8
|
Rust K, Spiliopoulou P, Tang CY, Bell C, Stirling D, Phang T, Davidson R, Mackean M, Nussey F, Glasspool RM, Reed NS, Sadozye A, Porteous M, McGoldrick T, Ferguson M, Miedzybrodzka Z, McNeish IA, Gourley C. Routine germline BRCA1 and BRCA2 testing in patients with ovarian carcinoma: analysis of the Scottish real-life experience. BJOG 2018; 125:1451-1458. [PMID: 29460478 DOI: 10.1111/1471-0528.15171] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2018] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine the rates of germline BRCA1 and BRCA2 mutations in Scottish patients with ovarian cancer, before and after a change in testing policy. DESIGN Retrospective cohort study. SETTING Four cancer/genetics centres in Scotland. POPULATION Patients with ovarian cancer undergoing germline BRCA1 and BRCA2 (gBRCA1/2) sequencing before 2013 (under the 'old criteria', with selection based solely on family history), after 2013 (under the 'new criteria', with sequencing offered to newly presenting patients with non-mucinous ovarian cancer), and in the 'prevalent population' (who presented before 2013, but were not eligible for sequencing under the old criteria but were sequenced under the new criteria). METHODS Clinicopathological and sequence data were collected before and for 18 months after this change in selection criteria. MAIN OUTCOME MEASURES Frequency of germline BRCA1, BRCA2, RAD51C, and RAD51D mutations. RESULTS Of 599 patients sequenced, 205, 236, and 158 were in the 'old criteria', 'new criteria', and 'prevalent' populations, respectively. The frequency of gBRCA1/2 mutations was 30.7, 13.1, and 12.7%, respectively. The annual rate of gBRCA1/2 mutation detection was 4.2 before and 20.7 after the policy change. A total of 48% (15/31) 'new criteria' patients with gBRCA1/2 mutations had a Manchester score of <15 and would not have been offered sequencing based on family history criteria. In addition, 20 patients with gBRCA1/2 were identified in the prevalent population. The prevalence of gBRCA1/2 mutations in patients aged >70 years was 8.2%. CONCLUSIONS Sequencing all patients with non-mucinous ovarian cancer gives a much higher annual gBRCA1/2 mutation detection rate, with the frequency of positive tests still exceeding the 10% threshold upon which many family history-based models operate. TWEETABLE ABSTRACT BRCA sequencing all non-mucinous cancer patients increases mutation detection five fold.
Collapse
Affiliation(s)
- K Rust
- Edinburgh Cancer Centre, Edinburgh, UK
| | | | - C Y Tang
- Department of Oncology, Ninewells Hospital, Dundee, UK
| | - C Bell
- Department of Medical Genetics, NHS Grampian, Aberdeen, UK
| | - D Stirling
- Department of Clinical Genetics, Western General Hospital, Edinburgh, UK
| | - Thf Phang
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - R Davidson
- Department of Genetics, Queen Elizabeth University Hospital, Glasgow, UK
| | - M Mackean
- Edinburgh Cancer Centre, Edinburgh, UK
| | - F Nussey
- Edinburgh Cancer Centre, Edinburgh, UK
| | | | - N S Reed
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - A Sadozye
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Porteous
- Department of Clinical Genetics, Western General Hospital, Edinburgh, UK
| | - T McGoldrick
- Department of Oncology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - M Ferguson
- Department of Oncology, Ninewells Hospital, Dundee, UK
| | - Z Miedzybrodzka
- Department of Medical Genetics, NHS Grampian, Aberdeen, UK
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - I A McNeish
- Beatson West of Scotland Cancer Centre, Glasgow, UK
- Institute of Cancer Sciences, University of Glasgow, Glasgow, UK
| | - C Gourley
- Edinburgh Cancer Centre, Edinburgh, UK
- Nicola Murray Centre for Ovarian Cancer Research, University of Edinburgh Cancer Research UK Centre, MRC IGMM, Western General Hospital, Edinburgh, UK
| |
Collapse
|
9
|
Rafii S, Macpherson I, Baird R, Saggese M, Spiliopoulou P, Kumar S, Italiano A, Bonneterre J, Campone M, Cresti N, Posner J, Takeda Y, Arimura A, Spicer J. Abstract P4-21-08: A phase I/II of S-222611, a reversible EGFR and HER2 inhibitor, combined with trastuzumab +/- chemotherapy in patients with HER2-positive metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: S-222611, an oral, reversible EGFR and HER2 inhibitor, has been shown to be well-tolerated as monotherapy at a dose of 800mg daily with good anti-tumor activity in patients previously treated with other anti-HER2-based regimens. This study evaluated the tolerability and safety of daily oral administration of S-222611 (S) in combination with trastuzumab (T), trastuzumab + vinorelbine (T+V) and trastzumab + capecitabine (T+C) in HER2-positive (HER2+) metastatic breast cancer (MBC) with or without brain metastases.
Methods: This study was performed as a 3+3 dose escalation followed by expansion to examine the tolerability and safety of S in combination with T, T+V and T+C in Arms A, B and C, respectively. S was administered orally once daily, starting at a dose of 400mg in Arm A, and 200mg in Arms B and C. The dosing of T was 8mg/kg loading followed by 6mg/kg or fixed dose of 600mg subcutaneously every 21 days as recommended. V was administered at 60mg/m2 orally on Day 1 and 8 of a 21-day cycle, and C 1000mg/m2 orally daily for 14 days followed by a 7-day rest period. All patients had HER2+ MBC and were required to have progressed following at least one prior line of anti-HER2 therapy. Prior treatments with V and C were permitted. Anti-diarrhea prophylaxis with loperamide was not required.
Results: A total of 45 patients were enrolled. All patients had received prior anti-tumor regimens including T (n=45), T-DM1 (n=26), pertuzumab (n=9) and lapatinib (n=12). The clinically recommended doses of S at which most adverse events were manageable,were determined as:600mg in Arm A, 200mg in Arm B and 400mg in Arm C. Dose limiting toxicities included Grade 3 diarrhea for Arm A; and Grade 4 neutropenia, Grade 3 Hypokalemia and Hypophosphatemia for Arm B. As of 13 May 2016, treatment is ongoing in 2 patients. No other Grade 4 AEs related to S-222611 have been observed. Grade 3 bilirubin elevation was observed in 5/45 patients, probably due to transporter (UGT1A1) inhibition, while no G3/4 liver dysfunction was reported. RECIST partial responses (PR) were observed in 6 of 9 patients in Arm A and 5 of 9 patients in Arm C, at respective clinically recommended doses. Nine of 45 patients had brain metastases; 4 of these patients showed RECIST PR including an intracranial tumor response in one patient (400mg in Arm C) who had prior treatments with paclitaxel, T+C, T-DM1 and V after diagnosis of BM.
Conclusions: The clinically recommended doses of S-222611 combined with T, T +V and T+C were determined for further clinical studies. Clinical benefit (PR and SD >6 month) was seen with each combination even in heavily pre-treated HER2+ MBC patients.
Summary of the safety and efficacy of S-222611 (S) combination. Dose (mg)nDLT (1st cycle)G3 Diarrhea during study (N of patients)RECIST tumor response, PR n/ SD ≥6M nORR n (%)CBR n (%)Arm A: S + T4005010/10/5 (0%)1/5 (20%)Arm A: S + T6009036/06/9 (67%)6/9 (67%)Arm A: S + T8007141/11/7 (14%)2/7 (29%)Arm B: S + T + V2005020/40/5 (0%)4/5 (80%)Arm B: S + T + V4002211/01/2 (50%)1/2 (50%)Arm C: S + T + C2004010/10/4 (0%)1/4 (25%)Arm C: S + T + C4009025/05/9 (56%)5/9 (56%)Arm C: S + T + C6004022/12/4 (50%)3/4 (75%)
Citation Format: Rafii S, Macpherson I, Baird R, Saggese M, Spiliopoulou P, Kumar S, Italiano A, Bonneterre J, Campone M, Cresti N, Posner J, Takeda Y, Arimura A, Spicer J. A phase I/II of S-222611, a reversible EGFR and HER2 inhibitor, combined with trastuzumab +/- chemotherapy in patients with HER2-positive metastatic breast cancer [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 P4-21-08.
Collapse
Affiliation(s)
- S Rafii
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - I Macpherson
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - R Baird
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - M Saggese
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - P Spiliopoulou
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - S Kumar
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - A Italiano
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - J Bonneterre
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - M Campone
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - N Cresti
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - J Posner
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - Y Takeda
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - A Arimura
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| | - J Spicer
- Sarah Cannon Research Institute UK, London, United Kingdom; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Cambridge Cancer Centre, Cambridge, United Kingdom; Institute Bergonie, Bordeaux, France; Centre Oscar Lambert, Lille, France; Institut de Cancérologie de l'Ouest, Nantes, France; Northern Centre for Cancer Care, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle, United Kingdom; Shionogi & Co. Ltd., Osaka, Japan; King's College London, Guy's Hospital, London, United Kingdom
| |
Collapse
|