 in late endosomes/lysosomes in MDA-MB231 cells.
Conclusions: Our clinical and in vitro data indicate an important role for CLIC3 in the invasive and metastatic behaviour of some breast cancers. Further work to elucidate molecular mechanisms is underway and will be presented.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P1-05-13.
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Affiliation(s)
- IR Macpherson
- University of Glasgow, United Kingdom; Beatson Institute for Cancer Research, Glasgow, United Kingdom
| | - M Dozynkiewicz
- University of Glasgow, United Kingdom; Beatson Institute for Cancer Research, Glasgow, United Kingdom
| | - G Kalna
- University of Glasgow, United Kingdom; Beatson Institute for Cancer Research, Glasgow, United Kingdom
| | - C Speirs
- University of Glasgow, United Kingdom; Beatson Institute for Cancer Research, Glasgow, United Kingdom
| | - S Chaudhary
- University of Glasgow, United Kingdom; Beatson Institute for Cancer Research, Glasgow, United Kingdom
| | - J Edwards
- University of Glasgow, United Kingdom; Beatson Institute for Cancer Research, Glasgow, United Kingdom
| | - P Timpson
- University of Glasgow, United Kingdom; Beatson Institute for Cancer Research, Glasgow, United Kingdom
| | - J Norman
- University of Glasgow, United Kingdom; Beatson Institute for Cancer Research, Glasgow, United Kingdom
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Macpherson IR, Poondru S, Simon GR, Gedrich R, Brock K, Hopkins CA, Stewart K, Stephens A, Evans TRJ. A phase 1 study of OSI-930 in combination with erlotinib in patients with advanced solid tumours. Eur J Cancer 2012; 49:782-9. [PMID: 23099006 DOI: 10.1016/j.ejca.2012.09.036] [Citation(s) in RCA: 4] [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] [Received: 08/10/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
AIM To determine the maximum tolerated dose (MTD) of OSI-930 that can be combined with erlotinib, and establish recommended phase 2 doses when both agents are administered daily in patients with advanced solid tumours. PATIENTS AND METHODS Eligible patients with advanced solid tumours were enrolled into this standard "three+three" dose escalation study. Study treatment commenced on day 1 with OSI-930, and erlotinib was introduced on day 8. PK profiles of OSI-930, erlotinib and its active metabolite, OSI-420, were determined. Changes in sVEGFR2 as a pharmacodynamic biomarker of OSI-930 activity were assessed. RESULTS Twenty one patients were enrolled to 1 of 3 cohorts: 200 mg OSI-930 BID+100 mg erlotinib QD; 200 mg OSI-930 BID+150 mg erlotinib QD; 300 mg OSI-930 BID+150 mg erlotinib QD. The most common adverse events were anorexia (85%), diarrhoea (75%), rash (70%) and lethargy (65%). The MTD was not reached but the onset of cumulative toxicity necessitating dose modification after the 28-d DLT assessment period was common at the highest dose level. A PK interaction was identified with co-administration of both agents resulting in a two-fold increase in OSI-930 exposure. Pharmacodynamic activity was observed with a decline in sVEGFR levels detected in all patients. Ten patients had disease stabilization (median duration 119 d). CONCLUSIONS 200 mg OSI-930 BID+150 mg erlotinib QD were the recommended doses for further evaluation of this combination.
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Affiliation(s)
- I R Macpherson
- Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
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Macpherson IR, Laskey J, Harden S, Canney P. Incidence and impact of abnormal liver function in patients receiving adjuvant chemotherapy for early breast cancer. Cancer Res 2009. [DOI: 10.1158/0008-5472.sabcs-4112] [Citation(s) in RCA: 4] [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
Abstract #4112
Background: Abnormalities in liver function tests (LFTs) which complicate adjuvant polychemotherapy may prompt prescribers to institute a dose reduction or delay due to fears of altered pharmacokinetics and increased toxicity. However, inappropriate reduction in dose intensity is associated with reduced efficacy of adjuvant therapy. We wished to identify the incidence of abnormal liver function and its influence on decision-making and toxicity in patients (pts) receiving adjuvant chemotherapy for early breast cancer in the west of Scotland.
 Methods: Data including baseline characteristics, LFTs (bilirubin, AST, ALT) on day 1 of each chemotherapy cycle, hematologic and grade 3/4 non-hematologic toxicity, dose delay or dose reduction were prospectively collected for 160 female pts commencing adjuvant chemotherapy at the Beatson West of Scotland Cancer Centre between August 2005 and February 2006. Association between LFT abnormality on day 1 of each chemotherapy cycle and toxicity occurring within that cycle was determined.
 Results: The most common regimen administered was Epirubicin-CMF (n=128; epirubicin 100mg/m2 q3/52 x4; cyclophosphamide 600mg / m2, methotrexate 40mg/m2, 5-FU 600mg/m2 d1+8 q4/52 x 4) followed by AC (n=25; Doxorubicin 60mg/m2, Cyclophosphamide 600mg/m2 q3/52 x4), FEC (n=5) and CMF (n=3). Median age was 55 yrs. Febrile neutropenia or grade 3 /4 non-hematologic toxicity were recorded in 1.9% and 3.2% of cycles respectively. 8.5% of all cycles were delayed and 14% of pts (n=23) had a dose reduction. In only 1 patient was dose reduction due to abnormal LFTs. Grade 1, 2 or 3 hyperbilirubinemia occurred in 3%, 2% and 0% of pts respectively. Grade 1, 2 or 3 elevated ALT occurred in 39%, 9% and 3% of pts. Grade 1, 2 or 3 elevated AST occurred in 38%, 4%, and 1% of pts respectively. No episodes of grade 4 hyperbilirubinemia or elevated transaminases occurred. Despite receiving chemotherapy at full dose no patient with grade 2/3 elevated AST or ALT on day 1 of a chemotherapy cycle experienced either grade 3/4 non-hematologic toxicity or febrile neutropenia in that cycle.
 Discussion: Although grade 1 elevation in transaminases was common, particularly in the context of the Epirubicin-CMF regimen, grade 2 or 3 abnormalities were infrequent. The absence of grade 3/4 chemotherapy-related toxicity in pts with grade 2/3 LFT abnormality supports maintenance of full dose anthracycline-based polychemotherapy in this population.
Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 4112.
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Affiliation(s)
- IR Macpherson
- 1 Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - J Laskey
- 1 Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - S Harden
- 2 Cancer Research UK Clinical Trials Unit, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - P Canney
- 1 Department of Medical Oncology, Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
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Macpherson IR, Hooper S, Serrels A, McGarry L, Ozanne BW, Harrington K, Frame MC, Sahai E, Brunton VG. p120-catenin is required for the collective invasion of squamous cell carcinoma cells via a phosphorylation-independent mechanism. Oncogene 2007; 26:5214-28. [PMID: 17334396 DOI: 10.1038/sj.onc.1210334] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Loss of E-cadherin-mediated cell-cell junctions has been correlated with cancer cell invasion and poor patient survival. p120-catenin has emerged as a key player in promoting E-cadherin stability and adherens junction integrity and has been proposed as a potential invasion suppressor by preventing release of cells from the constraints imposed by cadherin-mediated cell-cell adhesion. However, it has been proposed that tyrosine phosphorylation of p120 may contribute to cadherin-dependent junction disassembly during invasion. Here, we use small interfering RNA (siRNA) in A431 cells to show that knockdown of p120 promotes two-dimensional migration of cells. In contrast, p120 knockdown impairs epidermal growth factor-induced A431 invasion into three-dimensional matrix gels or in organotypic culture, whereas re-expression of siRNA-resistant p120, or a p120 isoform that cannot be phosphorylated on tyrosine, restores the collective mode of invasion employed by A431 cells in vitro. Thus, p120 promotes A431 cell invasion in a phosphorylation-independent manner. We show that the collective invasion of A431 cells depends on the presence of cadherin-mediated (P- and E-cadherin) cell-cell contacts, which are lost in cells where p120 expression is knocked down. Furthermore, membranous p120 is maintained in invasive squamous cell carcinomas in tumours suggesting that p120 may be important for the collective invasion of tumours cells in vivo.
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