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Loibl S, André F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, Cardoso MJ, Carey LA, Dawood S, Del Mastro L, Denkert C, Fallenberg EM, Francis PA, Gamal-Eldin H, Gelmon K, Geyer CE, Gnant M, Guarneri V, Gupta S, Kim SB, Krug D, Martin M, Meattini I, Morrow M, Janni W, Paluch-Shimon S, Partridge A, Poortmans P, Pusztai L, Regan MM, Sparano J, Spanic T, Swain S, Tjulandin S, Toi M, Trapani D, Tutt A, Xu B, Curigliano G, Harbeck N. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:159-182. [PMID: 38101773 DOI: 10.1016/j.annonc.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- S Loibl
- GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology, Bethanien, Frankfurt, Germany
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Cancer Campus, Villejuif
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - C H Barrios
- Oncology Department, Latin American Cooperative Oncology Group and Oncoclínicas, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet and Breast Cancer Centre, Karolinska Comprehensive Cancer Centre and University Hospital, Stockholm, Sweden
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Foundation, Champalimaud Cancer Centre, Lisbon; Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - L A Carey
- Division of Medical Oncology, The University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - S Dawood
- Department of Oncology, Mediclinic City Hospital, Dubai, UAE
| | - L Del Mastro
- Medical Oncology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Internal Medicine and Medical Specialities, School of Medicine, University of Genoa, Genoa, Italy
| | - C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Giessen and Marburg, Marburg
| | - E M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H Gamal-Eldin
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - K Gelmon
- Department of Medical Oncology, British Columbia Cancer, Vancouver, Canada
| | - C E Geyer
- Department of Internal Medicine, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA
| | - M Gnant
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Oncology 2 Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S B Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Martin
- Hospital General Universitario Gregorio Maranon, Universidad Complutense, GEICAM, Madrid, Spain
| | - I Meattini
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence; Department of Experimental and Clinical Biomedical Sciences 'M. Serio', University of Florence, Florence, Italy
| | - M Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - W Janni
- Department of Obstetrics and Gynaecology, University of Ulm, Ulm, Germany
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - A Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - L Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven
| | - M M Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - J Sparano
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - S Swain
- Medicine Department, Georgetown University Medical Centre and MedStar Health, Washington, USA
| | - S Tjulandin
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - M Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Bunkyo-ku, Japan
| | - D Trapani
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - A Tutt
- Breast Cancer Research Division, The Institute of Cancer Research, London; Comprehensive Cancer Centre, Division of Cancer Studies, Kings College London, London, UK
| | - B Xu
- Department of Medical Oncology, National Cancer Centre/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - N Harbeck
- Breast Centre, Department of Obstetrics & Gynaecology and Comprehensive Cancer Centre Munich, LMU University Hospital, Munich, Germany
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2
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Curigliano G, Burstein HJ, Gnant M, Loibl S, Cameron D, Regan MM, Denkert C, Poortmans P, Weber WP, Thürlimann B. Understanding breast cancer complexity to improve patient outcomes: The St Gallen International Consensus Conference for the Primary Therapy of Individuals with Early Breast Cancer 2023. Ann Oncol 2023; 34:970-986. [PMID: 37683978 DOI: 10.1016/j.annonc.2023.08.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 08/23/2023] [Indexed: 09/10/2023] Open
Abstract
The 18th St Gallen International Breast Cancer Conference held in March 2023, in Vienna, Austria, assessed significant new findings for local and systemic therapies for early breast cancer with a focus on the evaluation of multimodal treatment options. The emergence of more effective, innovative agents in both the preoperative (primary or neoadjuvant) and post-operative (adjuvant) settings has underscored the pivotal role of a multidisciplinary approach in treatment decision making, particularly when selecting systemic therapy for an individual patient. The importance of multidisciplinary discussions regarding the clinical benefits of interventions was explicitly emphasized by the consensus panel as an integral part of developing an optimal treatment plan with the 'right' degree of intensity and duration. The panelists focused on controversies surrounding the management of common ductal/no special type and lobular breast cancer histology, which account for the vast majority of breast tumors. The expert opinion of the panelists was based on interpretations of available data, as well as current practices in their professional environments, personal and socioeconomic factors affecting patients, and cognizant of varying reimbursement and accessibility constraints around the world. The panelists strongly advocated patient participation in well-designed clinical studies whenever feasible. With these considerations in mind, the St Gallen Consensus Conference aims to offer guidance to clinicians regarding appropriate treatments for early-stage breast cancer and assist in balancing the realistic trade-offs between treatment benefit and toxicity, enabling patients and clinicians to make well-informed choices through a shared decision-making process.
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Affiliation(s)
- G Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - H J Burstein
- Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston, USA.
| | - M Gnant
- Comprehensive Cancer Center, Medical University of Vienna, Vienna; Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - S Loibl
- Center for Hematology and Oncology Bethanien, Frankfurt; German Breast Group, Neu-Isenburg, Germany
| | - D Cameron
- Edinburgh Cancer Research Centre, University of Edinburgh and NHS Lothian, Edinburgh, UK
| | - M M Regan
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - C Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg, Marburg, Germany
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Wilrijk-Antwerp; University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - W P Weber
- Department of Surgery, University Hospital Basel, Basel, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - B Thürlimann
- SwissBreastCare, Bethanienspital, Zürich, Switzerland; SONK Foundation, St. Gallen, Switzerland
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3
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Loibl S, Azim HA, Bachelot T, Berveiller P, Bosch A, Cardonick E, Denkert C, Halaska MJ, Hoeltzenbein M, Johansson ALV, Maggen C, Markert UR, Peccatori F, Poortmans P, Saloustros E, Saura C, Schmid P, Stamatakis E, van den Heuvel-Eibrink M, van Gerwen M, Vandecaveye V, Pentheroudakis G, Curigliano G, Amant F. ESMO Expert Consensus Statements on the management of breast cancer during pregnancy (PrBC). Ann Oncol 2023; 34:849-866. [PMID: 37572987 DOI: 10.1016/j.annonc.2023.08.001] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/14/2023] Open
Abstract
The management of breast cancer during pregnancy (PrBC) is a relatively rare indication and an area where no or little evidence is available since randomized controlled trials cannot be conducted. In general, advances related to breast cancer (BC) treatment outside pregnancy cannot always be translated to PrBC, because both the interests of the mother and of the unborn should be considered. Evidence remains limited and/or conflicting in some specific areas where the optimal approach remains controversial. In 2022, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process on this topic to gain insights from a multidisciplinary group of experts and develop statements on controversial topics that cannot be adequately addressed in the current evidence-based ESMO Clinical Practice Guideline. The aim of this consensus-building process was to discuss controversial issues relating to the management of patients with PrBC. The virtual meeting included a multidisciplinary panel of 24 leading experts from 13 countries and was chaired by S. Loibl and F. Amant. All experts were allocated to one of four different working groups. Each working group covered a specific subject area with two chairs appointed: Planning, preparation and execution of the consensus process was conducted according to the ESMO standard operating procedures.
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Affiliation(s)
- S Loibl
- GBG c/o GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology Bethanien, Frankfurt am Main, Frankfurt; Goethe University Frankfurt, Frankfurt am Main, Frankfurt, Germany.
| | - H A Azim
- Breast Cancer Center, School of Medicine, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo Leon, Mexico
| | - T Bachelot
- Department of medical oncology, Centre Léon Bérard, Lyon, France
| | - P Berveiller
- Department of Gynecology and Obstetrics, Poissy-Saint Germain Hospital, Poissy; UMR 1198 - BREED, INRAE, Paris Saclay University, RHuMA, Montigny-Le-Bretonneux, France
| | - A Bosch
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund; Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | - E Cardonick
- Cooper Medical School at Rowan University, Camden, USA
| | - C Denkert
- Philipps-University Marburg and Marburg University Hospital (UKGM), Marburg, Germany
| | - M J Halaska
- Department of Obstetrics and Gynaecology, Third Faculty of Medicine, Charles University in Prague and Universital Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - M Hoeltzenbein
- Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Institute of Clinical Pharmacology and Toxicology, Embryotox Center of Clinical Teratology and Drug Safety in Pregnancy, Berlin, Germany
| | - A L V Johansson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Cancer Registry of Norway, Oslo, Norway
| | - C Maggen
- Department of Obstetrics and Prenatal Medicine, University Hospital Brussels, Brussels, Belgium
| | - U R Markert
- Placenta Lab, Department of Obstetrics, Jena University Hospital, Jena, Germany
| | - F Peccatori
- Gynecologic Oncology Department, European Institute of Oncology IRCCS, Milan, Italy
| | - P Poortmans
- Iridium Netwerk, Antwerp; University of Antwerp, Antwerp, Belgium
| | - E Saloustros
- Department of Oncology, University General Hospital of Larissa, Larissa, Greece
| | - C Saura
- Medical Oncology Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Schmid
- Cancer Institute, Queen Mary University London, London, UK
| | - E Stamatakis
- Department of Anesthesiology, 'Alexandra' General Hospital, Athens, Greece
| | | | - M van Gerwen
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Department of Child and Adolescent Psychiatry and Psychosocial Care, Amsterdam UMC, University of Amsterdam; Princess Maxima Center for Pediatric Oncology, Utrecht, The Netherlands
| | - V Vandecaveye
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - G Pentheroudakis
- European Society for Medical Oncology (ESMO), Lugano, Switzerland
| | - G Curigliano
- Division of Early Drug Development, European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Milan; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - F Amant
- Gynecologic Oncology, Antoni van Leeuwenhoek-Netherlands Cancer Institute, Amsterdam; Division Gynaecologic Oncology, UZ Leuven, Belgium
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Tarantino P, Viale G, Press MF, Hu X, Penault-Llorca F, Bardia A, Batistatou A, Burstein HJ, Carey LA, Cortes J, Denkert C, Diéras V, Jacot W, Koutras AK, Lebeau A, Loibl S, Modi S, Mosele MF, Provenzano E, Pruneri G, Reis-Filho JS, Rojo F, Salgado R, Schmid P, Schnitt SJ, Tolaney SM, Trapani D, Vincent-Salomon A, Wolff AC, Pentheroudakis G, André F, Curigliano G. ESMO expert consensus statements (ECS) on the definition, diagnosis, and management of HER2-low breast cancer. Ann Oncol 2023; 34:645-659. [PMID: 37269905 DOI: 10.1016/j.annonc.2023.05.008] [Citation(s) in RCA: 39] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/05/2023] Open
Abstract
Human epidermal growth factor receptor 2 (HER2)-low breast cancer has recently emerged as a targetable subset of breast tumors, based on the evidence from clinical trials of novel anti-HER2 antibody-drug conjugates. This evolution has raised several biological and clinical questions, warranting the establishment of consensus to optimally treat patients with HER2-low breast tumors. Between 2022 and 2023, the European Society for Medical Oncology (ESMO) held a virtual consensus-building process focused on HER2-low breast cancer. The consensus included a multidisciplinary panel of 32 leading experts in the management of breast cancer from nine different countries. The aim of the consensus was to develop statements on topics that are not covered in detail in the current ESMO Clinical Practice Guideline. The main topics identified for discussion were (i) biology of HER2-low breast cancer; (ii) pathologic diagnosis of HER2-low breast cancer; (iii) clinical management of HER2-low metastatic breast cancer; and (iv) clinical trial design for HER2-low breast cancer. The expert panel was divided into four working groups to address questions relating to one of the four topics outlined above. A review of the relevant scientific literature was conducted in advance. Consensus statements were developed by the working groups and then presented to the entire panel for further discussion and amendment before voting. This article presents the developed statements, including findings from the expert panel discussions, expert opinion, and a summary of evidence supporting each statement.
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Affiliation(s)
- P Tarantino
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston, USA; Department of Oncology and Hemato-Oncology, University of Milan, Milan
| | - G Viale
- Department of Pathology and Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
| | - M F Press
- Department of Pathology, Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, USA
| | - X Hu
- Department of Medical Oncology, Shanghai Cancer Center, Fudan University, Shanghai, China
| | - F Penault-Llorca
- Centre de Lutte Contre le Cancer Centre Jean PERRIN, Clermont-Ferrand, France
| | - A Bardia
- Harvard Medical School, Boston, USA; Department of Medical Oncology, Massachusetts General Hospital, Boston, USA
| | - A Batistatou
- Department of Pathology, Faculty of Medicine, University of Ioannina, Ioannina, Greece
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston, USA
| | - L A Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - J Cortes
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quironsalud Group, Barcelona; Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - C Denkert
- Philipps-University Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - V Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes
| | - W Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, INSERM U1194, Montpellier, France
| | - A K Koutras
- Division of Oncology, Department of Medicine, University Hospital of Patras, Greece
| | - A Lebeau
- Institute of Pathology, University Medical Center Hamburg-Eppendorf, Hamburg
| | - S Loibl
- German Breast Group/GBG Forschungs GmbH, Neu-Isenburg; Goethe University Frankfurt, Frankfurt, Germany
| | - S Modi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, USA
| | - M F Mosele
- Department of Medical Oncology, Institute Gustave Roussy, Villejuif, France
| | - E Provenzano
- Department of Histopathology, Cambridge University NHS Foundation Trust and NIH Cambridge Biomedical Research Centre, Cambridge, UK
| | - G Pruneri
- Department of Oncology and Hemato-Oncology, University of Milan, Milan; Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - J S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, USA
| | - F Rojo
- Department of Pathology, IIS-Fundacion Jimenez Diaz University Hospital-CIBERONC, Madrid, Spain
| | - R Salgado
- Department of Pathology, ZAS, Antwerp, Belgium; Division of Research, Peter Mac Callum Cancer Centre, Melbourne, Australia
| | - P Schmid
- Barts Cancer Institute, Queen Mary University London, London, UK
| | - S J Schnitt
- Harvard Medical School, Boston, USA; Department of Pathology, Brigham and Women's Hospital and Breast Oncology Program, Dana-Farber Cancer Institute, Boston, USA
| | - S M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston; Harvard Medical School, Boston, USA
| | - D Trapani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan; European Institute of Oncology, IRCCS, Milan, Italy
| | - A Vincent-Salomon
- Department of Pathology, Diagnostic and Theranostic Medicine Division, Institut Curie, PSL University, Paris, France
| | - A C Wolff
- The Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, USA
| | | | - F André
- INSERM U981 - Molecular Predictors and New Targets in Oncology, PRISM Center for Precision Medicine, Gustave Roussy, Villejuif, France
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, Milan; European Institute of Oncology, IRCCS, Milan, Italy.
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Riecke K, Müller V, Neunhöffer T, Park-Simon TW, Weide R, Polasik A, Schmidt M, Puppe J, Mundhenke C, Lübbe K, Hesse T, Thill M, Wuerstlein R, Denkert C, Decker T, Fehm T, Nekljudova V, Rey J, Loibl S, Laakmann E, Witzel I. Long-term survival of breast cancer patients with brain metastases: subanalysis of the BMBC registry. ESMO Open 2023; 8:101213. [PMID: 37075697 DOI: 10.1016/j.esmoop.2023.101213] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [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: 02/01/2023] [Revised: 02/26/2023] [Accepted: 03/10/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Up to 30% of metastatic breast cancer (BC) patients develop brain metastases (BM). Prognosis of patients with BM is poor and long-term survival is rare. Identification of factors associated with long-term survival is important for improving treatment modalities. PATIENTS AND METHODS A total of 2889 patients of the national registry for BM in BC (BMBC) were available for this analysis. Long-term survival was defined as overall survival (OS) in the upper third of the failure curve resulting in a cut-off of 15 months. A total of 887 patients were categorized as long-term survivors. RESULTS Long-term survivors compared to other patients were younger at BC and BM diagnosis (median 48 versus 54 years and 53 versus 59 years), more often had HER2-positive tumors (59.1% versus 36.3%), less frequently luminal-like (29.1% versus 35.7%) or triple-negative breast cancer (TNBC) (11.9% versus 28.1%), showed better Eastern Cooperative Oncology Group (ECOG) performance status (PS) at the time of BM diagnosis (ECOG 0-1, 76.9% versus 51.0%), higher pathological complete remission rates after neoadjuvant chemotherapy (21.6% versus 13.7%) and lower number of BM (n = 1, BM 40.9% versus 25.4%; n = 2-3, BM 26.5% versus 26.7%; n ≥4, BM 32.6% versus 47.9%) (P < 0.001). Long-term survivors had leptomeningeal metastases (10.4% versus 17.5%) and extracranial metastases (ECM, 73.6% versus 82.5%) less frequently, and asymptomatic BM more often at the time of BM diagnosis (26.5% versus 20.1%), (P < 0.001). Median OS in long-term survivors was about two times higher than the cut-off of 15 months: 30.9 months [interquartile range (IQR) 30.3] overall, 33.9 months (IQR 37.1) in HER2-positive, 26.9 months (IQR 22.0) in luminal-like and 26.5 months (IQR 18.2) in TNBC patients. CONCLUSIONS In our analysis, long-term survival of BC patients with BM was associated with better ECOG PS, younger age, HER2-positive subtype, lower number of BM and less extended visceral metastases. Patients with these clinical features might be more eligible for extended local brain and systemic treatment.
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Affiliation(s)
- K Riecke
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Neunhöffer
- Frauenärzte am Dom, Mainz, Germany; HELIOS Dr. Horst Schmidt Clinic Wiesbaden, Wiesbaden, Germany
| | - T-W Park-Simon
- Hanover Medical School (MHH University), Hanover, Germany
| | - R Weide
- Institute for Health Services Research in Oncology, Koblenz, Germany
| | - A Polasik
- Department of Gynecology and Obstetrics, Ulm University Hospital, Ulm, Germany
| | - M Schmidt
- The University Medical Center Mainz, Mainz, Germany
| | - J Puppe
- Department of Obstetrics & Gynecology, University Hospital of Cologne, Cologne, Germany
| | - C Mundhenke
- Klinikum Bayreuth GmbH/Medizincampus Oberfranken, Bayreuth, Germany; Comprehensive Cancer Center Erlangen-Europäische Metropolregion Nürnberg, Erlangen, Germany
| | - K Lübbe
- Diakovere Henriettenstift, Breast Center, Hannover, Germany
| | - T Hesse
- Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - M Thill
- Department of Gynecology and Gyneacological Oncology, Agaplesion Markus Hospital, Frankfurt, Germany
| | - R Wuerstlein
- Department of Obstetrics and Gynecology, Breast Center and CCC Munich, LMU University Hospital, Munich, Germany
| | - C Denkert
- Institute of Pathology, Philipps University Marburg and University Hospital Marburg (UKGM), Marburg, Germany
| | - T Decker
- Onkology, Haematology Ravensburg, Ravensburg, Germany
| | - T Fehm
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - J Rey
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - S Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - E Laakmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany; Department of Gynecology, University Hospital Zurich, Zürich, Switzerland.
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de Azambuja E, Agostinetto E, Procter M, Eiger D, Pondé N, Guillaume S, Parlier D, Lambertini M, Desmet A, Caballero C, Aguila C, Jerusalem G, Walshe JM, Frank E, Bines J, Loibl S, Piccart-Gebhart M, Ewer MS, Dent S, Plummer C, Suter T. Cardiac safety of dual anti-HER2 blockade with pertuzumab plus trastuzumab in early HER2-positive breast cancer in the APHINITY trial. ESMO Open 2023; 8:100772. [PMID: 36681013 PMCID: PMC10044361 DOI: 10.1016/j.esmoop.2022.100772] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Trastuzumab increases the incidence of cardiac events (CEs) in patients with breast cancer (BC). Dual blockade with pertuzumab (P) and trastuzumab (T) improves BC outcomes and is the standard of care for high-risk human epidermal growth factor receptor 2 (HER2)-positive early BC patients. We analyzed the cardiac safety of P and T in the phase III APHINITY trial. PATIENTS AND METHODS Left ventricular ejection fraction (LVEF) ≥ 55% was required at study entry. LVEF assessment was carried out every 3 months during treatment, every 6 months up to month 36, and yearly up to 10 years. Primary CE was defined as heart failure class III/IV and a significant decrease in LVEF (defined as ≥10% from baseline and to <50%), or cardiac death. Secondary CE was defined as a confirmed significant decrease in LVEF, or CEs confirmed by the cardiac advisory board. RESULTS The safety analysis population consisted of 4769 patients. With 74 months of median follow-up, CEs were observed in 159 patients (3.3%): 83 (3.5%) in P + T and 76 (3.2%) in T arms, respectively. Most CEs occurred during anti-HER2 therapy (123; 77.4%) and were asymptomatic or mildly symptomatic decreases in LVEF (133; 83.6%). There were two cardiac deaths in each arm (0.1%). Cardiac risk factors indicated were age > 65 years, body mass index ≥ 25 kg/m2, baseline LVEF between 55% and <60%, and use of an anthracycline-containing chemotherapy regimen. Acute recovery from a CE based on subsequent LVEF values was observed in 127/155 patients (81.9%). CONCLUSIONS Dual blockade with P + T does not increase the risk of CEs compared with T alone. The use of anthracycline-based chemotherapy increases the risk of a CE; hence, non-anthracycline chemotherapy may be considered, particularly in patients with cardiovascular risk factors.
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Affiliation(s)
- E de Azambuja
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium.
| | - E Agostinetto
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M Procter
- Frontier Science, Kincraig, Kingussie, UK
| | - D Eiger
- F.Hoffmann-La Roche Ltd, Basel, Switzerland
| | - N Pondé
- Clinical Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - S Guillaume
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - D Parlier
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - A Desmet
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - C Caballero
- Breast International Group, Brussels, Belgium
| | - C Aguila
- F.Hoffmann-La Roche Ltd, Basel, Switzerland
| | - G Jerusalem
- CHU Liege and Liege University, Liege, Belgium
| | - J M Walshe
- Cancer Trials Ireland, St Vincent's University Hospital, Dublin, Ireland
| | - E Frank
- Dana-Farber Cancer Institute, Boston, USA
| | - J Bines
- Instituto Nacional de Cancer, INCA, Rio de Janeiro, Brazil
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Piccart-Gebhart
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M S Ewer
- University of Texas, MD Anderson Cancer Center, Houston
| | - S Dent
- Duke Cancer Institute, Duke University, Durham, USA
| | - C Plummer
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - T Suter
- Department of Cardiology, Cardio-Oncology, Bern University Hospital, Bern, Switzerland
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7
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Sessa C, Balmaña J, Bober SL, Cardoso MJ, Colombo N, Curigliano G, Domchek SM, Evans DG, Fischerova D, Harbeck N, Kuhl C, Lemley B, Levy-Lahad E, Lambertini M, Ledermann JA, Loibl S, Phillips KA, Paluch-Shimon S. Risk reduction and screening of cancer in hereditary breast-ovarian cancer syndromes: ESMO Clinical Practice Guideline. Ann Oncol 2023; 34:33-47. [PMID: 36307055 DOI: 10.1016/j.annonc.2022.10.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/05/2022] [Accepted: 10/06/2022] [Indexed: 02/03/2023] Open
Affiliation(s)
- C Sessa
- Medical Oncology, Oncology Institute of Southern Switzerland, EOC, Bellinzona, Switzerland
| | - J Balmaña
- Medical Oncology Hospital Vall d'Hebron and Hereditary Cancer Genetics Group, Vall d'Hebron Institut of Oncology, Barcelona, Spain
| | - S L Bober
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute/Harvard Medical School, Boston, USA
| | - M J Cardoso
- Champalimaud Foundation, Breast Unit and Faculdade de Medicina, Lisbon, Portugal
| | - N Colombo
- Department of Gynecologic Oncology, Istituto Europeo di Oncologia e IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - S M Domchek
- Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania, Philadelphia, USA
| | - D G Evans
- Manchester Centre for Genomic Medicine, Division of Evolution Infection and Genomic Sciences, University of Manchester, MAHSC, Manchester, UK; Manchester Centre for Genomic Medicine, MAHSC, St Mary's Hospital, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - D Fischerova
- Gynecologic Oncology Center, Department of Obstetrics and Gynecology, First Faculty of Medicine, Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - N Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
| | - C Kuhl
- Department of Diagnostic and Interventional Radiology, University Hospital Aachen, University Hospital Aachen (UKA), RWTH Aachen, Germany
| | - B Lemley
- KIU - Patient Organisation for Women with Gynaecological Cancer, Copenhagen, Denmark; Clinical Trials Project, ESGO ENGAGe, Prague, Czech Republic
| | - E Levy-Lahad
- Medical Genetics Institute, Shaare Zedek Medical Center, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - J A Ledermann
- Department of Oncology, UCL Cancer Institute, University College London and UCL Hospitals, London, UK
| | - S Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - K-A Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre and The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
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8
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Schmidt M, Lübbe K, Decker T, Thill M, Bauer L, Müller V, Link T, Furlanetto J, Reinisch M, Mundhenke C, Hoffmann O, Zahn MO, Müller L, Denkert C, van Mackelenbergh M, Fasching P, Burchardi N, Nekljudova V, Loibl S. A multicentre, randomised, double-blind, phase II study to evaluate the tolerability of an induction dose escalation of everolimus in patients with metastatic breast cancer (DESIREE). ESMO Open 2022; 7:100601. [PMID: 36356410 PMCID: PMC9832733 DOI: 10.1016/j.esmoop.2022.100601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 09/14/2022] [Accepted: 09/15/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Stomatitis is one of the main reasons to discontinue everolimus in patients with hormone receptor-positive (HR+)/human epidermal growth factor receptor 2-negative (HER2-) metastatic breast cancer (mBC). To decrease stomatitis and subsequently early treatment discontinuations or dose reductions, the DESIREE trial investigated the use of a stepwise dose-escalation schedule of everolimus (EVE esc). PATIENTS AND METHODS DESIREE is a phase II, multicentre, randomised, double-blind, placebo-controlled trial in patients with HR+/HER2- mBC and progression/relapse after nonsteroidal aromatase inhibitor treatment. Patients were randomised to EVE esc (2.5 mg/day, week 1; 5 mg/day, week 2; 7.5 mg/day, week 3; 10 mg/day, weeks 4-24) or everolimus 10 mg/day (EVE 10mg) for 24 weeks plus exemestane. The primary endpoint was the incidence of stomatitis episodes grade ≥2 within 12 weeks of treatment. The secondary endpoints included toxicity, relative total dose intensity (RTDI) and quality of life (QoL). RESULTS A total of 160 patients were randomised and 156 started treatment (EVE esc: 80; EVE 10mg: 76). The median age of patients was 64 years (range 33-85), 56.3% patients in the EVE esc arm versus 42.1% in the EVE 10mg arm had liver metastasis (P = 0.081) and 62.5% versus 51.3% received over one metastatic therapy line (P = 0.196). Within 12 weeks, the incidence of stomatitis episodes grade ≥2 was significantly lower in the EVE esc arm compared with the EVE 10mg arm (28.8% versus 46.1%; odds ratio 0.47, 95% confidence interval 0.24-0.92; P = 0.026). Toxicity was in line with the known safety profile without new safety concerns. The median RTDI was 91.1% in the EVE esc arm versus 80.0% in the EVE 10mg arm (P = 0.329). Discontinuation rate in the first 3 weeks was 6.3% versus 15.8%, respectively (P = 0.073). QoL was comparable between the two treatment arms. CONCLUSIONS A dose-escalation schema of everolimus over 3 weeks can be successfully used to reduce the incidence of high-grade stomatitis in the first 12 weeks of treatment in patients with HR+/HER2- mBC. TRIAL REGISTRATION ClinicalTrials.govNCT02387099; https://clinicaltrials.gov/ct2/show/NCT02387099.
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Affiliation(s)
- M. Schmidt
- Universitätsmedizin Mainz, Mainz, Germany
| | - K. Lübbe
- Diakovere Henriettenstift Hannover, Hanover, Germany
| | - T. Decker
- Onkologie und Hämatologie Ravensburg, Ravensburg, Germany
| | - M. Thill
- Klinik für Gynäkologie und Gynäkologische Onkologie, Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - L. Bauer
- GRN gGmbH Klinik Weinheim, Weinheim, Germany
| | - V. Müller
- Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - T. Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | | | - M. Reinisch
- Interdisciplinary Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - C. Mundhenke
- Brustzentrum, Gynäkologisches Krebszentrum, Perinatalzentrum Level I, Klinikum Bayreuth, Bayreuth, Germany
| | | | - M.-O. Zahn
- MVZ Onkologische Kooperation Harz Dres./Zahn Fachärzte für Innere Medizin, Goslar, Germany
| | | | - C. Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - M. van Mackelenbergh
- Universitätsklinikum Schleswig-Holstein, Klinik für Gynäkologie und Geburtshilfe, Schleswig-Holstein, Kiel, Germany
| | | | | | | | - S. Loibl
- German Breast Group, Neu-Isenburg, Germany,Correspondence to: Prof. Sibylle Loibl, German Breast Group, Dornhofstr. 10, 63263 Neu-Isenburg, Germany. Tel: +49 6102 7480 335 @GBG_Forschunghttps://twitter.com/GBG_Forschung
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9
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Henneberg J, Grohmann-Izay B, Huang C, Schulze C, Llinas N, Giorgi D, Misra A, Pominchuk D, Prokhorof A, Rapoport B, Semiglazov V, Tseng L, Yanez Ruiz E, Loibl S. A Phase III, Randomized, Multicenter, Double-blind Study to Compare Efficacy and Safety of EG12014 (EirGenix Trastuzumab) with Herceptin® as Neoadjuvant Treatment in Combination with Anthracycline/Paclitaxel-based Systemic Therapy in Patients with HER2-positive Early Breast Cancer. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01510-6] [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: 11/19/2022]
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10
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Geyer C, Garber J, Gelber R, Yothers G, Taboada M, Ross L, Rastogi P, Cui K, Arahmani A, Aktan G, Armstrong A, Arnedos M, Balmaña J, Bergh J, Bliss J, Delaloge S, Domchek S, Eisen A, Elsafy F, Fein L, Fielding A, Ford J, Friedman S, Gelmon K, Gianni L, Gnant M, Hollingsworth S, Im SA, Jager A, Jóhannsson Ó, Lakhani S, Janni W, Linderholm B, Liu TW, Loman N, Korde L, Loibl S, Lucas P, Marmé F, Martinez de Dueñas E, McConnell R, Phillips KA, Piccart M, Rossi G, Schmutzler R, Senkus E, Shao Z, Sharma P, Singer C, Španić T, Stickeler E, Toi M, Traina T, Viale G, Zoppoli G, Park Y, Yerushalmi R, Yang H, Pang D, Jung K, Mailliez A, Fan Z, Tennevet I, Zhang J, Nagy T, Sonke G, Sun Q, Parton M, Colleoni M, Schmidt M, Brufsky A, Razaq W, Kaufman B, Cameron D, Campbell C, Tutt A. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer. Ann Oncol 2022; 33:1250-1268. [PMID: 36228963 DOI: 10.1016/j.annonc.2022.09.159] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.
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11
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Huober J, Janni W, Untch M, Blohmer JU, Zahm DM, Hanusch C, Jackisch C, Heinrich G, Schneeweiss A, Denkert C, Link T, Rhiem K, Furlanetto J, Solbach C, Klare P, Nekljudova V, Filmann N, Loibl S. 168P Long-term survival of a randomised, open-label, phase II study comparing the efficacy and safety of cabazitaxel versus weekly paclitaxel given as neoadjuvant treatment in patients with operable triple-negative or luminal B/HER2-negative breast cancer (GENEVIEVE). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.203] [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: 11/01/2022] Open
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12
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Laakmann E, Riecke K, Neunhöffer T, Park-Simon TW, Weide R, Polasik A, Schmidt M, Puppe J, Fasching P, Hesse T, Decker T, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Mueller V, Witzel I. 269P Long-term survival of HER2-positive breast cancer patients with brain metastases: Subanalysis of the BMBC registry. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.308] [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: 11/01/2022] Open
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13
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Galas K, Gleitsmann M, Rey J, Solbach C, Witzel I, Seliger B, Karn T, Schmatloch S, Schneeweiss A, Sinn B, Fehm T, Denkert C, Litmeyer AS, Jank P, Furlanetto J, Ortmann O, Van Mackelenbergh M, Nekljudova V, Loibl S. 151P Tumor biology and immunology in patients (pts) with breast cancer occurring during pregnancy (BCP) compared to non-pregnant breast cancer pts. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.186] [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: 11/27/2022] Open
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14
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Hägele M, Müller KR, Denkert C, Schneeweiss A, Sinn B, Untch M, Van Mackelenbergh M, Jackisch C, Nekljudova V, Karn T, Alber M, Marmé F, Schem C, Stickeler E, Fasching P, Mueller V, Weber K, Lederer B, Loibl S, Klauschen F. 68MO Generalization of a deep learning model for HER2 status predictions on H&E-stained whole slide images derived from 3 neoadjuvant clinical studies. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.101] [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: 11/01/2022] Open
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15
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Loibl S, Schneeweiss A, Huober J, Braun M, Rey J, Blohmer JU, Furlanetto J, Zahm DM, Hanusch C, Thomalla J, Jackisch C, Staib P, Link T, Rhiem K, Solbach C, Fasching PA, Nekljudova V, Denkert C, Untch M. Neoadjuvant durvalumab improves survival in early triple-negative breast cancer independent of pathological complete response. Ann Oncol 2022; 33:1149-1158. [PMID: 35961599 DOI: 10.1016/j.annonc.2022.07.1940] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [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: 02/18/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Addition of immune checkpoint inhibitors (CPI) to neoadjuvant chemotherapy (NACT) is a promising strategy in early breast cancer, but the optimal duration of therapy is currently unknown. In the GeparNuevo (NCT02685059) trial, addition of durvalumab to NACT as previously reported led to a moderate increase in pCR rate by absolute 9% (p=0.287). PATIENTS AND METHODS Durvalumab or placebo 1.5g/placebo q4 weeks plus nab-paclitaxel 125mg/m2 weekly for 12 weeks, followed by 4 cycles durvalumab/placebo plus epirubicin/cyclophosphamide (EC) q2 weeks was given to cT1b-cT4a-d TNBC patients. Durvalumab was not continued after surgery. Primary objective was pathological complete response (pCR). Secondary endpoints included invasive disease-free survival (iDFS), distant disease-free survival (DDFS) and overall survival (OS). RESULTS 174 patients were randomised between June 2016 and October 2017. After a median follow-up of 43.7 months, 34 events had occurred. Despite a non-significant increase in the pCR rate, significant differences were observed for 3-year iDFS, DDFS and OS: iDFS was 85.6% with durvalumab vs 77.2% with placebo (HR 0.48, 95%CI 0.24-0.97, stratified log-rank p=0.036); DDFS 91.7% vs 78.4% (HR 0.31, 95%CI 0.13-0.74, p=0.005); OS 95.2% vs 83.5% (HR 0.24, 95%CI 0.08-0.72, p=0.006). pCR patients had 3-year iDFS of 95.5% with durvalumab and 86.1% without (HR 0.22, 95% CI 0.05-1.06). In non-pCR cohort 3-year iDFS was 76.3% vs 69.7% (HR 0.67, 95% CI 0.29-1.54). Multivariable analysis confirmed durvalumab effect independent of the pCR effect. No new safety signals occurred. CONCLUSION Durvalumab added to NACT in TNBC significantly improved survival despite a modest pCR increase and no adjuvant component of durvalumab. Additional studies are needed to clarify the optimal duration and sequence of CPIs in the treatment of early TNBC.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, Germany; Center for Hematology and Oncology Bethanien, Frankfurt, Germany.
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - J Huober
- Universitätsklinikum Ulm, Germany; Breast Center, Cantonal hospital St Gallen, Switzerland
| | - M Braun
- Department of Gynecology, Breast Center, Red Cross Hospital Munich, Germany
| | - J Rey
- German Breast Group, Neu-Isenburg, Germany
| | - J-U Blohmer
- Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Germany
| | | | - D-M Zahm
- SRH Waldklinikum Gera GmbH, Germany
| | - C Hanusch
- Department of Gynecology, Breast Center, Red Cross Hospital Munich, Germany
| | - J Thomalla
- Praxis für Hämatologie und Onkologie Koblenz, Germany
| | | | - P Staib
- Klinik für Hämatologie und Onkologie, St.-Antonius Hospital, Eschweiler, Germany
| | - T Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Germany
| | - C Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-Nuremberg, National Center for Tumour Diseases, Erlangen, Germany
| | | | - C Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - M Untch
- HELIOS Klinikum Berlin Buch, Berlin, Germany
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16
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Laakmann E, Witzel I, Neunhöffer T, Park-Simon TW, Weide R, Riecke K, Polasik A, Schmidt M, Puppe J, Mundhenke C, Lübbe K, Hesse T, Thill M, Zahm DM, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Müller V. Characteristics of patients with brain metastases from human epidermal growth factor receptor 2-positive breast cancer: subanalysis of Brain Metastases in Breast Cancer Registry. ESMO Open 2022; 7:100495. [PMID: 35653983 PMCID: PMC9271494 DOI: 10.1016/j.esmoop.2022.100495] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 11/24/2022] Open
Abstract
Background Up to 40% of patients with metastatic human epidermal growth factor receptor 2 (HER2)-positive breast cancer develop brain metastases (BMs). Understanding of clinical features of these patients with HER2-positive breast cancer and BMs is vital. Patients and methods A total of 2948 patients from the Brain Metastases in Breast Cancer registry were available for this analysis, of whom 1311 had primary tumors with the HER2-positive subtype. Results Patients with HER2-positive breast cancer and BMs were—when compared with HER2-negative patients—slightly younger at the time of breast cancer and BM diagnosis, had a higher pathologic complete response rate after neoadjuvant chemotherapy and a higher tumor grade. Furthermore, extracranial metastases at the time of BM diagnosis were less common in HER2-positive patients, when compared with HER2-negative patients. HER2-positive patients had more often BMs in the posterior fossa, but less commonly leptomeningeal metastases. The median overall survival (OS) in all HER2-positive patients was 13.2 months (95% confidence interval 11.4-14.4). The following factors were associated with shorter OS (multivariate analysis): older age at BM diagnosis [≥60 versus <60 years: hazard ratio (HR) 1.63, P < 0.001], lower Eastern Cooperative Oncology Group status (2-4 versus 0-1: HR 1.59, P < 0.001), higher number of BMs (2-3 versus 1: HR 1.30, P = 0.082; ≥4 versus 1: HR 1.51, P = 0.004; global P = 0.015), BMs in the fossa anterior (HR 1.71, P < 0.001), leptomeningeal metastases (HR 1.63, P = 0.012), symptomatic BMs at diagnosis (HR 1.35, P = 0.033) and extracranial metastases at diagnosis of BMs (HR 1.43, P = 0.020). The application of targeted therapy after the BM diagnosis (HR 0.62, P < 0.001) was associated with longer OS. HER2-positive/hormone receptor-positive patients showed longer OS than HER2-positive/hormone receptor-negative patients (median 14.3 versus 10.9 months; HR 0.86, P = 0.03), but no differences in progression-free survival were seen between both groups. Conclusions We identified factors associated with the prognosis of HER2-positive patients with BMs. Further research is needed to understand the factors determining the longer survival of HER2-positive/hormone receptor-positive patients. Patients with HER2-positive BMs from breast cancer have the best prognosis compared with other tumor subtypes. Among HER2-positive patients, hormone receptor-positive patients have the longest survival. HER2-targeted therapy is significantly associated with a better prognosis in patients with BMs. On average, two HER2-targeted therapy lines were administered prior to the development of BMs. New compounds are urgently needed to improve the outcome of this subgroup of patients.
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Affiliation(s)
- E Laakmann
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - I Witzel
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - T Neunhöffer
- Frauenärzte am Dom, Mainz, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | | | - R Weide
- Institut für Versorgungsforschung in der Onkologie, Koblenz, Germany
| | - K Riecke
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Polasik
- Universitätsklinikum Ulm, Ulm, Germany
| | - M Schmidt
- Universitätsmedizin Mainz, Mainz, Germany
| | - J Puppe
- Universitätsfrauenklinik Köln, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Köln, Germany
| | - C Mundhenke
- Frauenklinik, Klinikum Bayreuth, Bayreuth, Germany
| | - K Lübbe
- Diakovere Henriettenstift, Breast Center, Hannover, Germany
| | - T Hesse
- Agaplesion Diakonieklinikum Rotenburg, Rotenburg, Germany
| | - M Thill
- Agaplesion Markus Krankenhaus, Frankfurt, Germany
| | - D-M Zahm
- Department of Gynecology, SRH Wald-Klinikum Gera GmbH, Gera, Germany
| | - C Denkert
- Institut für Pathologie UKGM - Universitätsklinikum Marburg, Marburg, Germany
| | - T Fehm
- Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | | | - J Rey
- GBG Forschungs GmbH, Germany
| | - S Loibl
- GBG Forschungs GmbH, Germany
| | - V Müller
- Department of Gynecology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
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17
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Loibl S, Untch M, Burchardi N, Huober J, Sinn BV, Blohmer JU, Grischke EM, Furlanetto J, Tesch H, Hanusch C, Engels K, Rezai M, Jackisch C, Schmitt WD, von Minckwitz G, Thomalla J, Kümmel S, Rautenberg B, Fasching PA, Weber K, Rhiem K, Denkert C, Schneeweiss A. Corrigendum to "A randomised phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadjuvant therapy in early triple-negative breast cancer: clinical results and biomarker analysis of GeparNuevo study": [Annals of Oncology (2019), volume 30:1279-1288]. Ann Oncol 2022; 33:743-744. [PMID: 35595658 DOI: 10.1016/j.annonc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg; Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main.
| | - M Untch
- HELIOS Klinikum Berlin-Buch, Berlin
| | | | - J Huober
- Brustzentrum, Universitätsfrauenklinik Ulm, Ulm
| | - B V Sinn
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin; Berlin Institute of Health (BIH), Berlin
| | - J-U Blohmer
- Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Berlin
| | | | | | - H Tesch
- Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main
| | - C Hanusch
- Rotkreuzklinikum München Frauenklinik, München
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss
| | - M Rezai
- Medical Center, Luisenkrankenhaus Düsseldorf, Düsseldorf
| | - C Jackisch
- Brustzentrum, Sana-Klinikum Offenbach, Offenbach
| | - W D Schmitt
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | | | - J Thomalla
- Praxisklinik für Hämatologie und Onkologie Koblenz, Koblenz
| | - S Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen
| | - B Rautenberg
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg
| | - P A Fasching
- Brustzentrum, Universitätsklinikum Erlangen, Erlangen
| | - K Weber
- German Breast Group, Neu-Isenburg
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne
| | - C Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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18
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Riecke K, Laakmann E, Neunhöffer T, Park-Simon TW, Weide R, Schmidt M, Polasik A, Puppe J, Mundhenke C, Lübbe K, Hesse T, Thill M, Zahm DM, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Müller V, Witzel I. 170P Long-term survival of breast cancer patients with brain metastases: Subanalysis of the BMBC registry. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.189] [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: 11/16/2022] Open
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19
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Reinisch M, Blohmer JU, Link T, Just M, Untch M, Stötzer O, Fasching P, Schneeweiss A, Wimberger P, Seiler S, Huober J, Thill M, Jackisch C, Rhiem K, Solbach C, Hanusch C, Denkert C, Engels K, Nekljudova V, Loibl S. 94P Patient quality of life (QoL) from the GeparX trial on the addition of denosumab (Dmab) added to two different nab-paclitaxel (nP) regimens as neoadjuvant chemotherapy (NACT) in primary breast cancer (BC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.110] [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: 11/01/2022] Open
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20
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Furlanetto J, Marmé F, Thode C, Nekljudova V, Liu Y, Martin Jimenez M, Reimer T, Knudsen E, Denkert C, Bassy M, Martin LA, Karn T, Sinn B, Filipitis M, van Mackelenbergh M, Fasching P, Müller V, Stickeler E, Schem C, Loibl S. 60MO Ovarian function in young patients (pts) treated with postneoadjuvant palbociclib (PAL) and endocrine therapy (ET) for hormone receptor (HR)-positive, HER2-negative early breast cancer (BC): Explorative analysis in Penelope-B. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.076] [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: 11/15/2022] Open
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21
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Greil R, Lin NU, Murthy RK, Abramson V, Anders C, Bachelot T, Bedard PL, Borges V, Cameron D, Carey L, Chien AJ, Curigliano G, DiGiovanna MP, Gelmon K, Hortobagyi G, Hurvitz S, Krop I, Loi S, Loibl S, Mueller V, Oliveira M, Paplomata E, Pegram M, Slamon D, Zelnak A, Ramos J, Feng W, Winer E. Aktualisierte Ergebnisse von Tucatinib versus Placebo in Kombination
mit Trastuzumab und Capecitabin bei Patienten mit vorbehandeltem, metastasierten
HER2-positiven Brustkrebs mit ZNS-Metastasen (HER2CLIMB). Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1746156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- R Greil
- Dritte medizinische Abteilung, Paracelsus Medizinische
Universität Salzburg, Salzburger Krebsforschungsinstitut –
Zentrum für Klinische Krebs- und Immunologiestudien und Cancer Cluster
Salzburg, Salzburg. Österreich
| | - N U Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - R K Murthy
- MD Anderson Cancer Center, Houston, Texas, USA
| | - V Abramson
- Vanderbilt University Medical Center, Nashville, Tennessee,
USA
| | - C Anders
- Duke Cancer Institute, Durham, North Carolina, USA
| | | | - P L Bedard
- University Health Network, Princess Margaret Cancer Centre, Toronto,
Ontario, Kanada
| | - V Borges
- University of Colorado Cancer Center, Aurora, Colorado,
USA
| | - D Cameron
- Edinburgh Cancer Research Centre, Edinburgh, Vereinigtes
Königreich
| | - L Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North
Carolina, USA
| | - A J Chien
- University of California at San Francisco, San Francisco, Kalifornien,
USA
| | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS, University of Milano, Mailand,
Italien
| | | | - K Gelmon
- British Columbia Cancer – Vancouver Centre, British Columbia,
Kanada
| | | | - S Hurvitz
- UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los
Angeles, Kalifornien, USA
| | - I Krop
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - S Loi
- Peter MacCallum Cancer Centre, Melbourne, Australien
| | - S Loibl
- Deutsche Brust-Gruppe, Neu-Isenburg. Deutschland
| | - V Mueller
- Universitätsklinikum Hamburg-Eppendorf, Hamburg,
Deutschland
| | - M Oliveira
- Hospital Universitario Vall D‘Hebron, Barcelona,
Spanien
| | - E Paplomata
- Carbone Cancer Center University of Wisconsin, Madison, Wisconsin,
USA
| | - M Pegram
- Stanford Comprehensive Cancer Institute Palo Alto, Kalifornien,
USA
| | - D Slamon
- UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los
Angeles, Kalifornien, USA
| | - A Zelnak
- Northside Hospital, Sandy Springs, Georgia, USA
| | - J Ramos
- Seagen Inc., Bothell, Washington, USA
| | - W Feng
- Seagen Inc., Bothell, Washington, USA
| | - E. Winer
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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22
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Geyer CE, Sikov WM, Loibl S. Reply to the Letter to the Editor "Risk of MDS/AML with the addition of neoadjuvant carboplatin to standard chemotherapy for triple negative breast cancer" by A. Okines and N. Turner. Ann Oncol 2022; 33:739-740. [PMID: 35390464 DOI: 10.1016/j.annonc.2022.03.275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 11/01/2022] Open
Affiliation(s)
- C E Geyer
- Department of Internal Medicine, NSABP Foundation Inc, Pittsburgh
| | - W M Sikov
- Breast Health Center, Women & Infants Hospital of Rhode Island, Providence, USA
| | - S Loibl
- Department of Medicine and Research, German Breast Group, Hessen, Germany
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23
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Abstract
Abstract
Introduction: In Rx ponder patients with nodal involvement and a recurrence score between 0-25 were randomised to receive either chemotherapy followed by endocrine therapy or endocrine therapy alone. Patients were stratified by recurrence score (RS) 0-13 vs 14-25, menopausal status and type of axillary surgery. 50% of the patients randomised to chemotherapy received TC (4 or 6 cycles) and ovarian function suppression (OFS) was used in 16% in the ET arm and 3% in the chemotherapy plus ET arm (CET). 33% of the patients enrolled were premenopausal. The overall analysis demonstrated that patients with CET had a significantly higher iDFS at 5 years than those with ET (92.4% vs 91%); HR 0.81, p=0.026. There was a significant interaction of menopausal status and chemotherapy. 5-year iDFS was 94.2% with CET and 89% with ET (delta 5.2%); HR 0.54; p=0.0004, which was larger in the group with a RS 13-25. Because the use of OFS in the CET arm was only 3% it was hypothesised that the main effect of chemotherapy is due to ovarian function suppression. Main Part: OFS added to tamoxifen or AI is very effective in premenopausal women as shown by the SOFT and TEXT studies. The majority of women in SOFT and TEXT received chemotherapy and the effect was observed mainly in the group receiving chemotherapy (a surrogacy for high risk). Adding OFS to tamoxifen plus chemotherapy vs chemotherapy plus tamoxifen is better. The LHRH metaanalysis demonstrated that LHRH was about equally effective to chemotherapy. However, the majority of trials used 2 years LHRH, chemotherapy consisted mainly of CMF and the effect was seen in women under 40 years. The subsequent metaanalyses by the EBCTCG support chemotherapy regardless of ET and menopausal status. Anthracycline and taxane containing chemotherapy is more effective than CMF and dose-dense chemotherapy is even more effective than standard chemotherapy. Chemotherapy can induce amenorrhoea and women with chemotherapy induced amenorrhea have a better outcome than those without. Cyclosphosphamide and especially in the CMF regimen have the highest rate of amenorrhea and the main effect is seen in women between 40 and 50 years. Younger women regain menses, so the ovarian function suppression is temporarily, especially in women below 40 years. The dose of cyclophosphamide in the TC regimen, which was predominantly used in Rx-Ponder is lower than in the CMF regimen but similar to modern type chemotherapy regimen. In RX-Ponder the chemotherapy effect was seen in all premenopausal women but there was no difference of the point estimate in women between 40-50 and younger than 40 years of age. The ovarian function suppression effect is transient and women under 40 year of age tend to regain menopause and should receive an LHRH in addition. In very young women the ovarian function suppression with an LHRH analogue is about 80% leaving 20% without adequate OFS. The toxicity rate of 5 years of LHRH containing ET is high and should not be underestimated compared to 4-6 months chemotherapy. Compliance of LHRH is lower than in adjuvant chemotherapy affecting the effectiveness of adjuvant therapy. If LHRH is discontinued at 2years of LHRH the patient will receive only tamoxifen, which is too little in high risk, premenopausal women. The recurrence score mainly measures endocrine sensitivity of the tumour which does not imply chemoresistance. Nodal status remains still the most important prognostic factor and chemotherapy reduces the risk of recurrence by 30-40%.The data from Rx-Ponder are comparable to the data generated in the Mindact trial. In women younger than 50 years being at clinical high risk but with a genomic low risk tumour chemotherapy improved 8-year DDFS to 93.6% compared to 88.6% without chemotherapy (HR 0.54 95%; CI 0.30-0.98).In conclusion: Premenopausal women with node-positive HR+/HER2- breast cancer benefit from the use of chemotherapy in addition to LHRH even if the RS indicates a biological low risk.
Citation Format: S Loibl. Con - RxPONDER: Was it all OFS? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr DEB1-2.
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24
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Geyer CE, Sikov WM, Huober J, Rugo HS, Wolmark N, O'Shaughnessy J, Maag D, Untch M, Golshan M, Ponce Lorenzo J, Metzger O, Dunbar M, Symmans WF, Rastogi P, Sohn J, Young R, Wright GS, Harkness C, McIntyre K, Yardley D, Loibl S. Long-term efficacy and safety of addition of carboplatin with or without veliparib to standard neoadjuvant chemotherapy in triple-negative breast cancer: 4-year follow-up data from BrighTNess, a randomized phase 3 trial. Ann Oncol 2022; 33:384-394. [PMID: 35093516 DOI: 10.1016/j.annonc.2022.01.009] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [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: 09/07/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Primary analyses of the phase 3 BrighTNess trial showed addition of carboplatin with/without veliparib to neoadjuvant chemotherapy significantly improved pathological complete response (pCR) rates with manageable acute toxicity in patients with triple-negative breast cancer (TNBC). Here, we report 4.5-year follow-up data from the trial. DESIGN Women with untreated stage II-III TNBC were randomized (2:1:1) to paclitaxel (weekly for 12 doses) plus either: (a) carboplatin (every 3 weeks for four cycles) plus veliparib (twice daily); (b) carboplatin plus veliparib placebo; or (c) carboplatin placebo plus veliparib placebo. All patients then received doxorubicin and cyclophosphamide (AC) every 2‒3 weeks for four cycles. The primary endpoint was pCR. Secondary endpoints included event-free survival (EFS), overall survival (OS), and safety. Since the co-primary endpoint of increased pCR with carboplatin plus veliparib with paclitaxel versus carboplatin with paclitaxel was not met, secondary analyses are descriptive. RESULTS Of 634 patients, 316 were randomized to carboplatin plus veliparib with paclitaxel, 160 to carboplatin with paclitaxel, and 158 to paclitaxel. With median follow-up of 4.5 years, the hazard ratio [HR] for EFS for carboplatin plus veliparib with paclitaxel versus paclitaxel was 0.63 (95% confidence interval [CI] 0.43‒0.92, P=0.02), but 1.12 (95% CI 0.72‒1.72, P=0.62) for carboplatin plus veliparib with paclitaxel versus carboplatin with paclitaxel. In post hoc analysis, HR for EFS was 0.57 (95% CI 0.36‒0.91, P=0.02) for carboplatin with paclitaxel versus paclitaxel. OS did not differ significantly between treatment arms, nor did rates of myelodysplastic syndromes, acute myeloid leukemia, or other secondary malignancies. CONCLUSION Improvement in pCR with addition of carboplatin was associated with long-term EFS benefit with a manageable safety profile, and without increasing the risk of second malignancies, while adding veliparib did not impact EFS. These findings support the addition of carboplatin to weekly paclitaxel followed by AC neoadjuvant chemotherapy for early stage TNBC.
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Affiliation(s)
- C E Geyer
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA, USA; Houston Methodist Cancer Center, Houston, TX, USA.
| | - W M Sikov
- Women, Infants Hospital of Rhode Island, Providence, RI, USA
| | - J Huober
- Breast Center Cantonal Hospital St Gallen, St Gallen, Switzerland
| | - H S Rugo
- University of California San Francisco Hellen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - N Wolmark
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA, USA; University of Pittsburgh, Pittsburgh, PA, USA
| | - J O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA; Baylor University Medical Center, Dallas, TX, USA
| | - D Maag
- AbbVie Inc., North Chicago, IL, USA
| | - M Untch
- HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - M Golshan
- Yale Cancer Center, Yale School of Medicine, New Haven, CT, USA
| | - J Ponce Lorenzo
- University General Hospital of Alicante, ISABIAL, Alicante, Spain
| | - O Metzger
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - M Dunbar
- AbbVie Inc., North Chicago, IL, USA
| | | | - P Rastogi
- National Surgical Adjuvant Breast and Bowel Project Foundation, Pittsburgh, PA, USA; UPMC Hillman Cancer Center/University of Pittsburgh, Pittsburgh, PA, USA
| | - J Sohn
- Yonsei University College of Medicine, Seoul, Korea
| | - R Young
- Division of Breast Oncology, The Center for Cancer and Blood Disorders, Fort Worth, USA
| | - G S Wright
- Florida Cancer Specialists and Sarah Cannon Research Institute, New Port Richey, FL, USA
| | - C Harkness
- Hope Women's Cancer Centers, Asheville, NC, USA
| | - K McIntyre
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, TX, USA
| | - D Yardley
- Sarah Cannon Research Institute, Tennessee Oncology, Nashville, TN, USA
| | - S Loibl
- German Breast Group, c/o GBG Forschungs GmbH, Neu-Isenburg, Germany; Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
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25
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Gennari A, André F, Barrios CH, Cortés J, de Azambuja E, DeMichele A, Dent R, Fenlon D, Gligorov J, Hurvitz SA, Im SA, Krug D, Kunz WG, Loi S, Penault-Llorca F, Ricke J, Robson M, Rugo HS, Saura C, Schmid P, Singer CF, Spanic T, Tolaney SM, Turner NC, Curigliano G, Loibl S, Paluch-Shimon S, Harbeck N. ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol 2021; 32:1475-1495. [PMID: 34678411 DOI: 10.1016/j.annonc.2021.09.019] [Citation(s) in RCA: 403] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- A Gennari
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif, France
| | - C H Barrios
- Oncology Research Center, Grupo Oncoclínicas, Porto Alegre, Brazil
| | - J Cortés
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona, Spain; Scientific Department, Medica Scientia Innovation Research, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - E de Azambuja
- Medical Oncology Department, Institute Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A DeMichele
- Hematology/Oncology Department, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - R Dent
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - D Fenlon
- College of Human and Health Sciences, Swansea University-Singleton Park Campus, Swansea, UK
| | - J Gligorov
- Départment d' Oncologie Médicale, Institut Universitaire de Cancérologie AP-HP, Sorbonne Université, Hôpital Tenon, Paris, France
| | - S A Hurvitz
- Department of Medicine/Division of Hematology Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA; Jonsson Comprehensive Cancer Center, Los Angeles, USA
| | - S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein-Campus Kiel, Kiely, Germany
| | - W G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - S Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F Penault-Llorca
- Centre de Lutte Contre le Cancer Jean Perrin, Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, UMR INSERM-UCA, Clermont Ferrand, France
| | - J Ricke
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif, France; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - M Robson
- Medicine Department, Memorial Sloan Kettering Cancer Center, New York, USA
| | - H S Rugo
- Department of Medicine, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - C Saura
- Breast Cancer Program, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Schmid
- Centre of Experimental Cancer Medicine, Cancer Research UK Barts Centre, Barts and The London School of Medicine and Dentistry, London, UK
| | - C F Singer
- Center for Breast Health and Department of Obstetrics & Gynecology, Medical University of Vienna, Vienna, Austria
| | - T Spanic
- Europa Donna Slovenia, Slovenia, USA
| | | | - N C Turner
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS and University of Milano, Milan, Italy
| | - S Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - N Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
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Loibl S, Loirat D, Tolaney S, Punie K, Oliveira M, Rugo H, Bardia A, Hurvitz S, Brufsky A, Kalinsky K, Cortés J, O'Shaughnessy J, Dieras V, Carey L, Gianni L, Gharaibeh M, Moore L, Shi L, Piccart M. 257P Health-related quality of life (HRQoL) in the ASCENT study of sacituzumab govitecan (SG) in metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.540] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Loibl S, Sikov W, Huober J, Rugo H, Wolmark N, O'Shaughnessy J, Maag D, Untch M, Golshan M, Lorenzo JP, Metzger O, Dunbar M, Symmans W, Geyer C. 119O Event-free survival (EFS), overall survival (OS), and safety of adding veliparib (V) plus carboplatin (Cb) or carboplatin alone to neoadjuvant chemotherapy in triple-negative breast cancer (TNBC) after ≥4 years of follow-up: BrighTNess, a randomized phase III trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.400] [Citation(s) in RCA: 6] [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] [Indexed: 10/20/2022] Open
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Marmé F, Hanusch C, Furlanetto J, Denkert C, Link T, Untch M, Blohmer JU, Jackisch C, Reinisch M, Rhiem K, Schneeweiss A, Solbach C, Schöllhorn L, Fasching P, Rey J, Loibl S. 199TiP Phase III post-neoadjuvant study evaluating sacituzumab govitecan (SG), an antibody drug conjugate in primary HER2-negative breast cancer patients with high relapse risk after standard neoadjuvant treatment: SASCIA. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.480] [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: 11/29/2022] Open
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Franzoi M, Martel S, Agbor-Tarh D, Piccart M, Bines J, Loibl S, Di Cosimo S, Vaz-Luis I, Di Meglio A, Del Mastro L, Gombos A, Desmedt C, Jerusalem G, Reaby L, Pienkowski T, Lambertini M, de Azambuja E. 131P Impact of body mass (BMI) and weight change after adjuvant treatment in patients (pts) with HER2-positive early breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.412] [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: 10/20/2022] Open
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Loibl S, Schmidt M, Lübbe K, Decker T, Thill M, Bauer L, Müller V, Link T, Furlanetto J, Kümmel S, Mundhenke C, Hoffmann O, Zahn MO, Müller L, Denkert C, van Mackelenbergh M, Fasching P, Burchardi N, Nekljudova V. LBA19 A multicenter, randomized, double-blind, phase II study to evaluate the tolerability of an induction dose escalation of everolimus in patients with metastatic breast cancer (mBC) (DESIREE). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.2092] [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: 10/20/2022] Open
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Swain S, Tan A, Gianni L, Kümmel S, Dang C, Schneeweiss A, O'Shaughnessy J, Liu H, Aguila C, Heeson S, Macharia H, Restuccia E, Loibl S. 138P Anaphylaxis and hypersensitivity in trials of intravenous pertuzumab + trastuzumab (PH IV) or the fixed-dose combination of pertuzumab and trastuzumab for subcutaneous injection (PH FDC SC) for HER2-positive breast cancer (BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.419] [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: 10/20/2022] Open
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Tolaney S, Barroso-Sousa R, Jiang Z, Park Y, Rimawi M, Saura Manich C, Schneeweiss A, Toi M, Yu T, Shetty J, Herbolsheimer P, Loibl S. 328TiP Phase III study of trastuzumab deruxtecan (T-DXd) with or without pertuzumab vs a taxane, trastuzumab and pertuzumab in first-line (1L), human epidermal growth factor receptor 2–positive (HER2+) metastatic breast cancer (mBC): DESTINY-Breast09. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.611] [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: 10/20/2022] Open
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Galactionova K, Loibl S, Salari P, Marmé F, Martin M, Untch M, Bonnefoi H, Kim SB, Bear H, McCarthy N, Gelmon K, García-Saenz J, Kelly C, Reimer T, Toi M, Rugo H, Gnant M, Makris A, Burchardi N, Schwenkglenks M. 132P Health economic properties of palbociclib in breast cancer patients with high risk of relapse following neoadjuvant therapy: Results from the Penelope-B trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.413] [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: 10/20/2022] Open
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Schrodi S, Braun M, Andrulat A, Harbeck N, Mahner S, Kiechle M, Klein E, Schnelzer A, Schindlbeck C, Bauerfeind I, Schubert-Fritschle G, Nekljudova V, Mayr D, Weichert W, Denkert C, Loibl S, Engel J. Outcome of breast cancer patients with low hormone receptor positivity: analysis of a 15-year population-based cohort. Ann Oncol 2021; 32:1410-1424. [PMID: 34419555 DOI: 10.1016/j.annonc.2021.08.1988] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [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: 02/17/2021] [Revised: 07/08/2021] [Accepted: 08/10/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Guideline recommendations for the treatment of breast cancer with low hormone receptor (HR) expression (1%-9%) are ambiguous and several studies showed more similarities with HR-negative tumors than with HR strongly positive tumors (≥10%). We used a population-based 15-year cohort to compare patient characteristics and outcome of HR low positive tumors with HR-negative and HR strongly positive tumors, respectively. PATIENTS AND METHODS A total of 38 560 women diagnosed with early invasive breast cancer between 2004 and 2018 within the scope of the Munich Cancer Registry with 4.9 million inhabitants were included. Descriptive analyses of prognostic factors, treatment, and outcome analyses using the Kaplan-Meier method; cumulative incidence in consideration of competing risks; and multivariate analyses (Cox regression and Fine-Gray model) were conducted. Endpoints were time to local recurrence (TTLR), time to lymph node recurrence (TTLNR), time to metastasis (TTM), overall survival (OS), and relative survival (RS). RESULTS A total of 861 patients (2%) had HR low positive, 4862 (13%) HR-negative, and 32 837 (85%) HR strongly positive tumors. Within the HER2-negative cohort (n = 33 366), survival of HR low positive tumors was significantly worse than that of HR strongly positive tumors [OS hazard ratio 0.66 (95% confidence interval 0.55-0.78)], whereas between HR low positive and HR-negative tumors no significant survival difference could be detected [OS hazard ratio 0.93 (95% confidence interval 0.78-1.11)]. TTLR, TTLNR, and TTM showed similar results. By contrast, within the HER2-positive cohort (n = 5194), no statistically significant differences between the three HR groups could be detected in multivariate analyses. CONCLUSION Current definitions for HR positivity and its clinical relevance should be reconsidered. Patients with HR low positive/HER2-negative tumors could be regarded and treated similar to patients with triple-negative tumors.
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Affiliation(s)
- S Schrodi
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Bavarian Cancer Registry - Regional Centre Munich, Bavarian Health and Food Safety Authority (LGL), Munich, Germany.
| | - M Braun
- Department of Gynecology and Obstetrics, Breast Centre, Red Cross Hospital, Munich, Germany
| | - A Andrulat
- Department of Gynecology and Obstetrics, Breast Centre, Red Cross Hospital, Munich, Germany
| | - N Harbeck
- Department of Obstetrics and Gynecology and Breast Centre, University Hospital, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - S Mahner
- Department of Obstetrics and Gynecology and Breast Centre, University Hospital, Ludwig-Maximilians-University Munich (LMU), Munich, Germany
| | - M Kiechle
- Department of Gynecology and Obstetrics, Breast Centre, University Hospital, Technical University Munich (TUM), Munich, Germany
| | - E Klein
- Department of Gynecology and Obstetrics, Breast Centre, University Hospital, Technical University Munich (TUM), Munich, Germany
| | - A Schnelzer
- Department of Obstetrics and Gynecology, Breast Centre, RoMed Kliniken, Rosenheim, Germany
| | - C Schindlbeck
- Department of Obstetrics and Gynecology and Breast Centre, University Hospital, Ludwig-Maximilians-University Munich (LMU), Munich, Germany; Department of Gynecology and Obstetrics, Breast Centre, Klinikum Traunstein, Traunstein, Germany
| | - I Bauerfeind
- Department of Gynecology and Obstetrics, Breast Centre, Klinikum Landshut, Landshut, Germany
| | - G Schubert-Fritschle
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Bavarian Cancer Registry - Regional Centre Munich, Bavarian Health and Food Safety Authority (LGL), Munich, Germany
| | - V Nekljudova
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany
| | - D Mayr
- Department of Pathology, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - W Weichert
- Institute of Pathology, Technical University Munich (TUM), Munich, Germany
| | - C Denkert
- Department of Pathology, University Hospital Marburg (UKGM), Philipps-University Marburg, Marburg, Germany
| | - S Loibl
- German Breast Group (GBG Forschungs GmbH), Neu-Isenburg, Germany; Centre for Haematology and Oncology Bethanien, Frankfurt, Germany
| | - J Engel
- Munich Cancer Registry (MCR) at the Institute of Medical Information Processing, Biometry, and Epidemiology (IBE), Ludwig-Maximilians-University (LMU), Bavarian Cancer Registry - Regional Centre Munich, Bavarian Health and Food Safety Authority (LGL), Munich, Germany
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Jerusalem G, Farah S, Courtois A, Chirgwin J, Aebi S, Karlsson P, Neven P, Hitre E, Graas MP, Simoncini E, Abdi E, Kamby C, Thompson A, Loibl S, Gavilá J, Kuroi K, Marth C, Müller B, O'Reilly S, Gombos A, Ruhstaller T, Burstein HJ, Rabaglio M, Ruepp B, Ribi K, Viale G, Gelber RD, Coates AS, Loi S, Goldhirsch A, Regan MM, Colleoni M. Continuous versus intermittent extended adjuvant letrozole for breast cancer: final results of randomized phase III SOLE (Study of Letrozole Extension) and SOLE Estrogen Substudy. Ann Oncol 2021; 32:1256-1266. [PMID: 34384882 DOI: 10.1016/j.annonc.2021.07.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [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: 03/12/2021] [Revised: 07/28/2021] [Accepted: 07/29/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Late recurrences in postmenopausal women with hormone receptor-positive breast cancers remain an important challenge. Avoidance or delayed development of resistance represents the main objective in extended endocrine therapy (ET). In animal models, resistance was reversed with restoration of circulating estrogen levels during interruption of letrozole treatment. This phase III, randomized, open-label Study of Letrozole Extension (SOLE) studied the effect of extended intermittent letrozole treatment in comparison with continuous letrozole. In parallel, the SOLE estrogen substudy (SOLE-EST) analyzed the levels of estrogen during the interruption of treatment. PATIENTS AND METHODS SOLE enrolled 4884 postmenopausal women with hormone receptor-positive, lymph node-positive, operable breast cancer between December 2007 and October 2012 and among them, 104 patients were enrolled in SOLE-EST. They must have undergone local treatment and have completed 4-6 years of adjuvant ET. Patients were randomized between continuous letrozole (2.5 mg/day orally for 5 years) and intermittent letrozole treatment (2.5 mg/day for 9 months followed by a 3-month interruption in years 1-4 and then 2.5 mg/day during all of year 5). RESULTS Intention-to-treat population included 4851 women in SOLE (n = 2425 in the intermittent and n = 2426 in the continuous letrozole groups) and 103 women in SOLE-EST (n = 78 in the intermittent and n = 25 in the continuous letrozole groups). After a median follow-up of 84 months, 7-year disease-free survival (DFS) was 81.4% in the intermittent group and 81.5% in the continuous group (hazard ratio: 1.03, 95% confidence interval: 0.91-1.17). Reported adverse events were similar in both groups. Circulating estrogen recovery was demonstrated within 6 weeks after the stop of letrozole treatment. CONCLUSIONS Extended adjuvant ET by intermittent administration of letrozole did not improve DFS compared with continuous use, despite the recovery of circulating estrogen levels. The similar DFS coupled with previously reported quality-of-life advantages suggest intermittent extended treatment is a valid option for patients who require or prefer a treatment interruption.
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Affiliation(s)
- G Jerusalem
- International Breast Cancer Study Group, Bern, Switzerland; Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium.
| | - S Farah
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA
| | - A Courtois
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium
| | - J Chirgwin
- Breast Cancer Trials-Australia and New Zealand, University of Newcastle, Callaghan, Australia; Box Hill and Maroondah Hospitals, Monash University, Clayton, Australia
| | - S Aebi
- Division of Medical Oncology, Cancer Center, Lucerne Cantonal Hospital, Lucerne, Switzerland; Faculty of Medicine, University of Bern, Bern, Switzerland
| | - P Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - P Neven
- Gynecologic Oncology and Multidisciplinary Breast Center, University Hospitals UZ-Leuven, KU Leuven, Leuven, Belgium
| | - E Hitre
- Department of Medical Oncology and Clinical Pharmacology "B", National Institute of Oncology, Budapest, Hungary
| | | | - E Simoncini
- ASST Spedali Civili di Brescia, Brescia, Italy
| | - E Abdi
- The Tweed Hospital, Griffith University Gold Coast, Tweed Heads, Australia
| | - C Kamby
- Danish Breast Cancer Group and Rigshospitalet, Copenhagen, Denmark
| | - A Thompson
- Scottish Cancer Trials Breast Group and Division of Surgical Oncology, Baylor College of Medicine, Houston, USA
| | - S Loibl
- German Breast Group Forschungs GmbH, Neu-Isenburg, Germany
| | - J Gavilá
- SOLTI Group and Fundación Instituto Valenciano de Oncologia, Valencia, Spain
| | - K Kuroi
- Japan Breast Cancer Research Group and Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - C Marth
- Austrian Breast & Colorectal Cancer Study Group and Department of Obstetrics and Gynecology, Medical University Innsbruck, Innsbruck, Austria
| | - B Müller
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Providencia, Santiago, Chile
| | - S O'Reilly
- Cancer Trials Ireland, Dublin, Ireland; University College Cork, Cork University Hospital, Cork, Ireland
| | - A Gombos
- Université Libre de Bruxelles, Institut Jules Bordet, Brussels, Belgium
| | - T Ruhstaller
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Breast Center St. Gallen, St. Gallen, Switzerland; Faculty of Medicine, University of Basel, Basel, Switzerland
| | - H J Burstein
- Medical Oncology Department, CHU Liège, Liège University, Liège, Belgium; Harvard Medical School, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Rabaglio
- International Breast Cancer Study Group, Bern, Switzerland; Swiss Group for Clinical Cancer Research SAKK, Bern, Switzerland; Department of Medical Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - B Ruepp
- International Breast Cancer Study Group, Bern, Switzerland
| | - K Ribi
- International Breast Cancer Study Group, Bern, Switzerland
| | - G Viale
- Department of Pathology, University of Milan, Milan, Italy; IEO European Institute of Oncology IRCCS, Milan, Italy
| | - R D Gelber
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA; Harvard TH Chan School of Public Health, Boston, USA; Frontier Science Foundation, Boston, USA
| | - A S Coates
- International Breast Cancer Study Group, Bern, Switzerland; NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | - S Loi
- International Breast Cancer Study Group, Bern, Switzerland; Peter MacCallum Cancer Center, University of Melbourne, Melbourne, Australia
| | - A Goldhirsch
- International Breast Cancer Study Group, Bern, Switzerland; IEO European Institute of Oncology, IRCCS, Milan, Italy
| | - M M Regan
- International Breast Cancer Study Group Statistical Center, Division of Biostatistics, Dana-Farber Cancer Institute, Boston, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - M Colleoni
- International Breast Cancer Study Group, Bern, Switzerland; Division of Medical Senology, IEO, European Institute of Oncology, IRCCS, Milan, Italy
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Loi S, Michiels S, Adams S, Loibl S, Budczies J, Denkert C, Salgado R. The journey of tumor-infiltrating lymphocytes as a biomarker in breast cancer: clinical utility in an era of checkpoint inhibition. Ann Oncol 2021; 32:1236-1244. [PMID: 34311075 DOI: 10.1016/j.annonc.2021.07.007] [Citation(s) in RCA: 87] [Impact Index Per Article: 29.0] [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: 02/07/2021] [Revised: 06/15/2021] [Accepted: 07/19/2021] [Indexed: 12/12/2022] Open
Abstract
In 2014, we described a method to quantify percentage of tumor-infiltrating lymphocytes (TILs) on hematoxylin and eosin-stained slides of breast cancer samples using light microscopy that could be performed easily by pathologists with no extra stains. The aim of detailing the method was to facilitate independent research groups replicating our prognostic findings using TIL quantity in early-stage breast cancers. A global working group of breast pathologists was convened to standardize, test reproducibility, and refine the method. A website was also established which allowed free training (www.tilsinbreastcancer.org). As a result of this work, TIL data have been collected in over 20 000 primary breast cancer samples worldwide and the robust associations with better prognoses in triple-negative breast cancer (TNBC) and HER2+ BC have been confirmed. This has resulted in the inclusion of the TIL biomarker in several international breast cancer guidelines as well as in national criteria for routine pathology reporting. TIL therefore represents the first biological prognostic biomarker for early-stage TNBCs, and here its prognostic effect is linear, with values of 30%-50% being suggested as suitable for use in potential chemotherapy de-escalation studies. The efficacy of immune checkpoint-targeted agents in breast cancer now provides direct evidence that host immune responses can modify tumor growth in some patients. With the recent granting of accelerated approvals for the first PD-1/PD-L1 targeting agents in early and advanced TNBC, our focus has now moved to investigating the clinical utility of TIL in the setting of immune checkpoint agents, with or without PD-L1 protein assessment. Emerging data suggest that TIL quantity can help clinicians identify patients with breast cancer who benefit most from PD-1/PD-L1 inhibition. In patients with advanced TNBC and HER2+ disease a TIL cut-off of 5% or 10%, with PD-L1 expression can define 'immune-enriched' tumors and currently seems to have the most clinical relevance in this context.
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Affiliation(s)
- S Loi
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia.
| | - S Michiels
- Department of Biostatistics and Epidemiology, Gustave Roussy Cancer Campus, University Paris-Saclay, Villejuif, France; Oncostat INSERM U1018, labeled Ligue Contre le Cancer, University Paris-Saclay, Villejuif, France
| | - S Adams
- Perlmutter Cancer Center, New York University School of Medicine, New York, USA
| | - S Loibl
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; German Breast Group, c/o GBG Forschungs GmbH, Frankfurt; Goethe University, Frankfurt
| | - J Budczies
- Institute of Pathology, Heidelberg University Hospital, Heidelberg, Germany; German Cancer Consortium (DKTK) and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UK-GM), Marburg, Germany
| | - R Salgado
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia; Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
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Vladimirova V, Schneeweiss A, Jackisch C, Weber K, Denkert C, Schmatloch S, Karn T, Fasching P, Braun S, Szeto C, Sinn B, van Mackelenbergh M, Schem C, Stickeler E, Soon-Shiong P, Marmé F, Mueller V, Untch M, Nekljudova V, Loibl S. 21P BACH1 and HIF1α predict response to neoadjuvant nab-paclitaxel (nP) treatment in early breast cancer (BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.035] [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: 12/01/2022] Open
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Laakmann E, Witzel I, Neunhöffer T, Park-Simon TW, Weide R, Riecke K, Polasik A, Schmidt M, Puppe J, Mundhenke C, Lübbe K, Hesse T, Thill M, Zahm DM, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Mueller V. 95MO Characteristics of patients with brain metastases from HER2-positive breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.109] [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: 11/29/2022] Open
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Labidi-Galy S, Schneeweiss A, Sinn H, Blohmer JU, Romanens L, Zahm DM, Huober J, Dohnal D, Link T, Hanusch C, Jackisch C, Fasching P, Solbach C, Rhiem K, Denkert C, Weber K, Lederer B, Untch M, Loibl S, Furlanetto J. 66P Baseline menopausal status, Ki-67 and stromal tumour-infiltrating lymphocytes (TILs) and association with outcome in triple-negative breast cancer (TNBC): Exploratory analysis in GeparSixto. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.080] [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: 11/15/2022] Open
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Llop-Guevara A, Vladimirova V, Schneeweiss A, Villacampa G, Karn T, Zahm DM, Herencia-Ropero A, Jank P, van Mackelenbergh M, Fasching P, Marmé F, Stickeler E, Schem C, Dienstmann R, Florian S, Nekljudova V, Balmaña J, Denkert C, Loibl S, Serra V. 2O Association of RAD51 with homologous recombination deficiency (HRD) and clinical outcomes in untreated triple-negative breast cancer (TNBC): Analysis of the GeparSixto randomized clinical trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.016] [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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Leichsenring J, Vladimirova V, Solbach C, Karn T, Ataseven B, Sinn B, Barinoff J, Mueller V, Blohmer JU, Schem C, Engels K, Marmé F, Fissler-Eckhoff A, Fasching P, Stickeler E, van Mackelenbergh M, Denkert C, Stenzinger A, Loibl S, Gröschel S. 28P EVI1 expression in early-stage breast cancer patients treated with neoadjuvant chemotherapy. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.042] [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: 11/28/2022] Open
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Furlanetto J, Denkert C, Untch M, Sinn B, Lederer B, Schneeweiss A, Mueller V, van Mackelenbergh M, Stickeler E, Fasching P, Schem C, Karn T, Marmé F, Nekljudova V, Loibl S. 17P Impact of body mass index (BMI) on prognostic and predictive value of stromal tumour-infiltrating lymphocytes (sTILs) in triple-negative breast cancer (TNBC): A pooled analysis of six neoadjuvant trials. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.031] [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: 11/24/2022] Open
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Mamounas EP, Untch M, Mano MS, Huang CS, Geyer CE, von Minckwitz G, Wolmark N, Pivot X, Kuemmel S, DiGiovanna MP, Kaufman B, Kunz G, Conlin AK, Alcedo JC, Kuehn T, Wapnir I, Fontana A, Hackmann J, Polikoff J, Saghatchian M, Brufsky A, Yang Y, Zimovjanova M, Boulet T, Liu H, Tesarowski D, Lam LH, Song C, Smitt M, Loibl S. Adjuvant T-DM1 versus trastuzumab in patients with residual invasive disease after neoadjuvant therapy for HER2-positive breast cancer: subgroup analyses from KATHERINE. Ann Oncol 2021; 32:1005-1014. [PMID: 33932503 DOI: 10.1016/j.annonc.2021.04.011] [Citation(s) in RCA: 50] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 04/13/2021] [Accepted: 04/20/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND In the KATHERINE study (NCT01772472), patients with residual invasive early breast cancer (EBC) after neoadjuvant chemotherapy (NACT) plus human epidermal growth factor receptor 2 (HER2)-targeted therapy had a 50% reduction in risk of recurrence or death with adjuvant trastuzumab emtansine (T-DM1) versus trastuzumab. Here, we present additional exploratory safety and efficacy analyses. PATIENTS AND METHODS KATHERINE enrolled HER2-positive EBC patients with residual invasive disease in the breast/axilla at surgery after NACT containing a taxane (± anthracycline, ± platinum) and trastuzumab (± pertuzumab). Patients were randomized to adjuvant T-DM1 (n = 743) or trastuzumab (n = 743) for 14 cycles. The primary endpoint was invasive disease-free survival (IDFS). RESULTS The incidence of peripheral neuropathy (PN) was similar regardless of neoadjuvant taxane type. Irrespective of treatment arm, baseline PN was associated with longer PN duration (median, 105-109 days longer) and lower resolution rate (∼65% versus ∼82%). Prior platinum therapy was associated with more grade 3-4 thrombocytopenia in the T-DM1 arm (13.5% versus 3.8%), but there was no grade ≥3 hemorrhage in these patients. Risk of recurrence or death was decreased with T-DM1 versus trastuzumab in patients who received anthracycline-based NACT [hazard ratio (HR) = 0.51; 95% confidence interval (CI): 0.38-0.67], non-anthracycline-based NACT (HR = 0.43; 95% CI: 0.22-0.82), presented with cT1, cN0 tumors (0 versus 6 IDFS events), or had particularly high-risk tumors (HRs ranged from 0.43 to 0.72). The central nervous system (CNS) was more often the site of first recurrence in the T-DM1 arm (5.9% versus 4.3%), but T-DM1 was not associated with a difference in overall risk of CNS recurrence. CONCLUSIONS T-DM1 provides clinical benefit across patient subgroups, including small tumors and particularly high-risk tumors and does not increase the overall risk of CNS recurrence. NACT type had a minimal impact on safety.
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Affiliation(s)
- E P Mamounas
- NSABP Foundation and; Department of Surgery, Orlando Health UF Health Cancer Center, Orlando, USA.
| | - M Untch
- AGO-B and Department of Gynecologic Oncology, HELIOS Klinikum Berlin Buch, Berlin, Germany
| | - M S Mano
- Department of Radiology and Oncology, Instituto do Câncer do Estado de São Paulo, São Paulo, Brazil
| | - C-S Huang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C E Geyer
- NSABP Foundation and; NSABP Foundation and Department of Internal Medicine, Division of Hematology and Medical Oncology, Houston Methodist Cancer Center, Houston, USA
| | | | - N Wolmark
- NSABP Foundation and; NSABP Foundation and Department of Surgery, The University of Pittsburgh, Pittsburgh, USA
| | | | - S Kuemmel
- Breast Unit Kliniken Essen-Mitte, Essen, Germany; Klinik für Gynäkologie mit Brustzentrum Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - M P DiGiovanna
- Yale University School of Medicine, Yale Cancer Center and Smilow Cancer Hospital, New Haven, USA
| | - B Kaufman
- Oncology Division, Sheba Medical Center, Tel Hashomer, Ramat Gan, Israel
| | - G Kunz
- GBG, Neu-Isenburg, Germany; St. Johannes Hospital Dortmund, Dortmund, Germany
| | - A K Conlin
- NSABP Foundation and; NSABP Foundation and Department of Medical Oncology, Providence Cancer Institute, Portland, USA
| | - J C Alcedo
- Department of Clinical Oncology, Centro Hemato Oncologico, Panama City, Panama
| | - T Kuehn
- AGO-B and Klinikum Esslingen, Esslingen, Germany
| | - I Wapnir
- NSABP Foundation and; NSABP Foundation and Stanford University School of Medicine, Stanford, USA
| | - A Fontana
- Division of Medical Oncology, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - J Hackmann
- GBG, Neu-Isenburg, Germany; Marien-Hospital Witten, SEG, Witten, Germany
| | - J Polikoff
- NSABP Foundation and; NSABP Foundation and Department of Hematology/Oncology, Kaiser Permanente, San Diego, USA
| | - M Saghatchian
- Breast Cancer Department, Institut Gustave Roussy, Villejuif, France
| | - A Brufsky
- NSABP Foundation and; NSABP Foundation and Division of Hematology-Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, USA
| | - Y Yang
- Division of Hematology-Oncolog, Taichung Veterans General Hospital and School of Medicine, China Medical University, Taichung City, Taiwan
| | - M Zimovjanova
- Department of Oncology, Charles University and General University Hospital, Prague, Czech Republic
| | - T Boulet
- Department of Biostatistics, F. Hoffmann-La Roche, Basel, Switzerland
| | - H Liu
- Product Development Safety, Genentech, Inc., South San Francisco, USA
| | - D Tesarowski
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - L H Lam
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - C Song
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - M Smitt
- Product Development Oncology, Genentech, Inc., South San Francisco, USA; Seattle Genetics, South San Francisco, USA
| | - S Loibl
- GBG, Neu-Isenburg, Germany; Center for Haematology and Oncology Bethanien, Frankfurt, Germany
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Denkert C, Untch M, Benz S, Schneeweiss A, Weber KE, Schmatloch S, Jackisch C, Sinn HP, Golovato J, Karn T, Marmé F, Link T, Budczies J, Nekljudova V, Schmitt WD, Stickeler E, Müller V, Jank P, Parulkar R, Heinmöller E, Sanborn JZ, Schem C, Sinn BV, Soon-Shiong P, van Mackelenbergh M, Fasching PA, Rabizadeh S, Loibl S. Reconstructing tumor history in breast cancer: signatures of mutational processes and response to neoadjuvant chemotherapy ⋆. Ann Oncol 2021; 32:500-511. [PMID: 33418062 DOI: 10.1016/j.annonc.2020.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 09/04/2020] [Revised: 11/13/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Different endogenous and exogenous mutational processes act over the evolutionary history of a malignant tumor, driven by abnormal DNA editing, mutagens or age-related DNA alterations, among others, to generate the specific mutational landscape of each individual tumor. The signatures of these mutational processes can be identified in large genomic datasets. We investigated the hypothesis that genomic patterns of mutational signatures are associated with the clinical behavior of breast cancer, in particular chemotherapy response and survival, with a particular focus on therapy-resistant disease. PATIENTS AND METHODS Whole exome sequencing was carried out in 405 pretherapeutic samples from the prospective neoadjuvant multicenter GeparSepto study. We analyzed 11 mutational signatures including biological processes such as APOBEC-mutagenesis, homologous recombination deficiency (HRD), mismatch repair deficiency and also age-related or tobacco-induced alterations. RESULTS Different subgroups of breast carcinomas were defined mainly by differences in HRD-related and APOBEC-related mutational signatures and significant differences between hormone-receptor (HR)-negative and HR-positive tumors as well as correlations with age, Ki-67 and immunological parameters were observed. We could identify mutational processes that were linked to increased pathological complete response rates to neoadjuvant chemotherapy with high significance. In univariate analyses for HR-positive tumors signatures, S3 (HRD, P < 0.001) and S13 (APOBEC, P = 0.001) as well as exonic mutation rate (P = 0.002) were significantly correlated with increased pathological complete response rates. The signatures S3 (HRD, P = 0.006) and S4 (tobacco, P = 0.011) were prognostic for reduced disease-free survival of patients with chemotherapy-resistant tumors. CONCLUSION The results of this investigation suggest that the clinical behavior of a tumor, in particular, response to neoadjuvant chemotherapy and disease-free survival of therapy-resistant tumors, could be predicted by the composition of mutational signatures as an indicator of the individual genomic history of a tumor. After additional validations, mutational signatures might be used to identify tumors with an increased response rate to neoadjuvant chemotherapy and to define therapy-resistant subgroups for future therapeutic interventions.
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Affiliation(s)
- C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UK-GM), Marburg, Germany; Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany.
| | - M Untch
- Helios Klinikum Berlin-Buch, Department of Obstetrics and Gynaecology, Berlin, Germany
| | - S Benz
- NantOmics, LLC, Culver City, USA
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - K E Weber
- German Breast Group (GBG), Neu-Isenburg, Germany
| | - S Schmatloch
- Brustzentrum Kassel, Elisabeth Krankenhaus, Kassel, Germany
| | - C Jackisch
- Department of Obstetrics and Gynecology and Breast Cancer Center, Sana Klinikum Offenbach, Offenbach, Germany
| | - H P Sinn
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; German Cancer consortium (DKTK), Heidelberg, Germany
| | | | - T Karn
- Klinik für Frauenheilkunde und Geburtshilfe, Goethe Universität, Frankfurt, Germany
| | - F Marmé
- Universitätsfrauenklinik Mannheim, Mannheim, Germany
| | - T Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - J Budczies
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany; Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; German Cancer consortium (DKTK), Heidelberg, Germany
| | - V Nekljudova
- German Breast Group (GBG), Neu-Isenburg, Germany
| | - W D Schmitt
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany
| | - E Stickeler
- Department of Gynecology, RWTH Aachen, Aachen, Germany
| | - V Müller
- Department of Gynecology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - P Jank
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UK-GM), Marburg, Germany; Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany
| | | | | | | | - C Schem
- Mammazentrum Hamburg am Krankenhaus Jerusalem, Hamburg, Germany
| | - B V Sinn
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany
| | | | - M van Mackelenbergh
- Universitätsklinikum Schleswig-Holstein, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | - S Loibl
- German Breast Group (GBG), Neu-Isenburg, Germany; University of Frankfurt, Frankfurt am Main, Germany
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André F, Ciruelos EM, Juric D, Loibl S, Campone M, Mayer IA, Rubovszky G, Yamashita T, Kaufman B, Lu YS, Inoue K, Pápai Z, Takahashi M, Ghaznawi F, Mills D, Kaper M, Miller M, Conte PF, Iwata H, Rugo HS. Alpelisib plus fulvestrant for PIK3CA-mutated, hormone receptor-positive, human epidermal growth factor receptor-2-negative advanced breast cancer: final overall survival results from SOLAR-1. Ann Oncol 2020; 32:208-217. [PMID: 33246021 DOI: 10.1016/j.annonc.2020.11.011] [Citation(s) in RCA: 230] [Impact Index Per Article: 57.5] [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: 10/06/2020] [Revised: 11/11/2020] [Accepted: 11/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Activation of the phosphatidylinositol-3-kinase (PI3K) pathway via PIK3CA mutations occurs in 28%-46% of hormone receptor-positive (HR+), human epidermal growth factor receptor-2-negative (HER2-) advanced breast cancers (ABCs) and is associated with poor prognosis. The SOLAR-1 trial showed that the addition of alpelisib to fulvestrant treatment provided statistically significant and clinically meaningful progression-free survival (PFS) benefit in PIK3CA-mutated, HR+, HER2- ABC. PATIENTS AND METHODS Men and postmenopausal women with HR+, HER2- ABC whose disease progressed on or after aromatase inhibitor (AI) were randomized 1 : 1 to receive alpelisib (300 mg/day) plus fulvestrant (500 mg every 28 days and once on day 15) or placebo plus fulvestrant. Overall survival (OS) in the PIK3CA-mutant cohort was evaluated by Kaplan-Meier methodology and a one-sided stratified log-rank test was carried out with an O'Brien-Fleming efficacy boundary of P ≤ 0.0161. RESULTS In the PIK3CA-mutated cohort (n = 341), median OS [95% confidence interval (CI)] was 39.3 months (34.1-44.9) for alpelisib-fulvestrant and 31.4 months (26.8-41.3) for placebo-fulvestrant [hazard ratio (HR) = 0.86 (95% CI, 0.64-1.15; P = 0.15)]. OS results did not cross the prespecified efficacy boundary. Median OS (95% CI) in patients with lung and/or liver metastases was 37.2 months (28.7-43.6) and 22.8 months (19.0-26.8) in the alpelisib-fulvestrant and placebo-fulvestrant arms, respectively [HR = 0.68 (0.46-1.00)]. Median times to chemotherapy (95% CI) for the alpelisib-fulvestrant and placebo-fulvestrant arms were 23.3 months (15.2-28.4) and 14.8 months (10.5-22.6), respectively [HR = 0.72 (0.54-0.95)]. No new safety signals were observed with longer follow-up. CONCLUSIONS Although the analysis did not cross the prespecified boundary for statistical significance, there was a 7.9-month numeric improvement in median OS when alpelisib was added to fulvestrant treatment of patients with PIK3CA-mutated, HR+, HER2- ABC. Overall, these results further support the statistically significant prolongation of PFS observed with alpelisib plus fulvestrant in this population, which has a poor prognosis due to a PIK3CA mutation. CLINICALTRIALS. GOV ID NCT02437318.
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Affiliation(s)
- F André
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif and Paris Saclay University, Orsay, France.
| | - E M Ciruelos
- Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - D Juric
- Department of Medicine, Massachusetts General Hospital Cancer Center, Boston, USA
| | - S Loibl
- Department of Medicine and Research, German Breast Group, GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - M Campone
- Medical Oncology, Institut de Cancerologie de l'Ouest, Saint-Herblain, Nantes Cedex, France
| | - I A Mayer
- Hematology/Oncology, Vanderbilt University, Nashville, USA
| | - G Rubovszky
- Department of Medical Oncology and Clinical Pharmacology, National Institute of Oncology, Budapest, Hungary
| | - T Yamashita
- Department of Breast and Endocrine Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - B Kaufman
- Medical Oncology, Tel Aviv University, Sheba Medical Centre, Tel Hashomer, Israel
| | - Y-S Lu
- Medical Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - K Inoue
- Breast Surgery, Saitama Cancer Center, Saitama, Japan
| | - Z Pápai
- Medical Oncology, Hungarian Defence Forces Medical Centre, Budapest, Hungary
| | - M Takahashi
- Breast Surgery, NHO Hokkaido Cancer Center, Sapporo, Japan
| | - F Ghaznawi
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - D Mills
- Novartis Pharma AG, Basel, Switzerland
| | - M Kaper
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - M Miller
- Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - P F Conte
- Medical Oncology, Universita di Padova and Oncologia Medica 2, Istituto Oncologico Veneto IRCCS, Padua, Italy
| | - H Iwata
- Breast Oncology, Aichi Cancer Center Hospital, Aichi, Japan
| | - H S Rugo
- Breast Department, UCSF Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
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Fasching PA, Link T, Hauke J, Seither F, Jackisch C, Klare P, Schmatloch S, Hanusch C, Huober J, Stefek A, Seiler S, Schmitt WD, Uleer C, Doering G, Rhiem K, Schneeweiss A, Engels K, Denkert C, Schmutzler RK, Hahnen E, Untch M, Burchardi N, Blohmer JU, Loibl S. Neoadjuvant paclitaxel/olaparib in comparison to paclitaxel/carboplatinum in patients with HER2-negative breast cancer and homologous recombination deficiency (GeparOLA study). Ann Oncol 2020; 32:49-57. [PMID: 33098995 DOI: 10.1016/j.annonc.2020.10.471] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [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: 07/27/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The efficacy and toxicity of olaparib as combination therapy in early breast cancer (BC) patients with homologous recombinant deficiency (HRD) [score high and/or germline (g) or tumour (t) BRCA1/2 mutation] is not well described. GeparOLA (ClinicalTrials.gov, NCT02789332) investigated olaparib in combination with paclitaxel in HER2-negative early BC with HRD. PATIENTS AND METHODS Patients with untreated primary HER2-negative cT2-cT4a-d or cT1c with either cN+ or pNSLN+ or cT1c and triple-negative breast cancer (TNBC) or cT1c and Ki-67>20% BC with HRD were randomised either to paclitaxel (P) 80 mg/m2 weekly plus olaparib (O) 100 mg twice daily for 12 weeks or P plus carboplatinum (Cb) area under the curve 2 weekly for 12 weeks, both followed by epirubicin/cyclophosphamide (EC). Stratification factors were hormone receptor (HR) status (HR+ versus HR-) and age (<40 versus ≥40 years). The primary endpoint was pathological complete response (pCR; ypT0/is ypN0). A two-sided one-group χ2-test was planned to exclude a pCR rate of ≤55% in the PO-EC arm. Secondary end points were other pCR definitions, breast conservation rate, clinical/imaging response, tolerability and safety. RESULTS A total of 107 patients were randomised between September 2016 and July 2018; 106 (PO N = 69; PCb N = 37) started treatment. Median age was 47.0 years (range 25.0-71.0); 36.2% had cT1, 61.0% cT2, 2.9% cT3, and 31.8% cN-positive tumours; grade 3 tumours: 86.8%; Ki-67>20%: 89.6%; TNBC: 72.6%; confirmed gBRCA1/2 mutation: 56.2%. The pCR rate with PO was 55.1% [90% confidence interval (CI) 44.5% to 65.3%] versus PCb 48.6% (90% CI 34.3% to 63.2%). Analysis for the stratified subgroups showed higher pCR rates with PO in the cohorts of patients <40 years and HR+ patients. CONCLUSION GeparOLA could not exclude a pCR rate of ≤55% in the PO arm. PO was significantly better tolerated and the combination merits further evaluation.
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Affiliation(s)
- P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-Nuremberg, National Center for Tumor Diseases, Erlangen, Germany
| | - T Link
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus Dresden, Germany
| | - J Hauke
- Center for Familial Breast and Ovarian Cancer, University of Cologne, Cologne, Germany
| | - F Seither
- German Breast Group, Neu-Isenburg, Germany
| | - C Jackisch
- Sana Klinikum Offenbach, Offenbach, Germany
| | - P Klare
- MediOnko-Institut GbR Berlin, Berlin, Germany
| | | | - C Hanusch
- Rotkreuzklinikum Munich, Munich, Germany
| | - J Huober
- University Hospital Ulm, Ulm, Germany
| | - A Stefek
- Johanniter-Krankenhaus Genthin-Stendal, Stendal, Germany
| | - S Seiler
- German Breast Group, Neu-Isenburg, Germany
| | - W D Schmitt
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - C Uleer
- Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | - G Doering
- Hämato-Onkologie im Medicum Bremen, Bremen, Germany
| | - K Rhiem
- Center for Familial Breast and Ovarian Cancer, University of Cologne, Cologne, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Engels
- Center for Pathology, Cytology and Molecular Pathology Neuss, Neuss, Germany
| | - C Denkert
- Institute of Pathology, Philipps-Universität Marburg und University Hospital Marburg (UKGM), Marburg, Germany
| | - R K Schmutzler
- Center for Familial Breast and Ovarian Cancer, University of Cologne, Cologne, Germany
| | - E Hahnen
- Center for Familial Breast and Ovarian Cancer, University of Cologne, Cologne, Germany
| | - M Untch
- Helios-Klinikum Berlin-Buch, Berlin, Germany
| | | | - J-U Blohmer
- Brustzentrum Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany.
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Laakmann E, Witzel I, Neunhöffer T, Weide R, Schmidt M, Park-Simon T, Möbus V, Mundhenke C, Polasik A, Lübbe K, Hesse T, Riecke K, Thill M, Fasching P, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Müller V. Characteristics and clinical outcome of breast cancer patients with asymptomatic brain metastases. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30567-0] [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: 11/30/2022]
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Laakmann E, Witzel I, Neunhöffer T, Weide R, Schmidt M, Park-Simon TW, Möbus V, Mudhenke C, Polasik A, Lübbe K, Hesse T, Riecke K, Thill M, Fasching PA, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Müller V. Charakteristika und Überlebensanalyse der Patienten mit asymptomatischen Hirnmetastasen eines Mammakarzinoms. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - I Witzel
- Universitätsklinikum Hamburg-Eppendorf
| | | | - R Weide
- Institut für Versorgungsforschung in der Onkologie
| | - M Schmidt
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz
| | | | - V Möbus
- Universitätsklinikum Frankfurt
| | | | | | - K Lübbe
- Diakovere Henriettenstift, Breast Center
| | - T Hesse
- Agaplesion Diakonieklinikum Rotenburg
| | - K Riecke
- Universitätsklinikum Hamburg- Eppendorf
| | - M Thill
- Agaplesion Markus Krankenhaus
| | - PA Fasching
- Frauenklinik des Universitätsklinikums Erlangen
| | - C Denkert
- nstitut für Pathologie UKGM – Universitätsklinikum Marburg
| | - T Fehm
- Universitätsklinikum Düsseldorf
| | | | - J Rey
- German Breast Group, GBG Forschungs GmbH
| | - S Loibl
- German Breast Group, GBG Forschungs GmbH
| | - V Müller
- Universitätsklinikum Hamburg- Eppendorf
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50
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Riecke K, Mueller V, Neunhöffer T, Weide R, Schmidt M, Park-Simon TW, Mundhenke C, Polasik A, Hesse T, Lübbe K, Laakmann E, Thill M, Fasching P, Denkert C, Fehm T, Nekljudova V, Rey J, Loibl S, Witzel I. Predicting prognosis of breast cancer patients with brain metastases in the BMBC registry – comparison of three different prognostic scores. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- K Riecke
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - V Mueller
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | | | - R Weide
- Institut für Versorgungsforschung in der Onkologie
| | | | | | | | | | - T Hesse
- Agaplesion Diakonieklinikum Rotenburg
| | - K Lübbe
- Diakovere Henriettenstift, Breast Center
| | - E Laakmann
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - M Thill
- Agaplesion Markus Krankenhaus
| | | | - C Denkert
- Institut für Pathologie UKGM – Universitätsklinikum Marburg
| | - T Fehm
- Universitätsklinikum Düsseldorf
| | | | - J Rey
- German Breast Group, GBG Forschungs GmbH
| | - S Loibl
- German Breast Group, GBG Forschungs GmbH
| | - I Witzel
- Universitätklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
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