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Turner NC, Swift C, Jenkins B, Kilburn L, Coakley M, Beaney M, Fox L, Goddard K, Garcia-Murillas I, Proszek P, Hall P, Harper-Wynne C, Hickish T, Kernaghan S, Macpherson IR, Okines AFC, Palmieri C, Perry S, Randle K, Snowdon C, Stobart H, Wardley AM, Wheatley D, Waters S, Winter MC, Hubank M, Allen SD, Bliss JM. Results of the c-TRAK TN trial: a clinical trial utilising ctDNA mutation tracking to detect molecular residual disease and trigger intervention in patients with moderate- and high-risk early-stage triple-negative breast cancer. Ann Oncol 2023; 34:200-211. [PMID: 36423745 DOI: 10.1016/j.annonc.2022.11.005] [Citation(s) in RCA: 33] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 11/04/2022] [Accepted: 11/08/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Post-treatment detection of circulating tumour DNA (ctDNA) in early-stage triple-negative breast cancer (TNBC) patients predicts high risk of relapse. c-TRAK TN assessed the utility of prospective ctDNA surveillance in TNBC and the activity of pembrolizumab in patients with ctDNA detected [ctDNA positive (ctDNA+)]. PATIENTS AND METHODS c-TRAK TN, a multicentre phase II trial, with integrated prospective ctDNA surveillance by digital PCR, enrolled patients with early-stage TNBC and residual disease following neoadjuvant chemotherapy, or stage II/III with adjuvant chemotherapy. ctDNA surveillance comprised three-monthly blood sampling to 12 months (18 months if samples were missed due to coronavirus disease), and ctDNA+ patients were randomised 2 : 1 to intervention : observation. ctDNA results were blinded unless patients were allocated to intervention, when staging scans were done and those free of recurrence were offered pembrolizumab. A protocol amendment (16 September 2020) closed the observation group; all subsequent ctDNA+ patients were allocated to intervention. Co-primary endpoints were (i) ctDNA detection rate and (ii) sustained ctDNA clearance rate on pembrolizumab (NCT03145961). RESULTS Two hundred and eight patients registered between 30 January 2018 and 06 December 2019, 185 had tumour sequenced, 171 (92.4%) had trackable mutations, and 161 entered ctDNA surveillance. Rate of ctDNA detection by 12 months was 27.3% (44/161, 95% confidence interval 20.6% to 34.9%). Seven patients relapsed without prior ctDNA detection. Forty-five patients entered the therapeutic component (intervention n = 31; observation n = 14; one observation patient was re-allocated to intervention following protocol amendment). Of patients allocated to intervention, 72% (23/32) had metastases on staging at the time of ctDNA+, and 4 patients declined pembrolizumab. Of the five patients who commenced pembrolizumab, none achieved sustained ctDNA clearance. CONCLUSIONS c-TRAK TN is the first prospective study to assess whether ctDNA assays have clinical utility in guiding therapy in TNBC. Patients had a high rate of metastatic disease on ctDNA detection. Findings have implications for future trial design, emphasising the importance of commencing ctDNA testing early, with more sensitive and/or frequent ctDNA testing regimes.
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Affiliation(s)
- N C Turner
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK; Breast Unit, The Royal Marsden Hospital, London, UK.
| | - C Swift
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - B Jenkins
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - L Kilburn
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - M Coakley
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - M Beaney
- The Institute of Cancer Research, London, UK
| | - L Fox
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - K Goddard
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - P Proszek
- NIHR Centre for Molecular Pathology, Royal Marsden Hospital, London, UK
| | - P Hall
- University of Edinburgh, Edinburgh, UK
| | - C Harper-Wynne
- Maidstone Hospital, Maidstone and Tunbridge Wells NHS Trust, Maidstone, UK
| | - T Hickish
- University Hospitals Dorset NHS Foundation Trust, Bournemouth, UK
| | - S Kernaghan
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | | | - A F C Okines
- Breast Unit, The Royal Marsden Hospital, London, UK
| | - C Palmieri
- Clatterbridge Cancer Centre NHS Trust, Liverpool, Wirral, UK
| | - S Perry
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - K Randle
- Independent Cancer Patients' Voice, London, UK
| | - C Snowdon
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - H Stobart
- Independent Cancer Patients' Voice, London, UK
| | - A M Wardley
- Outreach Research & Innovation Group Ltd, Manchester, UK
| | - D Wheatley
- Royal Cornwall Hospitals NHS Trust, Truro, UK
| | - S Waters
- Velindre Cancer Centre, Velindre University NHS Trust, Cardiff, UK
| | - M C Winter
- Sheffield Teaching Hospitals NHS Foundation Trust, Weston Park Hospital, Sheffield, UK
| | - M Hubank
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - S D Allen
- The Royal Marsden NHS Foundation Trust, Sutton, Surrey, UK
| | - J M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
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Kingston B, Cutts R, Beaney M, Walsh-Crestani G, Hrebien S, Kilburn L, Kernaghan S, Moretti L, Wilkinson K, MacPherson I, Baird R, Roylance R, Reis-Filho J, Hubank M, Faull I, Banks K, Garcia-Murillas I, Bliss J, Ring A, Turner N. 99P Analysis of ctDNA in advanced breast cancer reveals polyclonal disease associated with adverse outcome. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Sipos O, Tovey H, Quist J, Haider S, Nowinski S, Gazinska P, Kernaghan S, Toms C, Maguire S, Orr N, Linn SC, Owen J, Gillett C, Pinder SE, Bliss JM, Tutt A, Cheang MCU, Grigoriadis A. Assessment of structural chromosomal instability phenotypes as biomarkers of carboplatin response in triple negative breast cancer: the TNT trial. Ann Oncol 2021; 32:58-65. [PMID: 33098992 PMCID: PMC7784666 DOI: 10.1016/j.annonc.2020.10.475] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 08/05/2020] [Accepted: 10/13/2020] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In the TNT trial of triple negative breast cancer (NCT00532727), germline BRCA1/2 mutations were present in 28% of carboplatin responders. We assessed quantitative measures of structural chromosomal instability (CIN) to identify a wider patient subgroup within TNT with preferential benefit from carboplatin over docetaxel. PATIENTS AND METHODS Copy number aberrations (CNAs) were established from 135 formalin-fixed paraffin-embedded primary carcinomas using Illumina OmniExpress SNP-arrays. Seven published [allelic imbalanced CNA (AiCNA); allelic balanced CNA (AbCNA); copy number neutral loss of heterozygosity (CnLOH); number of telomeric allelic imbalances (NtAI); BRCA1-like status; percentage of genome altered (PGA); homologous recombination deficiency (HRD) scores] and two novel [Shannon diversity index (SI); high-level amplifications (HLAMP)] CIN-measurements were derived. HLAMP was defined based on the presence of at least one of the top 5% amplified cytobands located on 1q, 8q and 10p. Continuous CIN-measurements were divided into tertiles. All nine CIN-measurements were used to analyse objective response rate (ORR) and progression-free survival (PFS). RESULTS Patients with tumours without HLAMP had a numerically higher ORR and significantly longer PFS in the carboplatin (C) than in the docetaxel (D) arm [56% (C) versus 29% (D), PHLAMP,quiet = 0.085; PFS 6.1 months (C) versus 4.1 months (D), Pinteraction/HLAMP = 0.047]. In the carboplatin arm, patients with tumours showing intermediate telomeric NtAI and AiCNA had higher ORR [54% (C) versus 20% (D), PNtAI,intermediate = 0.03; 62% (C) versus 33% (D), PAiCNA,intermediate = 0.076]. Patients with high AiCNA and PGA had shorter PFS in the carboplatin arm [3.4 months (high) versus 5.7 months (low/intermediate); and 3.8 months (high) versus 5.6 months (low/intermediate), respectively; Pinteraction/AiCNA = 0.027, Padj.interaction/AiCNA = 0.125 and Pinteraction/PGA = 0.053, Padj.interaction/PGA = 0.176], whilst no difference was observed in the docetaxel arm. CONCLUSIONS Patients with tumours lacking HLAMP and demonstrating intermediate CIN-measurements formed a subgroup benefitting from carboplatin relative to docetaxel treatment within the TNT trial. This suggests a complex and paradoxical relationship between the extent of genomic instability in primary tumours and treatment response in the metastatic setting.
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Affiliation(s)
- O Sipos
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - H Tovey
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - J Quist
- Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - S Haider
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Nowinski
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - P Gazinska
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK
| | - S Kernaghan
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - C Toms
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - S Maguire
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - N Orr
- Patrick G Johnston Centre for Cancer Research, Queen's University Belfast, Belfast, UK
| | - S C Linn
- Division of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - J Owen
- King's Health Partners Cancer Biobank, London, UK
| | - C Gillett
- King's Health Partners Cancer Biobank, London, UK
| | - S E Pinder
- School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - J M Bliss
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - A Tutt
- Breast Cancer Now Toby Robins Research Centre, The Institute of Cancer Research, London, UK; Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK
| | - M C U Cheang
- Clinical Trials and Statistics Unit, The Institute of Cancer Research, London, UK
| | - A Grigoriadis
- Breast Cancer Now Unit, King's College London Faculty of Life Sciences and Medicine, London, UK; School of Cancer and Pharmaceutical Sciences, King's College London Faculty of Life Sciences and Medicine, London, UK.
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Sipos O, Tovey H, Quist J, Haider S, Nowinski S, Gazinska P, Kernaghan S, Toms C, Timms KM, Lanchbury JS, Linn SC, Pinder SE, Bliss JM, Tutt A, Cheang MC, Grigoriadis A. Abstract P1-06-07: Characterization of chromosomal instability in the TNT trial: A randomized phase III trial of carboplatin compared with docetaxel for patients with metastatic or recurrent locally advanced triple negative or BRCA1/2 breast cancer (CRUK/07/012). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p1-06-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
A distinctive trait of triple negative breast cancer (TNBC) is the acquisition of genome wide highly aberrant copy number states, which is more evident in metastatic settings. The level of copy number alterations can be characterized by quantitative estimates of chromosomal instability, such as allelic imbalanced copy number aberrations, telomeric allelic imbalance (NtAI), homologous recombination deficiency (HRD) score, referred here as genomic scars. Several of these scars are reported as being indicative of BRCAness and potential predictive and/or prognostic biomarkers of chemotherapy response, currently mostly demonstrated in neoadjuvant settings in TNBC.
Aims
Using several genomic scar measures, we aim to capture chromosomal instability and test their predictive and prognostic value in metastatic or recurrent locally advanced triple negative or BRCA1/2 mutated breast cancer in the TNT trial.
Methods
Patients recruited to TNT (n=376) had ER-/PR-/Her2- breast cancer or were germline BRCA mutation carriers. Genome-wide copy numbers (CN) were derived from FFPE samples including primary tumours and positive lymph nodes (n=183, docetaxel=93, carboplatin=90; BRCA1 mut=25). Genomic scars were generated using ASCAT (Van loo et al., PNAS 2010) CN profiles. HRD scores were established by Myriad Genetics, Inc. assay (n=272). BRCA1-like classifier was applied as described in Schouten et al., Mol Onc 2015. Shannon diversity index was calculated using ASCAT raw CN profiles. Association of genomic scars with PAM50 subtypes and BRCA1 deficiency status were evaluated using Kruskal-Wallis test; p-values were adjusted for multiple comparisons (Dunn's test). Statistical significance was defined as p<0.05. Association of genomic scars with objective tumour response rate (ORR) and Progression Free Survival (PFS) was assessed using logistic regression and restricted mean survival analysis, respectively.
Results
HRD and NtAI scores were higher in basal like samples compared to non-basal like (median diff. HRD=11.5, p=0.005; NtAI=3, p=0.04). HRD (p=2e-14) and NtAI (p=0.003) scores were also higher in BRCA1 deficient (BRCA1 germline/somatic mutant or BRCA1 methylated) samples compared to non-deficient. Using the BRCA1-like classifier, 42 out of 50 BRCA1 deficient samples and 93 out of 133 BRCA1 non-deficient/undetermined samples were identified as BRCA1-like. The Shannon diversity index, measuring CN heterogeneity, clustered samples into 3 groups. Analysis of ORR showed non-significant trends to preferential response rates with docetaxel in cluster 1 and 3. Membership of cluster 2 predicted higher ORR to carboplatin over docetaxel (interaction p=0.017). PFS indicated a treatment effect in cluster 2, but not in cluster 1 or 3; there was no evidence of interaction between subgroups and treatment (p=0.15).
Conclusions
Our results suggest that the overall heterogeneity of the copy number landscape is a promising area for seeking predictive/prognostic biomarkers in metastatic TNBC, and combined with other modalities of high-dimensional omics data could provide essential treatment response information.
Citation Format: Sipos O, Tovey H, Quist J, Haider S, Nowinski S, Gazinska P, Kernaghan S, Toms C, Timms KM, Lanchbury JS, Linn SC, Pinder SE, Bliss JM, Tutt A, Cheang MC, Grigoriadis A, On behalf of the TNT Trial Management Group and Investigators. Characterization of chromosomal instability in the TNT trial: A randomized phase III trial of carboplatin compared with docetaxel for patients with metastatic or recurrent locally advanced triple negative or BRCA1/2 breast cancer (CRUK/07/012) [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P1-06-07.
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Affiliation(s)
- O Sipos
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - H Tovey
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - J Quist
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - S Haider
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - S Nowinski
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - P Gazinska
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - S Kernaghan
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - C Toms
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - KM Timms
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - JS Lanchbury
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - SC Linn
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - SE Pinder
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - JM Bliss
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - A Tutt
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - MC Cheang
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
| | - A Grigoriadis
- The Institute of Cancer Research, The Breast Cancer Now Toby Robins Research Centre, London, United Kingdom; The Institute of Cancer Research, Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Breast Cancer Now Research Unit, Cancer Bioinformatics, London, United Kingdom; King's College London, Faculty of Life Sciences and Medicine, School of Cancer & Pharmaceutical Sciences, Cancer Bioinformatics, London, United Kingdom; Myriad Genetics, Inc., Salt Lake City, UT; Netherlands Cancer Institute, Amsterdam, Netherlands; King's College London, King's Health Partners Cancer Biobank, London, United Kingdom
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Turner N, Bye H, Kernaghan S, Proszek P, Fribbens C, Moretti L, Morden J, Snowdon C, Macpherson I, Wardley A, Roylance R, Baird R, Bliss J, Ring A. Abstract OT1-06-03: The plasmaMATCH trial: A multiple parallel cohort, open-label, multi-centre phase II clinical trial of ctDNA screening to direct targeted therapies in patients with advanced breast cancer (CRUK/15/010). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-06-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction
Circulating tumour DNA (ctDNA) is found in the plasma of over 90% of patients with advanced breast cancer (BC). Screening for the presence of mutations in ctDNA provides a current assessment of the genetic profile of the patient's recurrent BC. The plasmaMATCH trial is designed to assess the potential of ctDNA screening to direct targeted therapies in patients with advanced breast cancer.
Methods
plasmaMATCH is a multi-centre phase IIa umbrella trial platform of ctDNA screening and a therapeutic trial. The study will screen 1000 women with advanced breast cancer, who have received prior systemic treatment in the advanced setting, with digital PCR ctDNA assays for hotspot mutations in ESR1, HER2, AKT1, and PIK3CA, with HER2 copy number assessment, in a central laboratory. The study will recruit from up to 50 sites in the UK. Patients with mutations identified will enter the matching treatment cohort, ESR1 – extended dose fulvestrant 500mg every two weeks, HER2 – neratinib +/- fulvestrant, AKT1 – AZD5363 +/- fulvestrant.
Mutation prevalence is presented with corresponding exact 95% confidence intervals (CIs) both overall and excluding 14 patients who were known to have mutations from a prior screening program. Patients with more than one mutation are included once in each relevant row.
Results
We report the results of prospective ctDNA mutation testing in the first 92 patients. plasmaMATCH opened to recruitment on 15/12/2016. As of 08/06/2017, 120 patients have been registered for ctDNA screening from 7 UK centres, of which 92 have ctDNA screening results available:
plasmaMATCH ctDNA screening resultsMutationPrevalence (95% CI)Prevalence excluding 14 patients with known mutations (95% CI)ESR134/92: 37% (27%-48%)26/78: 33% (23%-45%)HER25/90: 6% (2%-12%)2/76: 3% (0%-9%)AKT17/92: 8% (3%-15%)4/78: 5% (1%-13%)PIK3CA*22/92: 24% (16%-34%)21/78: 27% (18%-38%)*No corresponding plasmaMATCH treatment cohort
14 patients had more than one mutation detected (10 ESR1+PIK3CA, 3 ESR1+AKT1, 1 ESR1+ +HER2+AKT1). ctDNA results were reported in a median of 8 working days.
Of the 40 patients with one or more actionable mutation, 15 have entered a cohort, 16 are being screened for entry into a cohort, 5 are currently receiving further systemic treatment prior to cohort entry and 4 will not enter a cohort. One additional patient has entered a treatment cohort on the basis of a mutation detected in an alternative tumour sequencing initiative.
Conclusions
plasmaMATCH ctDNA demonstrates the feasibility and accuracy of ctDNA testing as a screening tool for patients with advanced BC, with a high rate of subsequent recruitment into matching therapeutic trials.
Citation Format: Turner N, Bye H, Kernaghan S, Proszek P, Fribbens C, Moretti L, Morden J, Snowdon C, Macpherson I, Wardley A, Roylance R, Baird R, Bliss J, Ring A. The plasmaMATCH trial: A multiple parallel cohort, open-label, multi-centre phase II clinical trial of ctDNA screening to direct targeted therapies in patients with advanced breast cancer (CRUK/15/010) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-06-03.
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Affiliation(s)
- N Turner
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - H Bye
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - S Kernaghan
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - P Proszek
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - C Fribbens
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - L Moretti
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - J Morden
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - C Snowdon
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - I Macpherson
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - A Wardley
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - R Roylance
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - R Baird
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - J Bliss
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
| | - A Ring
- The Institute of Cancer Research, London, United Kingdom; The Royal Marsden NHS Foundation Trust, London, United Kingdom; The Institute of Cancer Research Clinical Trials & Statistics Unit (ICR-CTSU), London, United Kingdom; The Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; The Christie NHS Foundation Trust, Manchester, United Kingdom; NIHR University College London Hospitals Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, United Kingdom; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom; The Royal Marsden NHS Foundation Trust, Sutton, United Kingdom
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Giloth B, Kernaghan S. Health promotion sparks community service initiatives. Trustee 1991; 44:10-1, 24. [PMID: 10109379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
Affiliation(s)
- B Giloth
- American Hospital Association, Chicago, IL
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Kernaghan S. Allied health education still plagued by growing pains--Part 2. Respir Care 1978; 23:693-6. [PMID: 10314922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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