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Limnander A, Kaur N, Asrat S, Tasker C, Boyapati A, Ben LH, Janczy J, Pedraza P, Abreu P, Chen WC, Godin S, Daniel BJ, Chin H, DeVeaux M, Rodriguez Lorenc K, Sirulnik A, Harari O, Stahl N, Sleeman MA, Murphy AJ, Yancopoulos GD, Orengo JM. A therapeutic strategy to target distinct sources of IgE and durably reverse allergy. Sci Transl Med 2023; 15:eadf9561. [PMID: 38091405 DOI: 10.1126/scitranslmed.adf9561] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 11/14/2023] [Indexed: 12/18/2023]
Abstract
Immunoglobulin E (IgE) is a key driver of type 1 hypersensitivity reactions and allergic disorders, which are globally increasing in number and severity. Although eliminating pathogenic IgE may be a powerful way to treat allergy, no therapeutic strategy reported to date can fully ablate IgE production. Interleukin-4 receptor α (IL-4Rα) signaling is required for IgE class switching, and IL-4Rα blockade gradually reduces, but does not eliminate, IgE. The persistence of IgE after IL-4Rα blockade may be due to long-lived IgE+ plasma cells that maintain serological memory to allergens and thus may be susceptible to plasma cell-targeted therapeutics. We demonstrate that transient administration of a B cell maturation antigen x CD3 (BCMAxCD3) bispecific antibody markedly depletes IgE, as well as other immunoglobulins, by ablating long-lived plasma cells, although IgE and other immunoglobulins rapidly rebound after treatment. Concomitant IL-4Rα blockade specifically and durably prevents the reemergence of IgE by blocking IgE class switching while allowing the restoration of other immunoglobulins. Moreover, this combination treatment prevented anaphylaxis in mice. Together with additional cynomolgus monkey and human data, our studies demonstrate that allergic memory is primarily maintained by both non-IgE+ memory B cells that require class switching and long-lived IgE+ plasma cells. Our combination approach to durably eliminate pathogenic IgE has potential to benefit allergy in humans while preserving antibody-mediated immunity.
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Affiliation(s)
| | - Navneet Kaur
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | - Carley Tasker
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Anita Boyapati
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Li-Hong Ben
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - John Janczy
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | - Pablo Abreu
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Wen-Chi Chen
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Stephen Godin
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | - Harvey Chin
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | | | | | - Olivier Harari
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | - Neil Stahl
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
| | | | | | | | - Jamie M Orengo
- Regeneron Pharmaceuticals, Tarrytown, New York, 10591, USA
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Bardia A, Su F, Solovieff N, Im SA, Sohn J, Lee KS, Campos-Gomez S, Jung KH, Colleoni M, Vázquez RV, Franke F, Hurvitz S, Harbeck N, Chow L, Taran T, Rodriguez Lorenc K, Babbar N, Tripathy D, Lu YS. Genomic Profiling of Premenopausal HR+ and HER2- Metastatic Breast Cancer by Circulating Tumor DNA and Association of Genetic Alterations With Therapeutic Response to Endocrine Therapy and Ribociclib. JCO Precis Oncol 2021; 5:PO.20.00445. [PMID: 34504990 PMCID: PMC8423397 DOI: 10.1200/po.20.00445] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 04/14/2021] [Accepted: 07/28/2021] [Indexed: 12/31/2022] Open
Abstract
PURPOSE This analysis evaluated the genomic landscape of premenopausal patients with hormone receptor–positive and human epidermal growth factor receptor 2–negative advanced breast cancer and the association of genetic alterations with response to ribociclib in the phase III MONALEESA-7 trial. METHODS Premenopausal patients were randomly assigned 1:1 to receive endocrine therapy plus ribociclib or placebo. Plasma collected at baseline was sequenced using targeted next-generation sequencing for approximately 600 relevant cancer genes. The association of circulating tumor DNA alterations with progression-free survival (PFS) was evaluated to identify biomarkers of response and resistance to ribociclib. RESULTS Baseline circulating tumor DNA was sequenced in 565 patients; 489 had evidence of ≥ 1 alteration. The most frequent alterations included PIK3CA (28%), TP53 (19%), CCND1 (10%), MYC (8%), GATA3 (8%), receptor tyrosine kinases (17%), and the Chr8p11.23 locus (12%). A treatment benefit of ribociclib was seen with wild-type (hazard ratio [HR] 0.45 [95% CI, 0.33 to 0.62]) and altered (HR 0.57 [95% CI, 0.36 to 0.9]) PIK3CA. Overall, patients with altered CCND1 had shorter PFS regardless of treatment, suggesting CCND1 as a potential prognostic biomarker. Benefit with ribociclib was seen in patients with altered (HR 0.21 [95% CI, 0.08 to 0.54]) or wild-type (HR 0.52 [95% CI, 0.39 to 0.68]) CCND1, but greater benefit was observed with altered, suggesting predictive potential of CCND1. Alterations in TP53, MYC, Chr8p11.23 locus, and receptor tyrosine kinases were associated with worse PFS, but ribociclib benefit was independent of alteration status. CONCLUSION In this study—to our knowledge, the first large study of premenopausal patients with hormone receptor–positive and human epidermal growth factor receptor 2–negative advanced breast cancer—multiple genomic alterations were associated with poor outcome. A PFS benefit of ribociclib was observed regardless of gene alteration status, although in this exploratory analysis, a magnitude of benefits varied by alteration.
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Affiliation(s)
- Aditya Bardia
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - Fei Su
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea
| | - Joohyuk Sohn
- Yonsei Cancer Center, Yonsei University Health System, Seoul, South Korea
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang, South Korea
| | - Saul Campos-Gomez
- Centro Oncológico Estatal, Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico
| | - Kyung Hae Jung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Marco Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
| | | | - Fabio Franke
- Hospital de Caridade de Ijuí, CACON, Ijuí, Brazil
| | - Sara Hurvitz
- University of California, Los Angeles Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Nadia Harbeck
- Department of Obstetrics and Gynecology, Breast Center, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Louis Chow
- Organisation for Oncology and Translational Research, Hong Kong, China
| | - Tetiana Taran
- Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | | | | | - Debu Tripathy
- The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Yen-Shen Lu
- National Taiwan University Hospital, Taipei, Taiwan
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Bardia A, Modi S, Oliveira M, Cortes J, Campone M, Ma B, Dirix L, Weise A, Hewes B, Diaz-Padilla I, Han Y, Deshpande P, Samant TS, Lorenc KR, He W, Su F, Chavez-MacGregor M. Phase Ib Dose-escalation/Expansion Trial of Ribociclib in Combination With Everolimus and Exemestane in Postmenopausal Women with HR+, HER2− Advanced Breast Cancer. Clin Cancer Res 2020; 26:6417-6428. [DOI: 10.1158/1078-0432.ccr-20-1068] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/04/2020] [Accepted: 09/25/2020] [Indexed: 11/16/2022]
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Fasching PA, Beck JT, Chan A, De Laurentiis M, Esteva FJ, Jerusalem G, Neven P, Pivot X, Bianchi GV, Martin M, Chandiwana D, Lanoue B, Ridolfi A, Wang Y, Rodriguez Lorenc K, Nusch A. Ribociclib plus fulvestrant for advanced breast cancer: Health-related quality-of-life analyses from the MONALEESA-3 study. Breast 2020; 54:148-154. [PMID: 33065342 PMCID: PMC7567051 DOI: 10.1016/j.breast.2020.09.008] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/17/2020] [Accepted: 09/18/2020] [Indexed: 12/12/2022] Open
Abstract
Purpose In the MONALEESA-3 Phase III trial of patients with hormone receptor–positive human epidermal growth factor receptor–negative advanced breast cancer, ribociclib plus fulvestrant significantly improved progression-free survival (PFS) and overall survival (OS). Here, we present patient-reported outcomes from the trial, including health-related quality of life (HRQOL). Methods Patients were randomized (2:1) to receive ribociclib plus fulvestrant or placebo plus fulvestrant. Time to definitive 10% deterioration (TTD) from baseline in HRQOL (global health status [GHS] from the EORTC QLQ-C30 questionnaire) and pain (BPI-SF questionnaire) were assessed using Kaplan-Meier estimates; a stratified Cox regression model was used to estimate the hazard ratio (HR) and 95% CIs. Results Deterioration ≥10% in the EORTC-QLQ-C30 GHS was observed in 33% of patients in the ribociclib group vs 34% of patients in the placebo (reference) group (HR for TTD ≥ 10% = 0.81 [95% CI, 0.62–1.1]). Similar findings were noted for TTD ≥5% (HR = 0.79 [95% CI, 0.61–1.0]) and TTD ≥15% (HR = 0.81 [95% CI, 0.60–1.08]). TTD ≥10% in emotional functioning (HR = 0.76 [95% CI, 0.57–1.01]) trended in favor of the ribociclib group, whereas results for fatigue and pain were similar between arms. TTD ≥10% in BPI-SF pain severity index score (HR = 0.77 [95% CI, 0.57–1.05]) and worst pain item score (HR = 0.81 [95% CI, 0.58–1.12]) trended in favor of ribociclib vs placebo. Conclusions In addition to significantly prolonging PFS and OS compared with placebo plus fulvestrant, adding ribociclib to fulvestrant maintains HRQOL. Ribociclib + fulvestrant allowed maintenance of global health status (GHS). Time to deterioration (TTD) by 10% can convey duration until worsening of QOL. TTD ≥10% was delayed with ribociclib in GHS and emotional functioning. Ribociclib also demonstrated trends toward delayed TTD vs placebo in pain outcomes.
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Affiliation(s)
- Peter A Fasching
- University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Department of Gynecology and Obstetrics, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany.
| | | | - Arlene Chan
- Breast Cancer Research Centre-Western Australia, Nedlands, WA, Australia
| | | | | | | | - Patrick Neven
- Multidisciplinary Breast Centre, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | | | | | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, Ciberonc Geicam, Universidad Complutense de Madrid, Madrid, Spain
| | | | - Brad Lanoue
- Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA
| | | | | | | | - Arnd Nusch
- Practice for Haematology and Internal Oncology, Velbert, Germany
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Ji Y, Abdelhady AM, Samant TS, Yang S, Rodriguez Lorenc K. Evaluation of Absolute Oral Bioavailability and Bioequivalence of Ribociclib, a Cyclin‐Dependent Kinase 4/6 Inhibitor, in Healthy Subjects. Clin Pharmacol Drug Dev 2020; 9:855-866. [DOI: 10.1002/cpdd.853] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 06/18/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Yan Ji
- Novartis Pharmaceuticals Co. East Hanover New Jersey USA
| | | | | | - Shu Yang
- Novartis Pharmaceuticals Co. East Hanover New Jersey USA
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Solovieff N, Su F, Leary R, Balbin A, Chakravartty A, Lorenc KR, Taran T, Babbar N. Abstract A031: Association of tumor DNA in circulation with clinical characteristics and treatment response in HR+/HER2− advanced breast cancer. Mol Cancer Ther 2019. [DOI: 10.1158/1535-7163.targ-19-a031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The sensitivity of plasma-based oncological assays is influenced by the amount of tumor DNA shed into the circulation (ctDNA fraction). Higher ctDNA fraction has been shown to correlate with later-stage cancers and poorer overall survival (Bettegowda C, et al. Sci Transl Med. 2014; Dawson SJ, et al. N Engl J Med. 2014). Other factors affecting ctDNA fraction are poorly understood. We present results from three large Phase III breast cancer studies (MONALEESA-2, -3, and -7) to evaluate correlations between ctDNA fraction and clinical characteristics and impact on progression-free survival (PFS) and best overall tumor response. Methods: Baseline plasma samples were collected from patients (pts) in the MONALEESA-2, -3, and -7 studies, which are Phase III registration trials testing ribociclib, a cyclin-dependent kinase 4/6 inhibitor, in hormone receptor–positive, human epidermal growth factor receptor 2–negative advanced breast cancer. For each trial, cell-free DNA was extracted from plasma and sequenced using a validated next-generation sequencing assay targeting approximately 550 genes. ctDNA fraction was estimated by analyzing short-read sequences using PureCN (Riester M, et al. Source Code Biol Med. 2016) and tested for correlations with various tumor characteristics (size at baseline, Ki67 expression, number and type of metastatic sites, hormone receptor status) and pt characteristics (type of prior therapy, line of therapy, ECOG performance status, age, body mass index, race, histological grade, menopausal status). We also evaluated the prognostic value of ctDNA fraction on PFS and best overall response. To evaluate the prognostic effect on PFS, ctDNA fraction was binned into 3 categories (not detectable; low, 0.5%-10%; high, > 10%). Results: Higher ctDNA fractions were observed in pts with more metastatic sites (P < 0.0001), larger tumor diameter (P < 0.0001), higher Ki67 expression (P = 0.0001), higher lactate dehydrogenase levels (P < 0.0001), higher-grade tumors (P = 0.0004), worse ECOG performance status (P < 0.0001), progesterone receptor–negative tumors (P = 0.01), presence of liver metastases (P < 0.0001), and shorter disease-free intervals (P < 0.0001). ctDNA fractions were also higher in younger pts (continuous variable; P < 0.0001) and pts with lower BMI (P = 0.0003), prior chemotherapy (P = 0.002), and prior endocrine therapy (P = 0.01). Lower ctDNA fractions were observed in pts with better overall response (P < 0.0001), with median ctDNA fractions lowest in pts with complete responses followed by partial response, stable disease, and progressive disease. Pts with low (0.5%-10%) ctDNA fractions had longer PFS than pts with high (> 10%) ctDNA fractions (HR [95% CI], 0.63 [0.48-0.82], 0.64 [0.51-0.80], and 0.67 [0.52-0.86] in the MONALEESA-2, -3, and -7 trials, respectively). A more pronounced effect on PFS was observed in pts with undetectable levels of ctDNA vs pts with higher ctDNA fractions (HR [95% CI], 0.35 [0.23-0.52], 0.34 [0.21-0.55], and 0.31 [0.21-0.47] in the MONALEESA-2, -3, and -7 trials, respectively). Conclusions: Generally, higher ctDNA fraction was associated with more aggressive tumor characteristics and prior exposure to therapy. Lower ctDNA fraction was associated with longer PFS and better overall response. Together these data suggest that ctDNA fraction is a robust prognostic factor.
Citation Format: Nadia Solovieff, Faye Su, Rebecca Leary, Alejandro Balbin, Arunava Chakravartty, Karen Rodriguez Lorenc, Tetiana Taran, Naveen Babbar. Association of tumor DNA in circulation with clinical characteristics and treatment response in HR+/HER2− advanced breast cancer [abstract]. In: Proceedings of the AACR-NCI-EORTC International Conference on Molecular Targets and Cancer Therapeutics; 2019 Oct 26-30; Boston, MA. Philadelphia (PA): AACR; Mol Cancer Ther 2019;18(12 Suppl):Abstract nr A031. doi:10.1158/1535-7163.TARG-19-A031
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Affiliation(s)
| | - Faye Su
- 2Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - Rebecca Leary
- 1Novartis Institutes for Biomedical Research, Cambidge, MA
| | | | | | | | - Tetiana Taran
- 2Novartis Pharmaceutical Corporation, East Hanover, NJ
| | - Naveen Babbar
- 1Novartis Institutes for Biomedical Research, Cambidge, MA
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Bardia A, Su F, Solovieff N, Im SA, Sohn J, Lee KS, Campos-Gomez S, Jung KH, Vazquez RV, Lu YS, Franke F, Hurvitz S, Harbeck N, Chow L, Lorenc KR, Taran T, Babbar N, Tripathy D. Abstract CT141: Genetic landscape of premenopausal HR+/HER2- advanced breast cancer (ABC) based on comprehensive circulating tumor DNA analysis and association with clinical outcomes in the Phase III MONALEESA-7 trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-ct141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The genetic landscape of premenopausal hormone receptor-positive (HR+) ABC is not well understood. The Phase III MONALEESA-7 study (NCT02278120), the first trial of endocrine therapy ± a cyclin-dependent kinase 4/6 inhibitor for premenopausal patients (pts) with HR+/human epidermal growth factor receptor 2-negative (HER2-) ABC, demonstrated that the addition of ribociclib (RIB) to a nonsteroidal aromatase inhibitor (NSAI) or tamoxifen (TAM) + goserelin (GOS) significantly extended progression-free survival (PFS; Tripathy D, et al. Lancet Oncol. 2018). We conducted a comprehensive ctDNA genomic analysis from MONALEESA-7.
Methods: Premenopausal pts with HR+/HER2- ABC were randomized 1:1 to RIB or placebo (PBO) + NSAI (letrozole [LET] or anastrozole) or TAM + GOS. Plasma samples for ctDNA analysis were collected at baseline and end of treatment. ctDNA was analyzed using next-generation sequencing (targeted panel of 550 genes).
Results: Among the 489 pts with ctDNA analyzed at baseline, the most common alterations were in PIK3CA (28%), TP53 (19%), CCND1 (11%), MYC (8%), and GATA3 (8%). Poorer prognosis in both treatment groups was most evident in patients with TP53 and MYC alterations. A PFS treatment effect in favor of RIB was noted in all subsets, independent of biomarker status (Table). However, based on HR, a trend for more pronounced benefit with RIB + NSAI/TAM + GOS was observed in pts with altered CCND1, GATA3, and genes involved in receptor tyrosine kinase signaling.
Conclusions: RIB + NSAI/TAM + GOS provided PFS benefit irrespective of baseline biomarker alteration status and represents recommended first-line therapy for pts with premenopausal HR+/HER2- ABC. The genetic landscape of premenopausal ABC might modulate the magnitude of therapeutic benefit; these novel findings require confirmation in additional biomarker studies.
RIB + NSAI/TAM + GOSPBO + NSAI/TAM + GOSEvents, n/NPFS, median monthsEvents, n/NPFS, median, monthsHRa (95% CI)PIK3CAWT68/18024.6798/17012.190.45 (0.33-0.62)Alt38/6914.7546/7012.850.57(0.36-0.9)TP53WT78/20324.67109/19412.980.48(0.36-0.65)Alt28/469.2335/467.160.47(0.27-0.82)CCND1WT91/22122.11126/21712.880.52(0.39-0.68)Alt15/2811.2718/235.520.21(0.08-0.54)MYCWT90/22924.67125/22112.880.49(0.37-0.65)Alt16/207.3419/197.160.57(0.25-1.31)GATA3WT96/22622.11131/22212.850.52(0.39-0.68)Alt10/23NA13/185.520.18(0.05-0.62)Receptor tyrosine kinasesbWT76/19827.53114/20614.520.5(0.37-0.67)Alt30/5114.5530/345.650.26(0.14-0.47)8p11.23cWT84/21523.03124/21412.780.47(0.36-0.63)Alt22/3412.5220/269.130.51(0.26-1)8p11.23, chromosome 8, short arm, region 11.23; alt, alteration; CCND1, cyclin D1; CI, confidence interval; GATA3, GATA binding protein 3; GOS, goserelin; NA, not applicable; NSAI, nonsteroidal aromatase inhibitor; MYC, MYC proto-oncogene, bHLH transcription factor; PBO, placebo; PFS, progression-free survival; PIK3CA, phosphatidylinositol 4,5-bisphosphate 3-kinase catalytic subunit α; RIB, ribociclib; TAM, tamoxifen; TP53, tumor protein p53; WT, wild type.a HR for PFS of RIB vs PBO. b Receptor tyrosine kinase genes include EGFR, ERBB2, ERBB3, ERBB4, FGFR1, IGF1, IGF1R, KDR, KIT, PDGFRA, PDGFRB, and VEGFA. c Includes FGFR1, WHSC1L1, and ZNF703.
Citation Format: Aditya Bardia, Faye Su, Nadia Solovieff, Seock-Ah Im, Joohyuk Sohn, Keun Seok Lee, Saul Campos-Gomez, Kyung Hae Jung, Rafael Villanueva Vazquez, Yen-Shen Lu, Fabio Franke, Sara Hurvitz, Nadia Harbeck, Louis Chow, Karen Rodriguez Lorenc, Tetiana Taran, Naveen Babbar, Debu Tripathy. Genetic landscape of premenopausal HR+/HER2- advanced breast cancer (ABC) based on comprehensive circulating tumor DNA analysis and association with clinical outcomes in the Phase III MONALEESA-7 trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr CT141.
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Affiliation(s)
| | - Faye Su
- 2Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Nadia Solovieff
- 3Novartis Institutes for BioMedical Research, Inc, Cambridge, MA
| | - Seock-Ah Im
- 4Seoul National University Hospital Cancer Research Institute, Seoul, Republic of Korea
| | - Joohyuk Sohn
- 5Yonsei University Health System, Seoul, Republic of Korea
| | - Keun Seok Lee
- 6Seoul National University Hospital, Seoul, Republic of Korea
| | - Saul Campos-Gomez
- 7Instituto de Seguridad Social del Estado de México y Municipios, Toluca, Mexico
| | - Kyung Hae Jung
- 8University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Yen-Shen Lu
- 10National Taiwan University Hospital, Taipei City, Taiwan
| | - Fabio Franke
- 11Médico Oncologista Clínico Coordenador do Cacon, Ijuí, Brazil
| | - Sara Hurvitz
- 12The University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Nadia Harbeck
- 13Ludwig-Maximilians-Universitat Munich, Munich, Germany
| | - Louis Chow
- 14Organisation for Oncology and Translational Research, Hong Kong, Hong Kong
| | | | - Tetiana Taran
- 2Novartis Pharmaceuticals Corporation, East Hanover, NJ
| | - Naveen Babbar
- 15Novartis Pharmaceuticals Corporation, Cambridge, MA
| | - Debu Tripathy
- 16The University of Texas MD Anderson Cancer Center, Houston, TX
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Slamon DJ, Neven P, Chia S, Fasching PA, De Laurentiis M, Im SA, Petrakova K, Bianchi GV, Esteva FJ, Martín M, Nusch A, Sonke GS, De la Cruz-Merino L, Beck JT, Pivot X, Vidam G, Wang Y, Rodriguez Lorenc K, Miller M, Taran T, Jerusalem G. Phase III Randomized Study of Ribociclib and Fulvestrant in Hormone Receptor–Positive, Human Epidermal Growth Factor Receptor 2–Negative Advanced Breast Cancer: MONALEESA-3. J Clin Oncol 2018; 36:2465-2472. [DOI: 10.1200/jco.2018.78.9909] [Citation(s) in RCA: 503] [Impact Index Per Article: 83.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose This phase III study evaluated ribociclib plus fulvestrant in patients with hormone receptor–positive/human epidermal growth factor receptor 2–negative advanced breast cancer who were treatment naïve or had received up to one line of prior endocrine therapy in the advanced setting. Patients and Methods Patients were randomly assigned at a two-to-one ratio to ribociclib plus fulvestrant or placebo plus fulvestrant. The primary end point was locally assessed progression-free survival. Secondary end points included overall survival, overall response rate, and safety. Results A total of 484 postmenopausal women were randomly assigned to ribociclib plus fulvestrant, and 242 were assigned to placebo plus fulvestrant. Median progression-free survival was significantly improved with ribociclib plus fulvestrant versus placebo plus fulvestrant: 20.5 months (95% CI, 18.5 to 23.5 months) versus 12.8 months (95% CI, 10.9 to 16.3 months), respectively (hazard ratio, 0.593; 95% CI, 0.480 to 0.732; P < .001). Consistent treatment effects were observed in patients who were treatment naïve in the advanced setting (hazard ratio, 0.577; 95% CI, 0.415 to 0.802), as well as in patients who had received up to one line of prior endocrine therapy for advanced disease (hazard ratio, 0.565; 95% CI, 0.428 to 0.744). Among patients with measurable disease, the overall response rate was 40.9% for the ribociclib plus fulvestrant arm and 28.7% for placebo plus fulvestrant. Grade 3 adverse events reported in ≥ 10% of patients in either arm (ribociclib plus fulvestrant v placebo plus fulvestrant) were neutropenia (46.6% v 0%) and leukopenia (13.5% v 0%); the only grade 4 event reported in ≥ 5% of patients was neutropenia (6.8% v 0%). Conclusion Ribociclib plus fulvestrant might represent a new first- or second-line treatment option in hormone receptor–positive/human epidermal growth factor receptor 2–negative advanced breast cancer.
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Affiliation(s)
- Dennis J. Slamon
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Patrick Neven
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Stephen Chia
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Peter A. Fasching
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Michelino De Laurentiis
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Seock-Ah Im
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Katarina Petrakova
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Giulia Val Bianchi
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Francisco J. Esteva
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Miguel Martín
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Arnd Nusch
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Gabe S. Sonke
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Luis De la Cruz-Merino
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - J. Thaddeus Beck
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Xavier Pivot
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Gena Vidam
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Yingbo Wang
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Karen Rodriguez Lorenc
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Michelle Miller
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Tetiana Taran
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
| | - Guy Jerusalem
- Dennis J. Slamon, University of California Los Angeles Medical Center, Santa Monica, CA; Patrick Neven, Multidisciplinary Breast Centre, Universitair Ziekenhuis, Leuven; Guy Jerusalem, Centre Hospitalier Universitaire de Liege and Liege University, Liège, Belgium; Stephen Chia, British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Peter A. Fasching, University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen; Arnd Nusch, Practice for Hematology and Internal
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