1
|
Gluz O, Nitz UA, Christgen M, Kuemmel S, Holtschmidt J, Schumacher J, Hartkopf A, Potenberg J, Lüedtke-Heckenkamp K, Just M, Schem C, von Schumann R, Kolberg-Liedtke C, Eulenburg CZ, Schinköthe T, Graeser M, Wuerstlein R, Kates RE, Kreipe HH, Harbeck N. Efficacy of Endocrine Therapy Plus Trastuzumab and Pertuzumab vs De-escalated Chemotherapy in Patients with Hormone Receptor-Positive/ERBB2-Positive Early Breast Cancer: The Neoadjuvant WSG-TP-II Randomized Clinical Trial. JAMA Oncol 2023; 9:946-954. [PMID: 37166817 PMCID: PMC10176180 DOI: 10.1001/jamaoncol.2023.0646] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 01/27/2023] [Indexed: 05/12/2023]
Abstract
Importance Combination of chemotherapy with (dual) ERBB2 blockade is considered standard in hormone receptor (HR)-positive/ERBB2-positive early breast cancer (EBC). Despite some promising data on endocrine therapy (ET) combination with dual ERBB2 blockade in HR-positive/ERBB2-positive BC, to our knowledge, no prospective comparison of neoadjuvant chemotherapy vs ET plus ERBB2 blockade in particular with focus on molecular markers has yet been performed. Objective To determine whether neoadjuvant de-escalated chemotherapy is superior to endocrine therapy, both in combination with pertuzumab and trastuzumab, in a highly heterogeneous HR-positive/ERBB2-positive EBC. Design, Setting, and Participants This prospective, multicenter, neoadjuvant randomized clinical trial allocated 207 patients with centrally confirmed estrogen receptor-positive and/or progesterone receptor-positive (>1%) HR-positive/ERBB2-positive EBC to 12 weeks of standard ET (n = 100) vs paclitaxel (n = 107) plus trastuzumab and pertuzumab. A total of 186 patients were required to detect a statistically significant difference in pathological complete response (pCR) (assumptions: 19% absolute difference in pCR; power, ≥80%; 1-sided Fisher exact test, 2.5% significance level). Interventions Standard ET (aromatase inhibitor or tamoxifen) or paclitaxel, 80 mg/m2, weekly plus trastuzumab and pertuzumab every 21 days. Main Outcomes and Measures The primary end point was pCR (ypT0/is, ypN0). Secondary end points included safety, translational research, and health-related quality of life. Omission of further chemotherapy was allowed in patients with pCR. PAM50 analysis was performed on baseline tumor biopsies. Results Of the 207 patients included (median [range] age, 53 [25-83] years), 121 (58%) had cT2 to cT4 tumors, and 58 (28%) had clinically node-positive EBC. The pCR rate in the ET plus trastuzumab and pertuzumab arm was 23.7% (95% CI, 15.7%-33.4%) vs 56.4% (95% CI, 46.2%-66.3%) in the paclitaxel plus trastuzumab and pertuzumab arm (odds ratio, 0.24; 95% CI, 0.12-0.46; P < .001). Both immunohistochemical ERBB2 score of 3 or higher and ERBB2-enriched subtype were independent predictors for pCR in both arms. Paclitaxel was superior to ET only in the first through third quartiles but not in the highest ERBB2 quartile by messenger RNA. In contrast with the paclitaxel plus trastuzumab and pertuzumab arm, no decrease in health-related quality of life after 12 weeks was observed in the ET plus trastuzumab and pertuzumab arm. Conclusions and Relevance The WSG-TP-II randomized clinical trial is, to our knowledge, the first prospective trial comparing 2 neoadjuvant de-escalation treatments in HR-positive/ERBB2-positive EBC and demonstrated an excellent pCR rate after 12 weeks of paclitaxel plus trastuzumab and pertuzumab that was clearly superior to the pCR rate after ET plus trastuzumab and pertuzumab. Trial Registration ClinicalTrials.gov Identifier: NCT03272477.
Collapse
Affiliation(s)
- Oleg Gluz
- West German Study Group, Mönchengladbach, Germany
- Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
- University Clinics Cologne, Cologne, Germany
| | - Ulrike A. Nitz
- West German Study Group, Mönchengladbach, Germany
- Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
| | | | - Sherko Kuemmel
- West German Study Group, Mönchengladbach, Germany
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Department of Gynecology with Breast Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
| | - Johannes Holtschmidt
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
- Breast Center, St Elisabeth-Krankenhaus Köln-Hohenlind, Cologne, Germany
| | | | - Andreas Hartkopf
- Department of Gynecology and Obstetrics, Tüebingen University Hospital, Tüebingen, Germany
| | | | | | | | | | | | - Cornelia Kolberg-Liedtke
- Department of Gynecology with Breast Center, Charité–Universitätsmedizin Berlin, Berlin, Germany
- Women’s Clinic, University Clinics Essen, Essen, Germany
| | - Christine Zu Eulenburg
- West German Study Group, Mönchengladbach, Germany
- Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg, Germany
| | - Timo Schinköthe
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich, Ludwig Maximilians University Hospital, Munich, Germany
- CANKADO Service GmbH, Kirchheim bei München, Germany
| | - Monika Graeser
- West German Study Group, Mönchengladbach, Germany
- Breast Center Niederrhein, Ev. Hospital Bethesda, Mönchengladbach, Germany
- Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Rachel Wuerstlein
- West German Study Group, Mönchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich, Ludwig Maximilians University Hospital, Munich, Germany
| | | | | | - Nadia Harbeck
- West German Study Group, Mönchengladbach, Germany
- Breast Center, Department of Gynecology and Obstetrics, Comprehensive Cancer Center Munich, Ludwig Maximilians University Hospital, Munich, Germany
| |
Collapse
|
2
|
Harbeck N, Nitz UA, Christgen M, Kümmel S, Braun M, Schumacher C, Potenberg J, Tio J, Aktas B, Forstbauer H, Grischke EM, Scheffen I, Malter W, von Schumann R, Just M, Zu Eulenburg C, Biehl C, Kolberg-Liedtke C, Deurloo R, de Haas S, Jóźwiak K, Hauptmann M, Kates R, Graeser M, Wuerstlein R, Kreipe HH, Gluz O. De-Escalated Neoadjuvant Trastuzumab-Emtansine With or Without Endocrine Therapy Versus Trastuzumab With Endocrine Therapy in HR+/HER2+ Early Breast Cancer: 5-Year Survival in the WSG-ADAPT-TP Trial. J Clin Oncol 2023:JCO2201816. [PMID: 36809046 DOI: 10.1200/jco.22.01816] [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: 02/23/2023] Open
Abstract
PURPOSE Neoadjuvant chemotherapy is standard of care in human epidermal growth factor receptor 2-positive (HER2+) early breast cancer (EBC), irrespective of the hormone receptor status. Trastuzumab-emtansine (T-DM1), antibody-drug conjugate, is highly effective in HER2+ EBC; however, no survival data are available for de-escalated antibody-drug conjugate-based neoadjuvant therapy without conventional chemotherapy. PATIENTS AND METHODS In the WSG-ADAPT-TP (ClinicalTrials.gov identifier: NCT01779206) phase II trial, 375 centrally reviewed patients with hormone receptor-positive (HR+)/HER2+ EBC (clinical stage I-III) were randomly assigned to 12 weeks of T-DM1 with or without endocrine therapy (ET) or trastuzumab + ET once every 3 weeks (ratio 1:1:1). Adjuvant chemotherapy (ACT) omission was allowed in patients with pathologic complete response (pCR). In this study, we report the secondary survival end points and biomarker analysis. Patients who received at least one dose of study treatment were analyzed. Survival was analyzed using the Kaplan-Meier method, two-sided log-rank statistics, and Cox regression models stratified for nodal and menopausal status. P values < .05 were considered statistically significant. RESULTS T-DM1, T-DM1 + ET, and trastuzumab + ET induced similar 5-year invasive disease-free survival (iDFS; 88.9%, 85.3%, 84.6%; Plog-rank = .608) and overall survival rates (97.2%, 96.4%, 96.3%; Plog-rank = .534). Patients with pCR versus non-pCR had improved 5-year iDFS rates (92.7% v 82.7%; hazard ratio, 0.40; 95% CI, 0.18 to 0.85). Among the 117 patients with pCR, 41 did not receive ACT; 5-year iDFS rates were similar in those with (93.0%; 95% CI, 84.0 to 97.0) and without ACT (92.1%; 95% CI, 77.5 to 97.4; Plog-rank = .848). Translational research revealed that tumors with PIK3CA wild type, high immune marker expression, and luminal-A tumors (by PAM50) had an excellent prognosis with de-escalated anti-HER2 therapy. CONCLUSION The WSG-ADAPT-TP trial demonstrated that pCR after 12 weeks of chemotherapy-free de-escalated neoadjuvant therapy was associated with excellent survival in HR+/HER2+ EBC without further ACT. Despite higher pCR rates for T-DM1 ± ET versus trastuzumab + ET, all trial arms had similar outcomes because of mandatory standard chemotherapy after non-pCR. WSG-ADAPT-TP demonstrated that such de-escalation trials in HER2+ EBC are feasible and safe for patients. Patient selection on the basis of biomarkers or molecular subtypes may increase the efficacy of systemic chemotherapy-free HER2-targeted approaches.
Collapse
Affiliation(s)
- Nadia Harbeck
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Ulrike A Nitz
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany
| | | | - Sherko Kümmel
- West German Study Group, Moenchengladbach, Germany.,Breast Unit, Kliniken Essen-Mitte, Essen, Germany.,Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Braun
- Breast Center, Rotkreuz Clinics Munich, Munich, Germany
| | | | | | - Joke Tio
- Department of Gynecology, University Hospital Münster, Münster, Germany
| | - Bahriye Aktas
- Women's Clinic, University Clinics Essen, Essen, Germany.,University Clinics Leipzig, Women's Clinic, Leipzig, Germany
| | | | | | - Iris Scheffen
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany
| | - Wolfram Malter
- Department of Obstetrics and Gynecology, Breast Center, University Hospital, Cologne, Germany
| | | | | | - Christine Zu Eulenburg
- West German Study Group, Moenchengladbach, Germany.,Department of Medical Biometry and Epidemiology, University Medical Center Hamburg, Hamburg, Germany
| | - Claudia Biehl
- Westphalian Brest Center Dortmund, Dortmund, Germany
| | - Cornelia Kolberg-Liedtke
- Department of Gynecology with Breast Center, Charité-Universitätsmedizin Berlin, Berlin, Germany.,Women's Clinic, University Clinics Essen, Essen, Germany
| | | | | | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Ronald Kates
- West German Study Group, Moenchengladbach, Germany
| | - Monika Graeser
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany.,Department of Gynecology, University Medical Center Hamburg, Hamburg, Germany
| | - Rachel Wuerstlein
- West German Study Group, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics and CCCMunich, Breast Center, LMU University Hospital, Munich, Germany
| | - Hans H Kreipe
- Institute of Pathology, Medical School Hannover, Hannover, Germany
| | - Oleg Gluz
- West German Study Group, Moenchengladbach, Germany.,Breast Center Niederrhein, Ev. Hospital Bethesda, Moenchengladbach, Germany.,University Clinics Cologne, Cologne, Germany
| | | |
Collapse
|
3
|
Nitz U, Gluz O, Graeser M, Christgen M, Kuemmel S, Grischke EM, Braun M, Augustin D, Potenberg J, Krauss K, Schumacher C, Forstbauer H, Reimer T, Stefek A, Fischer HH, Pelz E, zu Eulenburg C, Kates R, Wuerstlein R, Kreipe HH, Harbeck N, von Schumann R, Kuhn W, Polata S, Bielecki W, Meyer R, Just M, Kraudelt S, Siggelkow W, Wortelmann H, Kleine-Tebbe A, Leitzen L, Kirchhof H, Krabisch P, Hackmann J, Depenbusch R, Gnauert K, Staib P, Lehnert A, Hoffmann O, Briest S, Lindner C, Heyl V, Bauer L, Uleer C, Mohrmann S, Viehstaedt N, Malter W, Link T, Buendgen N, Tio J. De-escalated neoadjuvant pertuzumab plus trastuzumab therapy with or without weekly paclitaxel in HER2-positive, hormone receptor-negative, early breast cancer (WSG-ADAPT-HER2+/HR–): survival outcomes from a multicentre, open-label, randomised, phase 2 trial. Lancet Oncol 2022; 23:625-635. [DOI: 10.1016/s1470-2045(22)00159-0] [Citation(s) in RCA: 4] [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: 12/15/2021] [Revised: 02/28/2022] [Accepted: 03/07/2022] [Indexed: 12/18/2022]
|
4
|
Harbeck N, von Schumann R, Kates RE, Braun M, Kuemmel S, Schumacher C, Potenberg J, Malter W, Augustin D, Aktas B, Forstbauer H, Tio J, Grischke EM, Biehl C, Liedtke C, De Haas SL, Deurloo R, Wuerstlein R, Kreipe HH, Gluz O. Immune Markers and Tumor-Related Processes Predict Neoadjuvant Therapy Response in the WSG-ADAPT HER2-Positive/Hormone Receptor-Positive Trial in Early Breast Cancer. Cancers (Basel) 2021; 13:4884. [PMID: 34638369 PMCID: PMC8508505 DOI: 10.3390/cancers13194884] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2021] [Revised: 09/23/2021] [Accepted: 09/24/2021] [Indexed: 11/16/2022] Open
Abstract
Prognostic or predictive biomarkers in HER2-positive early breast cancer (EBC) may inform treatment optimization. The ADAPT HER2-positive/hormone receptor-positive phase II trial (NCT01779206) demonstrated pathological complete response (pCR) rates of ~40% following de-escalated treatment with 12 weeks neoadjuvant ado-trastuzumab emtansine (T-DM1) ± endocrine therapy. In this exploratory analysis, we evaluated potential early predictors of response to neoadjuvant therapy. The effects of PIK3CA mutations and immune (CD8 and PD-L1) and apoptotic markers (BCL2 and MCL1) on pCR rates were assessed, along with intrinsic BC subtypes. Immune response and pCR were lower in PIK3CA-mutated tumors compared with wildtype. Increased BCL2 at baseline in all patients and at Cycle 2 in the T-DM1 arms was associated with lower pCR. In the T-DM1 arms only, the HER2-enriched subtype was associated with increased pCR rate (54% vs. 28%). These findings support further prospective pCR-driven de-escalation studies in patients with HER2-positive EBC.
Collapse
Affiliation(s)
- Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCCLMU, University of Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany;
- The West German Study Group, 41061 Mönchengladbach, Germany; (R.E.K.); (O.G.)
| | - Raquel von Schumann
- Evangelical Hospital Bethesda, 41061 Mönchengladbach, Germany; (R.v.S.); (S.K.)
| | - Ronald Ernest Kates
- The West German Study Group, 41061 Mönchengladbach, Germany; (R.E.K.); (O.G.)
| | | | - Sherko Kuemmel
- Evangelical Hospital Bethesda, 41061 Mönchengladbach, Germany; (R.v.S.); (S.K.)
- Breast Unit, Kliniken Essen-Mitte, 45136 Essen, Germany
- Klinik für Gynäkologie mit Brustzentrum Charité-Universitätsmedizin, 10117 Berlin, Germany
| | | | | | - Wolfram Malter
- Breast Center, Department of Obstetrics and Gynecology, University Hospital Cologne, 50937 Cologne, Germany;
| | - Doris Augustin
- Breast Center, Clinic Deggendorf, 94469 Deggendorf, Germany;
| | | | | | - Joke Tio
- University Hospital Münster, 48149 Münster, Germany;
| | | | - Claudia Biehl
- Westphalian Breast Center, City Hospital Dortmund, 44137 Dortmund, Germany;
| | | | | | - Regula Deurloo
- F. Hoffmann-La Roche Ltd., 4070 Basel, Switzerland; (S.L.D.H.); (R.D.)
| | - Rachel Wuerstlein
- Breast Center, Department of Obstetrics and Gynecology and CCCLMU, University of Munich (LMU), Marchioninistrasse 15, 81377 Munich, Germany;
| | | | - Oleg Gluz
- The West German Study Group, 41061 Mönchengladbach, Germany; (R.E.K.); (O.G.)
- Evangelical Hospital Bethesda, 41061 Mönchengladbach, Germany; (R.v.S.); (S.K.)
- Breast Center, Department of Obstetrics and Gynecology, University Hospital Cologne, 50937 Cologne, Germany;
| |
Collapse
|
5
|
Graeser M, Schrading S, Gluz O, Strobel K, Würstlein R, Kümmel S, Schumacher C, Grischke E, Forstbauer H, Braun M, Christgen M, Adams J, Nitzsche H, Just M, Fischer HH, Aktas B, Potenberg J, von Schumann R, Kolberg‐Liedtke C, Harbeck N, Kuhl CK, Nitz U. Early response by MR imaging and ultrasound as predictor of pathologic complete response to 12-week neoadjuvant therapy for different early breast cancer subtypes: Combined analysis from the WSG ADAPT subtrials. Int J Cancer 2021; 148:2614-2627. [PMID: 33533487 PMCID: PMC8048810 DOI: 10.1002/ijc.33495] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 12/18/2020] [Accepted: 12/21/2020] [Indexed: 12/31/2022]
Abstract
We evaluated the role of early response after 3 weeks of neoadjuvant treatment (NAT) assessed by ultrasound (US), magnetic resonance imaging (MRI) and Ki-67 dynamics for prediction of pathologic complete response (pCR) in different early breast cancer subtypes. Patients with HR+/HER2+, HR-/HER2- and HR-/HER2+ tumors enrolled into three neoadjuvant WSG ADAPT subtrials underwent US, MRI and Ki-67 assessment at diagnosis and after 3 weeks of NAT. Early response was defined as complete or partial response (US, MRI) and ≥30% proliferation decrease or <500 invasive tumor cells (Ki-67). Predictive values and area under the receiver operating characteristic (AUC) curves for prediction of pCR (ypT0/is ypN0) after 12-week NAT were calculated. Two hundred twenty-six had MRI and 401 US; 107 underwent both MRI and US. All three methods yielded a similar AUC in HR+/HER2+ (0.66-0.67) and HR-/HER2- tumors (0.53-0.63), while MRI and Ki-67 performed better than US in HR-/HER2+ tumors (0.83 and 0.79 vs 0.56). Adding MRI+/-Ki-67 increased AUC of US in HR-/HER2+ tumors to 0.64 to 0.75. MRI and Ki-67 demonstrated highest sensitivity in HR-/HER2- (0.8-1) and HR-/HER2+ tumors (1, both). Negative predictive value was similar for all methods in HR+/HER2+ (0.71-0.74) and HR-/HER2- tumors (0.85-1), while it was higher for MRI and Ki-67 compared to US in HR-/HER2+ subtype (1 vs 0.5). Early response assessed by US, MRI and Ki-67 is a strong predictor for pCR after 12-week NAT. Strength of pCR prediction varies according to tumor subtype. Adding MRI+/-Ki-67 to US did not improve pCR prediction in majority of our patients.
Collapse
Affiliation(s)
- Monika Graeser
- West German Study GroupMoenchengladbachGermany
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
- Department of GynecologyUniversity Medical Center HamburgHamburgGermany
| | - Simone Schrading
- Department of Diagnostic and Interventional RadiologyHospital of the University of Aachen, RWTHAachenGermany
| | - Oleg Gluz
- West German Study GroupMoenchengladbachGermany
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
- University Hospital CologneCologneGermany
| | - Kevin Strobel
- Department of Diagnostic and Interventional RadiologyHospital of the University of Aachen, RWTHAachenGermany
| | - Rachel Würstlein
- West German Study GroupMoenchengladbachGermany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMULMU University HospitalMunichGermany
| | - Sherko Kümmel
- West German Study GroupMoenchengladbachGermany
- Breast UnitKliniken Essen‐MitteEssenGermany
- University Hospital Charité, Humboldt University BerlinBerlinGermany
| | | | | | | | - Michael Braun
- Department of GynecologyBreast Center, Red Cross Hospital MunichMunichGermany
| | | | | | - Henrik Nitzsche
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
| | | | | | - Bahriye Aktas
- Department of Gynecology and ObstetricsUniversity Clinics EssenEssenGermany
- Department of GynecologyUniversity Hospital LeipzigLeipzigGermany
| | | | | | - Cornelia Kolberg‐Liedtke
- University Hospital Charité, Humboldt University BerlinBerlinGermany
- Department of Gynecology and ObstetricsUniversity Clinics EssenEssenGermany
| | - Nadia Harbeck
- West German Study GroupMoenchengladbachGermany
- Breast Center, Department of Gynecology and Obstetrics and CCCLMULMU University HospitalMunichGermany
| | - Christiane K. Kuhl
- Department of Diagnostic and Interventional RadiologyHospital of the University of Aachen, RWTHAachenGermany
| | - Ulrike Nitz
- West German Study GroupMoenchengladbachGermany
- Ev. Hospital Bethesda, Breast Center NiederrheinMoenchengladbachGermany
| |
Collapse
|
6
|
Graeser M, Schrading S, Gluz O, Strobel K, Herzog C, Umutlu L, Frydrychowicz A, Rjosk-Dendorfer D, Würstlein R, Culemann R, Eulenburg C, Adams J, Nitzsche H, Prange A, Kümmel S, Grischke EM, Forstbauer H, Braun M, Potenberg J, von Schumann R, Aktas B, Kolberg-Liedtke C, Harbeck N, Kuhl CK, Nitz U. Magnetic resonance imaging and ultrasound for prediction of residual tumor size in early breast cancer within the ADAPT subtrials. Breast Cancer Res 2021; 23:36. [PMID: 33736679 PMCID: PMC7977310 DOI: 10.1186/s13058-021-01413-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 02/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Prediction of histological tumor size by post-neoadjuvant therapy (NAT) ultrasound and magnetic resonance imaging (MRI) was evaluated in different breast cancer subtypes. Methods Imaging was performed after 12-week NAT in patients enrolled into three neoadjuvant WSG ADAPT subtrials. Imaging performance was analyzed for prediction of residual tumor measuring ≤10 mm and summarized using positive (PPV) and negative (NPV) predictive values. Results A total of 248 and 588 patients had MRI and ultrasound, respectively. Tumor size was over- or underestimated by < 10 mm in 4.4% and 21.8% of patients by MRI and in 10.2% and 15.8% by ultrasound. Overall, NPV (proportion of correctly predicted tumor size ≤10 mm) of MRI and ultrasound was 0.92 and 0.83; PPV (correctly predicted tumor size > 10 mm) was 0.52 and 0.61. MRI demonstrated a higher NPV and lower PPV than ultrasound in hormone receptor (HR)-positive/human epidermal growth factor receptor 2 (HER2)-positive and in HR−/HER2+ tumors. Both methods had a comparable NPV and PPV in HR−/HER2− tumors. Conclusions In HR+/HER2+ and HR−/HER2+ breast cancer, MRI is less likely than ultrasound to underestimate while ultrasound is associated with a lower risk to overestimate tumor size. These findings may help to select the most optimal imaging approach for planning surgery after NAT. Trial registration Clinicaltrials.gov, NCT01815242 (registered on March 21, 2013), NCT01817452 (registered on March 25, 2013), and NCT01779206 (registered on January 30, 2013). Supplementary Information The online version contains supplementary material available at 10.1186/s13058-021-01413-y.
Collapse
Affiliation(s)
- Monika Graeser
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany. .,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany. .,Department of Gynecology, University Medical Center Hamburg, Martinistrasse 52, 20251, Hamburg, Germany.
| | - Simone Schrading
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Oleg Gluz
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,University Hospital Cologne, Kerpener Strasse 62, 50937, Cologne, Germany
| | - Kevin Strobel
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | | | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Alex Frydrychowicz
- Department of Radiology and Nuclear Medicine, Schleswig-Holstein University Hospital, Campus Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Dorothea Rjosk-Dendorfer
- Department of Radiology, University Hospital, LMU Munich, Marchioninistrasse. 15, 81377, Munich, Germany
| | - Rachel Würstlein
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Marchioninistrasse 15, 81377, Munich, Germany
| | - Ralph Culemann
- Medizinisches Versorgungszentrum Radiologie Rhein-Sieg, GFO Kliniken Troisdorf, Hospitalstrasse 45, 53840, Troisdorf, Germany
| | - Christine Eulenburg
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
| | - Jascha Adams
- Alcedis GmbH, Winchesterstrasse 3, 35394, Giessen, Germany
| | - Henrik Nitzsche
- Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
| | - Anna Prange
- Department of Radiology, Clinics Essen-Mitte, Breast Centre, Henricistrasse 92, 45136, Essen, Germany
| | - Sherko Kümmel
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Clinics Essen-Mitte, Breast Centre, Henricistrasse 92, 45136, Essen, Germany.,University Hospital Charité, Women's Clinic, Berlin, Charitéplatz 1, 10117, Berlin, Germany
| | - Eva-Maria Grischke
- University Clinic Tuebingen, Women's Clinic, Calwerstrasse 7, 72076, Tuebingen, Germany
| | - Helmut Forstbauer
- Practice Network Troisdorf, Schlossstrasse 18, 53840, Troisdorf, Germany
| | - Michael Braun
- Red Cross Women's Hospital, Nymphenburger Strasse 163, 80634, Munich, Germany
| | - Jochem Potenberg
- Ev. Waldkrankenhaus Berlin, Stadtrandstrasse 555, 13589, Berlin, Germany
| | - Raquel von Schumann
- Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
| | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany.,Department of Gynecology, University Hospital Leipzig, Liebeigstrasse 20A, 04103, Leipzig, Germany
| | - Cornelia Kolberg-Liedtke
- University Hospital Charité, Women's Clinic, Berlin, Charitéplatz 1, 10117, Berlin, Germany.,Department of Gynecology and Obstetrics, University Hospital Essen, Hufelandstrasse 55, 45147, Essen, Germany
| | - Nadia Harbeck
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Department of Gynecology and Obstetrics, Breast Center, University of Munich (LMU) and CCCLMU, Marchioninistrasse 15, 81377, Munich, Germany
| | - Christiane K Kuhl
- Department of Diagnostic and Interventional Radiology, Hospital of the University of Aachen, RWTH, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Ulrike Nitz
- West German Study Group, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany.,Ev. Hospital Bethesda, Breast Center Niederrhein, Ludwig-Weber-Strasse 15, 41061, Moenchengladbach, Germany
| |
Collapse
|
7
|
Wuerstlein R, Harbeck N, Grischke EM, Forstmeyer D, von Schumann R, Krabisch P, Lüdtke-Heckenkamp K, Stefek A, Stoetzer O, Grafe A, Kaltenecker G, Forstbauer H, Augustin D, Schrader I, Tio J, Nitz U, Gluz O, Kates RE, Graeser MK. Protroca: A Noninterventional Study on Prophylactic Lipegfilgrastim against Chemotherapy-Induced Neutropenia in Nonselected Breast Cancer Patients. Breast Care (Basel) 2021; 16:50-58. [PMID: 33716632 DOI: 10.1159/000506622] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 02/18/2020] [Indexed: 11/19/2022] Open
Abstract
Background Protroca evaluated the efficacy and safety of primary and secondary prophylaxis of neutropenia with lipegfilgrastim (Lonquex®) in breast cancer patients receiving neoadjuvant or adjuvant chemotherapy (CT). Patients and Methods Of the 255 patients enrolled, 248 patients were evaluable for the intent-to-treat (ITT) and 194 patients for the per-protocol set. Primary and secondary end points after lipegfilgrastim treatment were assessed. Results Nine patients of the ITT set receiving lipegfilgrastim as primary prophylaxis (n = 222) had febrile neutropenia of grade 3-4 (5 patients) or infection of grade 3-4 (4 patients); 1/26 of those receiving secondary prophylaxis had an event. Dose reductions were performed in 9.5% of the patients. Postponement of cancer CT cycles for >3 days occurred in <15% of patients; 10.8% (92/851 AEs) and 8% (2/25 SAEs) of documented adverse events and serious adverse events, respectively, were related to lipegfilgrastim. Conclusions Application of lipegfilgrastim was effective as primary and secondary prophylaxis in the prevention of CT-induced neutropenia in breast cancer.
Collapse
Affiliation(s)
- Rachel Wuerstlein
- Breast Center and CCC Munich, Department of Obstetrics and Gynecology, University of Munich (LMU), Munich, Germany.,West German Study Group, Mönchengladbach, Germany
| | - Nadia Harbeck
- Breast Center and CCC Munich, Department of Obstetrics and Gynecology, University of Munich (LMU), Munich, Germany.,West German Study Group, Mönchengladbach, Germany
| | | | - Dirk Forstmeyer
- University Clinic Leipzig, University Cancer Center Leipzig (UCCL), Leipzig, Germany
| | - Raquel von Schumann
- Evangelical Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany
| | | | | | - Andrea Stefek
- Johanniter Clinics Stendal, Breast Center Altmark, Stendal, Germany
| | - Oliver Stoetzer
- Medical Center for Hematology and Oncology Munich, Munich, Germany
| | | | | | | | - Doris Augustin
- Donau-Isar Clinic Deggendorf, Breast Center, Deggendorf, Germany
| | - Iris Schrader
- Gynecological Oncological Practice Hanover, Hanover, Germany
| | - Joke Tio
- University Clinic Münster, Breast Center, Münster, Germany
| | - Ulrike Nitz
- West German Study Group, Mönchengladbach, Germany.,Evangelical Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany
| | - Oleg Gluz
- West German Study Group, Mönchengladbach, Germany.,Evangelical Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany.,University Hospital Cologne, Cologne, Germany
| | | | - Monika Karla Graeser
- West German Study Group, Mönchengladbach, Germany.,Evangelical Hospital Bethesda, Breast Center Niederrhein, Mönchengladbach, Germany
| |
Collapse
|
8
|
Kuemmel S, Gluz O, Nitz U, Braun M, Christgen M, Luedtke-Heckenkamp K, von Schumann R, Darsow M, Forstbauer H, Potenberg J, Grischke EM, Aktas B, Schumacher C, Kates R, Graeser M, Wuerstlein R, Uleer C, Hauptmann M, Shak S, Baehner R, Kreipe H, Harbeck N. Abstract GS4-03: Neoadjuvant nab-paclitaxel weekly versus dose-dense paclitaxel followed by dose-dense EC in high risk HR+/HER2- early BC by: Results from the neoadjuvant part of ADAPT HR+/HER2- trial. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-gs4-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Pathological complete response (pCR) is associated with improved outcome in patients with high-risk HR+/HER2- breast cancer (BC) but the use of (neo)adjuvant chemotherapy in early HR+/HER2- BC remains controversial. Oncotype DX / Recurrence Score (RS) and dynamic Ki67 response after short preoperative endocrine therapy are potentially predictive for pCR. Still, no prospective data are available so far to predict chemotherapy efficacy in this key patient group. Use of dose-dense chemotherapy is associated with improved outcome in meta-analysis, but its use in the neoadjuvant setting is less studied. Furthermore, use of nab-paclitaxel instead of solvent-based paclitaxel has shown promising results in some studies. Here, we present for the first time data from a randomized prospective trial comparing these risk-selection strategies according to RS and Ki67 decrease in high-risk HR+/HER2- BC. Methods: High-risk BC patients [cN0-1 with RS>25 or (RS 12-25 AND (centrally measured) post-endocrine Ki67 >10%] OR [cN2-3 status] OR [G3 AND Ki67>40%] were randomized to (neo)adjuvant 4x paclitaxel175 q2w or 8xnab-paclitaxel 125 mg/m2q1w followed by 4x E90C600 q2w. pCR was defined as no invasive tumor in breast and lymph nodes. Results: 858 patients with available surgery data randomized to neoadjuvant Pac-EC (N=423) or nab-Pac-EC (N=435) were analyzed. Median age was 51 years; median RS was 30 (N=572); 34% had node-positive; 46% (locally) G3 tumors. Baseline characteristics were well balanced between study arms. Patients receiving nab-Pac-EC had higher pCR than those with Pac-EC (20.3% vs. 12.3%, p=.002); patients with RS<25 (about 27%) had a lower pCR rate than those with RS>25 (6.5% vs. 15.8%, p=.003). The association of RS with pCR appeared more pronounced in premenopausal women, but a test of interaction was not significant; RS was about 3 points higher (mean 32.9 vs. 29.8, p<.001) in postmenopausal cases (p=.001). Clinical tumor stage cT2-4 was reported in 65%, with a lower pCR rate than in cT1 tumors (14% vs. 20%, p=.02). RS was moderately correlated (R=.45) with baseline Ki67. In multivariable analysis with tumor stage, RS, Ki67, menopausal status, and ER and PR positivity, higher RS and cT1 stage were favorable for pCR. Excluding RS, higher Ki67 and lower ER (as well as cT1) were favorable. In patients with RS<25, there was no pCR with Pac-EC (0/72 pCR); pCR was almost 20% with RS>25 and nab-Pac-EC. Further details and data including impacts of Ki67 dynamics and additional markers on pCR will be presented at the meeting. Conclusions: Use of neoadjuvant nab-paclitaxel instead of solvent-based paclitaxel appears promising within a short (16-weeks) dose-dense chemotherapy schedule in high-risk HR+/HER2- BC. For the first time, data from a large neoadjuvant randomized trial confirm RS could help to select patients for neoadjuvant chemotherapy in high-risk HR+/HER2- breast cancer (BC).
Citation Format: Sherko Kuemmel, Oleg Gluz, Ulrike Nitz, Michael Braun, Matthias Christgen, Kerstin Luedtke-Heckenkamp, Raquel von Schumann, Maren Darsow, Helmut Forstbauer, Jochem Potenberg, Eva-Maria Grischke, Bahriye Aktas, Claudia Schumacher, Ronald Kates, Monika Graeser, Rachel Wuerstlein, Christoph Uleer, Michael Hauptmann, Steve Shak, Rick Baehner, Hans Kreipe, Nadia Harbeck, West German Study Group. Neoadjuvant nab-paclitaxel weekly versus dose-dense paclitaxel followed by dose-dense EC in high risk HR+/HER2- early BC by: Results from the neoadjuvant part of ADAPT HR+/HER2- trial [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS4-03.
Collapse
Affiliation(s)
- Sherko Kuemmel
- 1Breast Unit, Clinics Essen-Mitte, Essen and West German Study Group, Essen, Germany
| | - Oleg Gluz
- 2Breast Center Niederrhein, Johanniter Bethesda Moenchengladbach and West German Study Group and University of Cologne, Moenchengaldbach, Germany
| | - Ulrike Nitz
- 3Breast Center Niederrhein, Johanniter Bethesda Moenchengladbach and West German Study Group, Moenchengladbach, Germany
| | | | - Matthias Christgen
- 5Medical College of Hannover, Institute for Pathology, Hannover, Germany
| | | | - Raquel von Schumann
- 7Breast Center Niederrhein, Johanniter Bethesda Moenchengladbach, Moenchengladbach, Germany
| | - Maren Darsow
- 8Luisenhospital Duesseldorf, Practice for Senologic Oncology, Duesseldorf, Germany
| | | | | | | | - Bahriye Aktas
- 12University Clinics Leipzig, Women’s Clinic, Leipzig, Germany
| | | | - Ronald Kates
- 14West German Study Group, Moenchengladbach, Germany
| | - Monika Graeser
- 3Breast Center Niederrhein, Johanniter Bethesda Moenchengladbach and West German Study Group, Moenchengladbach, Germany
| | - Rachel Wuerstlein
- 15Breast Center, Dept. OB&GYN and CCCLMU, LMU University Hospital, Munich, Germany
| | | | | | - Steve Shak
- 18Genomic Health, Inc., Redwood City, CA
| | | | - Hans Kreipe
- 5Medical College of Hannover, Institute for Pathology, Hannover, Germany
| | - Nadia Harbeck
- 15Breast Center, Dept. OB&GYN and CCCLMU, LMU University Hospital, Munich, Germany
| | | |
Collapse
|
9
|
Gluz O, Nitz U, Christgen M, Kuemmel S, Holtschmidt J, Priel J, Hartkopf A, Potenberg J, Luedtke-Heckenkamp K, Just M, Wuelfing P, von Schumann R, Graeser M, Wuerstlein R, Kates RE, Kreipe HH, Harbeck N. De-escalated chemotherapy versus endocrine therapy plus pertuzumab+ trastuzumab for HR+/HER2+ early breast cancer (BC): First efficacy results from the neoadjuvant WSG-TP-II study. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.515] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
515 Background: HR+/HER2+ breast cancer (BC) is a distinct entity associated with better prognosis compared to HR-/HER2+ BC. However, combination of chemotherapy (CT) with (dual) anti-HER2 blockade is standard in HER2+ early BC (EBC), irrespective of HR-status. Despite of some promising data on combination of endocrine therapy (ET) with dual anti-HER2 blockade in EBC and metastatic HR+/HER2+ BC, no prospective comparison of neoadjuvant CT vs. ET + dual HER2-blockade has yet been performed. Methods: In the prospective WSG TP-II phase II-trial (NCT03272477; Sponsor: Palleos GmbH, Wiesbaden, Germany), 207 patients (pts) (257 screened; 40 centers) with centrally confirmed HR+/HER2+ EBC were randomized to 12 weeks of standard ET (n=100) vs. paclitaxel 80 mg/m2 weekly (n=107) +trastuzumab+pertuzumab q3w for all pts. Primary endpoint was pCR (ypT0/is/ypN0). Secondary endpoints include safety, disease-free and overall survival, translational research, and quality of life (QoL). Omission of further CT was allowed in all pts with pCR; dual HER2-blockade was administered in the adjuvant setting in all pts. Results: Baseline characteristics were well balanced between the arms. Median age was 53 years; 58% had cT2-4, 28% had cN+; 43% had G3 tumors. pCR data were available in 198 pts (ET: n=96; Pac: n=102). pCR was observed in 24% (95% CI: 16-34%) with ET+T+P vs. 57% (95% CI:47-67%) with Pac+T+P (OR 0.24, 95% CI: 0-0.46, p<0.001). In multivariable logistic regression analysis and corresponding sensitivity analysis (bootstrap/subsample inclusion frequencies and lasso regression) including study arm, BMI, menopausal, cT, and cN status, histological grade, HER2-status, Ki67, ER, PR as continuous variables, only study arm and HER2 3+ status were significantly associated with pCR. Neoadjuvant treatment was well tolerated in both study arms and completed per protocol in 93/92 (ET+P+T/Pac+P+T) patients. Only 9/13 SAEs (ET+P+T/Pac+P+T) were reported during neoadjuvant therapy. PAM50 and QoL analysis are ongoing. Conclusions: WSG TP-II is the first randomized prospective trial comparing two neoadjuvant de-escalation treatments in HR+/HER2+ EBC. The excellent pCR rate of 57% after only 12 weeks of Pac+P+T was clearly superior to the still promising 24% pCR rate in pts treated by ET+P+T. In both arms, treatment efficacy was most pronounced in HER2 3+ tumors. Survival results need to be awaited before definite recommendations for a de-escalated regimen in HR+/HER2+ EBC can be made. Clinical trial information: 2016-005157-21 .
Collapse
Affiliation(s)
- Oleg Gluz
- Breast Center Niederrhein, University Clinics Cologne and West German Study Group, Moenchengladbach, Germany
| | - Ulrike Nitz
- West German Study Group/Breast Center Niederrhein, Moenchengladbach, Germany
| | | | | | | | - Jan Priel
- Palleos Healthcare GmbH, Wiesbaden, Germany
| | | | | | | | | | - Pia Wuelfing
- Mammazentrum Hamburg – Brustklinik am Krankenhaus Jerusalem, Hamburg, Germany
| | | | | | - Rachel Wuerstlein
- Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
| | | | | | - Nadia Harbeck
- Brustzentrum der Universität München (LMU), Munich, Germany
| |
Collapse
|
10
|
Kuemmel S, Gluz O, Christgen M, Potenberg J, Hackmann J, von Schumann R, Graeser M, Mangold M, Wuerstlein R, Kates R, Kreipe HH, Nitz U, Harbeck N. Abstract P2-16-05: Efficacy of response- and toxicity-guided neoadjuvant chemotherapy in elderly early breast cancer patients: Results of WSG ADAPT elderly sub-trial. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p2-16-05] [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
Introduction: More than 1/3 of early breast cancers (EBC) are diagnosed in women ≥ 70 years. Although polychemotherapy has been shown to be more effective than monochemotherapy also in these patients, only limited prospective data on efficacy of neoadjuvant therapy are available so far. Here, we present results of the prospective ADAPT Elderly sub-study from the WSG ADAPT umbrella protocol.
Methods: Patients ≥70 years with high-risk HR+/HER2- EBC (i.e. Recurrence Score (RS)>25 or RS 12-25 with post-endocrine Ki67 of >10% or ≥cN2) or HR-/HER2- EBC were treated by 2 cycles of liposomal doxorubicin (Myocet® 60 mg/m2)/cyclophosphamide 600 mg/m2 (MC). In case of clinical response by ultrasound (>50% reduction in the sum of two largest diameters) and no AE grade 3-4, patients received an additional 2 cycles MC, otherwise they were switched to 6 cycles of paclitaxel (80 mg/m2) weekly. A sample size of n=150 was planned to demonstrate non-inferiority of the response- and toxicity-guided regimen vs. 4 cycles MC in responding patients (25% assumed pCR). The study was stopped early due to slow recruitment.
Results: Between 09/2014 and 10/2015, 83 EBC patients from 31 centers were registered; 78 started with therapy (40 HR+/HER2-; 38 HR-/HER2-). Median age was 74 years. 64% had G3 tumors, 66% cT24, and 34% cN+. Median Ki67 was 40%. 75/78 pts underwent stratification after 2 cycles; 1 pt withdrew consent: 45(61%) were responders with no severe toxicities, 29 (39%) non-responders or suffered toxicity grade 3-4. Surgical information is available in 72 patients (43 responder/no toxicity, 29 no response/toxicity groups respectively). pCR was observed in 7 patients in the responder/no toxicity group (i.e. 16% irrespective of HR status) and in n=3 patients in the no response/toxicity group (10%). Updated efficacy and safety data will be presented at the meeting.
Discussion: In one of the largest neoadjuvant chemotherapy-studies specifically for elderly pts with HER2- EBC, we observed a lower than expected pCR rate after 4 cycles of anthracycline-containing neoadjuvant chemotherapy. Taxane-based standard chemotherapy may thus be preferable in this population. Nevertheless, neoadjuvant chemotherapy seems feasible in elderly pts with high-risk HER2- EBC and should further be explored in the context of potential pCR-based (de)escalation strategies.
Citation Format: Sherko Kuemmel, Oleg Gluz, Matthias Christgen, Jochem Potenberg, John Hackmann, Raquel von Schumann, Monika Graeser, Marina Mangold, Rachel Wuerstlein, Ronald Kates, Hans H. Kreipe, Ulrike Nitz, Nadia Harbeck, West German Study Group. Efficacy of response- and toxicity-guided neoadjuvant chemotherapy in elderly early breast cancer patients: Results of WSG ADAPT elderly sub-trial [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P2-16-05.
Collapse
Affiliation(s)
| | - Oleg Gluz
- 2West German Study Group and Breast Center Niederrhein Johanniter Clincs Moenchengladbach and University Hospital Cologne, Moenchengladbach, Germany
| | | | - Jochem Potenberg
- 4Ev. Waldkrankenhaus Spandau, Department of Oncology, Berlin, Germany
| | | | | | - Monika Graeser
- 7West German Study Group and Breast Center Niederrhein Johanniter Clinics, Moenchengladbach, Germany
| | | | - Rachel Wuerstlein
- 9Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
| | - Ronald Kates
- 8West German Study Group, Moenchengladbach, Germany
| | - Hans H. Kreipe
- 3Medical School Hannover, Institute of Pathology, Hannover, Germany
| | - Ulrike Nitz
- 7West German Study Group and Breast Center Niederrhein Johanniter Clinics, Moenchengladbach, Germany
| | - Nadia Harbeck
- 9Breast Center, Dept. OB&GYN, University of Munich (LMU) and CCCLMU, Munich, Germany
| | | |
Collapse
|
11
|
Gluz O, Nitz U, Liedtke C, Christgen M, Grischke EM, Forstbauer H, Braun M, Warm M, Hackmann J, Uleer C, Aktas B, Schumacher C, Bangemann N, Lindner C, Kuemmel S, Clemens M, Potenberg J, Staib P, Kohls A, von Schumann R, Kates R, Kates R, Schumacher J, Wuerstlein R, Kreipe HH, Harbeck N. Comparison of Neoadjuvant Nab-Paclitaxel+Carboplatin vs Nab-Paclitaxel+Gemcitabine in Triple-Negative Breast Cancer: Randomized WSG-ADAPT-TN Trial Results. J Natl Cancer Inst 2017; 110:628-637. [PMID: 29228315 DOI: 10.1093/jnci/djx258] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Accepted: 11/08/2017] [Indexed: 01/02/2023] Open
Affiliation(s)
- Oleg Gluz
- Moenchengladabach, West German Study Group
- Moenchengladbach, Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda
- University Clinics Cologne
| | - Ulrike Nitz
- Moenchengladabach, West German Study Group
- Moenchengladbach, Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda
| | - Cornelia Liedtke
- Department of Gynecology and Obstetrics, University Clinics Schleswig-Holstein/Campus Luebeck
| | | | | | | | | | - Mathias Warm
- Breast Center, City Hospital of Cologne Holweide
| | | | | | - Bahriye Aktas
- Department of Gynecology and Obstetrics, University Clinics Essen
- Department of Gynecology, University Hospital Leipzig
| | | | | | - Christoph Lindner
- Clinic of Gynecology, Charité University Clinics Berlin
- Department of Gynecology and Obstetrics, Agaplesion Diakonie Clinic
| | | | | | | | - Peter Staib
- Department of Oncology, St. Antonius Hospital
| | - Andreas Kohls
- Department of Gynecology and Obstetrics, Evangelical Hospital Ludwigsfelde
| | - Raquel von Schumann
- Moenchengladbach, Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda
| | | | | | | | - Rachel Wuerstlein
- Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| | | | - Nadia Harbeck
- Moenchengladabach, West German Study Group
- Breast Center, University of Munich (LMU) and CCCLMU, Munich, Germany
| |
Collapse
|
12
|
Harbeck N, Gluz O, Christgen M, Kates RE, Braun M, Küemmel S, Schumacher C, Potenberg J, Kraemer S, Kleine-Tebbe A, Augustin D, Aktas B, Forstbauer H, Tio J, von Schumann R, Liedtke C, Grischke EM, Schumacher J, Wuerstlein R, Kreipe HH, Nitz UA. De-Escalation Strategies in Human Epidermal Growth Factor Receptor 2 (HER2)–Positive Early Breast Cancer (BC): Final Analysis of the West German Study Group Adjuvant Dynamic Marker-Adjusted Personalized Therapy Trial Optimizing Risk Assessment and Therapy Response Prediction in Early BC HER2- and Hormone Receptor–Positive Phase II Randomized Trial—Efficacy, Safety, and Predictive Markers for 12 Weeks of Neoadjuvant Trastuzumab Emtansine With or Without Endocrine Therapy (ET) Versus Trastuzumab Plus ET. J Clin Oncol 2017; 35:3046-3054. [PMID: 28682681 DOI: 10.1200/jco.2016.71.9815] [Citation(s) in RCA: 91] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Human epidermal growth factor receptor 2 (HER2)–positive/hormone receptor (HR)–positive breast cancer is a distinct subgroup associated with lower chemotherapy sensitivity and slightly better outcome than HER2-positive/HR-negative disease. Little is known about the efficacy of the combination of endocrine therapy (ET) with trastuzumab or with the potent antibody-cytotoxic, anti-HER2 compound trastuzumab emtansine (T-DM1) with or without ET for this subgroup. The West German Study Group trial, ADAPT (Adjuvant Dynamic Marker-Adjusted Personalized Therapy Trial Optimizing Risk Assessment and Therapy Response Prediction in Early Breast Cancer) compares pathologic complete response (pCR) rates of T-DM1 versus trastuzumab with ET in early HER2-positive/HR-positive breast cancer. Patients and Methods In this prospective, neoadjuvant, phase II trial, 375 patients with early breast cancer with HER2-positive and HR-positive status (n = 463 screened) were randomly assigned to 12 weeks of T-DM1 with or without ET or to trastuzumab with ET. The primary end point was pCR (ypT0/is/ypN0). Early response was assessed in 3-week post-therapeutic core biopsies (proliferation decrease ≥ 30% Ki-67 or cellularity response). Secondary end points included safety and predictive impact of early response on pCR. Adjuvant therapy followed national standards. Results Baseline characteristics were well balanced among the arms. More than 90% of patients completed the therapy per protocol. pCR was observed in 41.0% of patients treated with T-DM1, 41.5% of patients treated with T-DM1 and ET, and 15.1% with trastuzumab and ET ( P < .001). Early responders (67% of patients with assessable response) achieved pCR in 35.7% compared with 19.8% in nonresponders (odds ratio, 2.2; 95% CI, 1.24 to 4.19). T-DM1 was associated with a significantly higher prevalence of grade 1 to 2 toxicities, especially thrombocytopenia, nausea, and elevation of liver enzymes. Overall toxicity was low; seventeen therapy-related severe adverse events (T-DM1 arms v trastuzumab plus ET; 5.3% v 3.1%, respectively) were reported. Conclusion The ADAPT HER2-positive/HR-positive trial demonstrates that neoadjuvant T-DM1 (with or without ET) given for only 12 weeks results in a clinically meaningful pCR rate. Thus, a substantial number of patients are spared the adverse effects of systemic chemotherapy.
Collapse
Affiliation(s)
- Nadia Harbeck
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Oleg Gluz
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Matthias Christgen
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Ronald Ernest Kates
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Michael Braun
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Sherko Küemmel
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Claudia Schumacher
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Jochem Potenberg
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Stefan Kraemer
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Anke Kleine-Tebbe
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Doris Augustin
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Bahriye Aktas
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Helmut Forstbauer
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Joke Tio
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Raquel von Schumann
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Cornelia Liedtke
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Eva-Maria Grischke
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Johannes Schumacher
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Rachel Wuerstlein
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Hans Heinrich Kreipe
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| | - Ulrike Anneliese Nitz
- Nadia Harbeck, Ludwig Maximilians University Hospital of Munich; Michael Braun, Red Cross Hospital Munich; Rachel Wuerstlein, University Hospital Munich, Munich; Nadia Harbeck, Oleg Gluz, Ronald Ernest Kates, Rachel Wuerstlein, and Ulrike Anneliese Nitz, The West German Study Group; Oleg Gluz, Raquel von Schumann, and Ulrike Anneliese Nitz, Evangelical Hospital Bethesda, Mönchengladbach; Matthias Christgen and Hans Heinrich Kreipe, Hannover Medical School, Hannover; Sherko Küemmel, Kliniken Essen-Mitte
| |
Collapse
|
13
|
Nitz U, Gluz O, von Schumann R, Hofmann D, Kates RE, Kuemmel S, Braun M, Schumacher C, Nuding B, Aktas B, Forstbauer H, Maass N, Rezai M, Kraemer S, Warm M, Wuerstlein R, Harbeck N. Abstract OT3-2-04: ADAPT - Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early breast cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-ot3-2-04] [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: Early therapy response is currently not regarded for further treatment decisions as standard of care in the treatment of breast cancer (BC). Predictive markers for the success of a certain therapy could support the physician’s choice of adequate and beneficial therapies by simultaneous reduction of unnecessary toxicity. Proliferation makers as Ki-67 seem to be a suitable tool, as dynamic changes of proliferation (as result of induction therapy) have been shown to be most important for outcome of neoadjuvant chemotherapy prediction in patients with pCR in distinct BC subtypes (luminal B, TNBC, HER2+).
Methods: Trial design: ADAPT combines early assessment of prognosis by conventional markers (e.g. molecular classification, nodal status) with dynamic measurement of proliferation changes during a 3-week induction therapy, using baseline diagnostic core biopsy and a second biopsy after induction therapy. ADAPT consists of an umbrella trial and five different sub-trials (HR+/HER2-, HR+/HER2+, HR-/HER2+, HR-/HER2-, Elderly) and is set up as prospective, multi-center, controlled, non-blinded, randomized phase II/III trial.
Subtype-specific treatment across the sub-trials is highly innovative and involves the following treatment strategies:
• HR+/HER2-: endocrine therapy (ET) vs. chemotherapy (4xPac q2w – 4xEC q2w vs. 8xNab-Pac q1w – 4xEC q2w) + ET, depending on risk classification/early response.
• HER2+/HR+: T-DM1 vs. T-DM1 + ET vs. trastuzumab + ET.
• HER2+/HR-: Trastuzumab + Pertzumab ± Paclitaxel q1w.
• TN: Nab-Paclitaxel + Gemcitabine vs. nab-Pac + Carboplatin.
• Elderly: 2xMyocet + Cyclophosphamide q3w, depending on cPR/cCR or NC/toxicity the treatment will be continued for two more cycles or changed to 6xPac q1w.
Adaptation/change in therapy regimens can be made by interim analysis after n=130 in each sub-trial.
Eligibility criteria: Histologically confirmed unilateral primary invasive BC with known HR-/HER2-status (central pathology) for allocation to the respective sub-trial. Pts requiring chemo- or targeted (anti-HER2) therapy must have adequate laboratory values and organ function and must have no contraindications for the planned treatment.
Primary endpoints: Evaluation of dynamic test for outcome prediction/prospective comparison of 5yr EFS in responders (intermediate risk (RS 12-25) / good response to short-term ET in HR+/HER2- or pts with pCR in HER2+/TN BC) compared to low risk HR+/HER2- (RS≤11, N0-1) pts (control group).
Statistical methods: Assumption across sub-protocols: adjuvant CTx can be spared in HR+/HER2- or pCR be achieved in HER2+/TN in expected 1120 (HR+/HER2-) or 170 (HER2+/TN) pts, respectively. Outcome will be compared to the control group (expected n=640 HR+/HER2- pts: low risk (by RS), i.e. no CTx). Assuming 94% 5yr survival in control group, one-sided test of non-inferiority at 95% CI will have 80% power for survival non-inferiority margin of 3.2% (i.e. 90.8% survival).
Present and target accrual: By June 2014, 73 active sites have recruited 1820 pts for ADAPT HR+/HER2-. Target accrual is 4000 pts. 190 of 380 pts were successfully randomized for ADAPT HER2+/HR+. ADAPT HER2+/HR- has included 17 of 220 pts and ADAPT Triple Negative has recruited 150 of 336 pts.
Citation Format: Ulrike Nitz, Oleg Gluz, Raquel von Schumann, Daniel Hofmann, Ronald E Kates, Sherko Kuemmel, Michael Braun, Claudia Schumacher, Benno Nuding, Bahriye Aktas, Helmut Forstbauer, Nicolai Maass, Mahdi Rezai, Stefan Kraemer, Mathias Warm, Rachel Wuerstlein, Nadia Harbeck. ADAPT - Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr OT3-2-04.
Collapse
Affiliation(s)
- Ulrike Nitz
- 1West German Study Group
- 2Ev. Bethesda Hospital, Breast Center Niederrhein
| | - Oleg Gluz
- 1West German Study Group
- 2Ev. Bethesda Hospital, Breast Center Niederrhein
| | | | | | | | - Sherko Kuemmel
- 3Clinics Essen-Mitte, Clinics for Senology/Breast Center
| | | | | | | | | | | | | | - Mahdi Rezai
- 10LuisenHospital Duesseldorf, Practice for Senologic Oncology
| | | | - Mathias Warm
- 12Clinics Cologne – Holweide Hospital, Breast Center
| | - Rachel Wuerstlein
- 1West German Study Group
- 13University Hospital Munich, Breast Center, CCC of LMU
| | - Nadia Harbeck
- 1West German Study Group
- 13University Hospital Munich, Breast Center, CCC of LMU
| |
Collapse
|