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Llombart-Cussac A, Pérez-Garcia JM, Ruiz Borrego M, Tolosa P, Blanch S, Fernández-Ortega A, Urruticoechea A, Blancas I, Saura C, Rojas B, Bermejo B, Ponce Lorenzo J, Gion M, Cortez-Castedo P, Llabres E, Galve E, Cueva JF, López A, Alonso-Romero JL, González-Santiago S, Martínez de Dueñas E, Ciruelos E, Martrat G, Gener P, Alcalá-López D, Sampayo-Cordero M, Gómez-Peralta F, Cortés J. Preventing alpelisib-related hyperglycaemia in HR+/HER2-/ PIK3CA-mutated advanced breast cancer using metformin (METALLICA): a multicentre, open-label, single-arm, phase 2 trial. EClinicalMedicine 2024; 71:102520. [PMID: 38638399 PMCID: PMC11024566 DOI: 10.1016/j.eclinm.2024.102520] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 02/07/2024] [Accepted: 02/19/2024] [Indexed: 04/20/2024] Open
Abstract
Background Hyperglycaemia is an early and frequent adverse event during alpelisib treatment. METALLICA aimed to evaluate prophylactic metformin to prevent or reduce hyperglycaemia occurrence in patients with HR+/HER2-/PIK3CA-mutated advanced breast cancer (ABC). Methods Between August 13th, 2020 and March 23rd, 2022, this 2-cohort, phase 2, multicentre, single-arm trial (NCT04300790) enrolled patients with HR+/HER2-/PIK3CA-mutated ABC: cohort A, normal glycaemia (fasting plasma glucose <100 mg/dL [<5.6 mmol/L] and HbA1c <5.7%), and cohort B, prediabetes (fasting plasma glucose 100-140 mg/dL [5.6-7.8 mmol/L] and/or haemoglobin A1C [HbA1c] 5.7-6.4%). Participants were at least 18 years old, with Eastern Cooperative Oncology Group performance status of 0-1, and up to two prior lines of endocrine therapy (ET) for ABC. Alpelisib plus ET were administered in 28-day cycles after initiation of prophylactic metformin plus ET. Primary endpoint was the incidence of grade 3-4 hyperglycaemia over the first 8 weeks. Secondary endpoints included safety, progression-free survival (PFS), objective response rate (ORR), and clinical benefit rate (CBR). The primary objective for cohort A and B is met with ≤7 (14.6%) and ≤4 (20%) patients with grade 3-4 hyperglycaemia over the first 8 weeks, respectively. Findings 233 patients were screened, and 68 (20.2%) patients were enrolled in cohorts A (n = 48) and B (n = 20). Median follow-up was 7.8 months (IQR 1.4-19.6). Over the first 8 weeks, one (2.1%) of 48 patients in cohort A (95% CI: 0.5-11.1; P < 0.0001), and three (15.0%) of 20 patients in cohort B (95% CI: 5.6-37.8; P = 0.016) had grade 3-4 hyperglycaemia. Serious treatment-related adverse events occurred in seven patients (10.3%). The most common were rash (two [2.9%]), vomiting (two [2.9%]), and diarrhoea (two [2.9%]). Discontinuation of alpelisib caused by AEs was reported in nine patients (13.2%), none caused by hyperglycaemia. At data cutoff (15 June, 2022), no treatment-related deaths were observed. In the full analysis set, median PFS was 7.3 months (95% CI: 5.9-not reached), ORR was 20.6% (95% CI: 11.7-32.1%), and CBR was 52.9% (95% CI: 40.4-65.2). Interpretation In HR+/HER2-/PIK3CA-mutated ABC, prophylactic metformin before alpelisib plus endocrine treatment has low incidence and severity of alpelicib-induced hyperglycaemia. Funding Novartis Pharmaceuticals.
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Affiliation(s)
- Antonio Llombart-Cussac
- Hospital Arnau de Vilanova, Universidad Católica de Valencia, Valencia, Spain
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | - José Manuel Pérez-Garcia
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quiron Group, Barcelona, Spain
| | | | - Pablo Tolosa
- 12 de Octubre University Hospital, Madrid, Spain
| | | | | | | | - Isabel Blancas
- Hospital Universitario Clínico San Cecilio, Medicine Department, Medicine Faculty, Granada University, Instituto de Investigación Biosanitaria de Granada (ibs. Granada), Spain
| | - Cristina Saura
- Vall d'Hebron University Hospital, Barcelona, Vall d’Hebron Institute of Oncology (VHIO), Spain
| | - Beatriz Rojas
- Hospital Universitario HM Sanchinarro, Madrid, Spain
| | - Begoña Bermejo
- Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
- Medicine Department, Universidad de Valencia, Oncology Biomedical Research National Network (CIBERONC-ISCIII), Madrid, Spain
| | - José Ponce Lorenzo
- Dr. Balmis General University Hospital, Alicante Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain
| | - María Gion
- Hospital Ruber Internacional, Madrid, Spain
- Hospital Ramon y Cajal, Madrid, Spain
| | | | - Elisenda Llabres
- Hospital Universitario Insular de Gran Canarias, Las Palmas de Gran Canaria, Spain
| | - Elena Galve
- Hospital Universitario de Basurto, Bilbao, Spain
| | | | - Ana López
- University Hospital of León, León, Spain
| | | | | | | | - Eva Ciruelos
- 12 de Octubre University Hospital, Madrid, Spain
| | | | - Petra Gener
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | | | | | | | - Javier Cortés
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
- International Breast Cancer Center (IBCC), Pangaea Oncology, Quiron Group, Barcelona, Spain
- Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
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Blanch S, Gil-Gil JM, Arumí M, Aguirre E, Seguí MÁ, Atienza M, Díaz-Cerezo S, Molero A, Cervera JM, Gavilá J. Observational study of HR+/HER2- metastatic breast cancer patients treated with abemaciclib in Spain in the Named Patient Use Program (AbemusS). Clin Transl Oncol 2023; 25:2950-2959. [PMID: 37029241 PMCID: PMC10462534 DOI: 10.1007/s12094-023-03159-9] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/18/2023] [Indexed: 04/09/2023]
Abstract
INTRODUCTION/OBJECTIVES To describe abemaciclib use in patients with hormone receptor-positive, human epidermal growth factor receptor-negative (HR+/HER2-) metastatic breast cancer (mBC) who participated in the Named Patient Use program (NPU) in Spain. MATERIAL AND METHODS This retrospective study was based on medical record review of patients across 20 centers during 2018/2019. Patients were followed up until death, enrolment in a clinical trial, loss of follow-up or study end. Clinical and demographic characteristics, treatment patterns and abemaciclib effectiveness were analyzed; time-to-event and median times were estimated using the Kaplan-Meier (KM) method. RESULTS The study included 69 female patients with mBC (mean age 60.4 ± 12.4 years), 86% of whom had an initial diagnosis of early BC and 20% had an ECOG ≥ 2. Median follow-up was 23 months (range 16-28). Metastases were frequently observed in bone (79%) and visceral tissue (65%), with 47% having metastases in > 2 sites. Median number of treatment lines before abemaciclib was 6 (range 1-10). Abemaciclib monotherapy was received by 72% of patients and combination therapy with endocrine therapy by 28% of patients; 54% of patients required dose adjustments, with a median time to first adjustment of 1.8 months. Abemaciclib was discontinued in 86% of patients after a median of 7.7 months (13.2 months for combination therapy and 7.0 months for monotherapy) mainly due to disease progression (69%). CONCLUSION These results suggest that abemaciclib is effective, as monotherapy and in combination, for patients with heavily pretreated mBC, consistent with clinical trial results.
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Affiliation(s)
- Salvador Blanch
- Instituto Valenciano de Oncología (IVO), Carrer del Professor Beltrán Báguena, 8, 46009 Valencia, Valencia Spain
| | - Juan Miguel Gil-Gil
- Institut Català d’Oncologia (ICO), Gran Via 199-201, Hospitalet, 08908 Barcelona, Spain
| | - Miriam Arumí
- Department of Medical Oncology, Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Passeig de la Vall d’Hebron, 119, 08035 Barcelona, Spain
| | - Elena Aguirre
- Hospital Universitario Miguel Servet, Paseo Isabel la Católica, 1-3, 50009 Zaragoza, Spain
| | - Miguel Ángel Seguí
- Hospital Parc Taulí de Sabadell, Parc Taulí, 1, 08208 Sabadell, Barcelona Spain
| | - Manuel Atienza
- Medical Department, Lilly Spain, Av. de la Industria 30, 28108 Madrid, Spain
| | - Silvia Díaz-Cerezo
- Medical Department, Lilly Spain, Av. de la Industria 30, 28108 Madrid, Spain
| | - Alberto Molero
- Medical Department, Lilly Spain, Av. de la Industria 30, 28108 Madrid, Spain
| | - José Manuel Cervera
- Medical Department, Lilly Spain, Av. de la Industria 30, 28108 Madrid, Spain
| | - Joaquín Gavilá
- Instituto Valenciano de Oncología (IVO), Carrer del Professor Beltrán Báguena, 8, 46009 Valencia, Valencia Spain
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Borrego MR, Tolosa P, Blanch S, Fernández A, Urriticoechea A, Blancas I, Saura C, Rojas B, Bermejo B, Ponce J, Gión M, Llabres E, Galve E, Cueva JF, López A, Alonso-Romero JL, González-Santiago S, De Dueñas EM, Peralta FG, Ciruelos E, Pérez-García JM, Llombart-Cussac A, Cortés J. Abstract PD8-02: Metformin (MET) for the prevention of Alpelisib (ALP)-related Hyperglycemia (HG) in PIK3CA-mutated, Hormone Receptor-Positive (HR[+]) HER2-Negative (HER2[-]) Advanced Breast Cancer (ABC): The METALLICA study. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd8-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: HG is an on-target AE of PI3K inhibition, reported in 63.7% (36.6% G≥3) of HR[+]/HER2[-] ABC patients (pts) treated with ALP plus fulvestrant in SOLAR-1. HG was the most frequent adverse event (AE) leading to ALP discontinuation (6.3%). MET reduces systemic insulin resistance and suppress PI3K and Ras signaling. METALLICA is assessing the prophylactic use of MET for prevention of ALP-induced G3-4 HG in PIK3CA-mutated, HR[+]/HER2[-] ABC pts with normal fasting glycemia or prediabetic criteria. Methods: This is an open-label, single-arm, two-cohort, phase 2 trial. Pts aged ≥18 years, ECOG PS of 0–1, and PIK3CA-mutated, HR[+]/HER2[-] ABC, progressing to an aromatase inhibitor (AI)-containing regimen, ≤2 previous endocrine therapy (ET) and ≤1 prior chemotherapy regimens for ABC were eligible. Pts were enrolled into cohorts according to glycemia at baseline: (A) pts with normal fasting glycemia < 100 mg/dL and glycosylated hemoglobin (HbA1c) < 5.7%; (B) pts with prediabetic fasting glycaemia 100–140 mg/dL and/or HbA1c 5.7–6.4%. Pts received oral ALP 300 mg/day, starting from C1D8, in combination with ET; fulvestrant, letrozole, or exemestane as per standard of care; and oral MET 1000 mg/day on days 1-3 and 2000 mg/day thereafter. The primary endpoint was G3-4 HG incidence as per NCI-CTCAE v.4.03 at 2 first cycles of treatment. Assessment of glycemia was performed by rigorous self-monitoring blood glucose and local laboratory confirmation in fasting conditions. Secondary endpoints included objective response (ORR), clinical benefit rate (CBR), duration of response (DoR), progression-free survival (PFS), and safety. Sample size was based on a Simon’s two-stage design in cohorts A (H0: G3-4 HG ≥25%; H1: G3-4 HG ≤10%) and B (H0: G3-4 HG ≥40%; H1: G3-4 HG ≤15%). We planned to attain 80% power at the nominal one-sided α level of 0.05 for each cohort. Results: Between Aug 30, 2020, and Mar 10, 2022, 68 pts were enrolled at 18 sites (48 cohort A, 20 cohort B). Median age was 55 (range, 29–79) years and 58.8% pts had visceral disease and an ECOG PS 0. A total of 66 (97.1%) pts had been previously treated with a CDK4/6i and 13 (19.2%) pts had received chemotherapy for advanced disease. Sixty-three (92.6%) pts received fulvestrant as ET (45 cohort A, 18 cohort B). With a median follow-up of 8 (range, 1.6–14.9) months, 28 (41.2%) pts remain on study treatment. Disease progression was the main reason for discontinuation, reported in 32 (47.1%) pts. The primary endpoint of the study was reached, with 1 (2.1%) pts (95%CI, 0.8–9.5; p < 0.001) in cohort A and 3 (15%) pts (95%CI, 4.5–33; p = 0.012) in cohort B experiencing a G3-4 HG episode over the 2 first cycles of treatment. For patients on fulvestrant, G3-4 HG rates were 1 pts (2.2%) and 3 (16.7%) pts for cohorts A and B, respectively. No ALP discontinuation related to HG was reported during the first 2 treatment cycles. Median PFS in all patients was 7.4 months (95%CI, 6–NA). Among pts with measurable disease, ORR was 14 (36.8%) pts (95%CI, 21.8–54). At the time of this analysis, DoR and CBR were still immature. The most common AEs were diarrhea (67.6%; 13.2% G≥3), nausea (67.6%; 0% G≥3), and fatigue (45.6%; 2.9% G≥3). Serious AEs occurred in 15 (22.1%) pts. The main serious AEs were rash (2.9% G≥3) and vomiting (1.5% G≥3). No additional pts reported G≥3 HG after the first 2 cycles. The dose of ALP was reduced according to the protocol in 19 (27.9%) pts. Eight (11.8%) pts permanently discontinued ALP due to AEs, none of whom related to HG. No treatment-related deaths were reported. Conclusions: Prophylactic use of MET substantially reduced the incidence and severity of ALP-related HG with no additional toxicities and could be a new standard for PIK3CA-mutated, HR[+]/HER2[-] ABC pts receiving ALP plus fulvestrant or other ET.
Citation Format: Manuel Ruiz Borrego, Pablo Tolosa, Salvador Blanch, Adela Fernández, Ander Urriticoechea, Isabel Blancas, Cristina Saura, Beatriz Rojas, Begoña Bermejo, Jose Ponce, Maria Gión, Elisenda Llabres, Elena Galve, Juan Fernando Cueva, Ana López, José L Alonso-Romero, Santiago González-Santiago, Eduardo Martínez De Dueñas, Fernando Gomez Peralta, Eva Ciruelos, José Manuel Pérez-García, Antonio Llombart-Cussac, Javier Cortés. Metformin (MET) for the prevention of Alpelisib (ALP)-related Hyperglycemia (HG) in PIK3CA-mutated, Hormone Receptor-Positive (HR[+]) HER2-Negative (HER2[-]) Advanced Breast Cancer (ABC): The METALLICA study. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD8-02.
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Affiliation(s)
| | - Pablo Tolosa
- 2SOLTI Cancer Research Group, Barcelona, Spain/Medical Oncology Department, Hospital 12 de Octubre, Madrid., Madrid, Madrid, Spain
| | - Salvador Blanch
- 3Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey, US. Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Adela Fernández
- 4Medical Oncology Department, Hospital Ramon y Cajal, Madrid, Spain; Alcalá de Henares University, Faculty of Medicine, Madrid, Spain
| | | | - Isabel Blancas
- 6Medical Oncology Dept, University Hospital San Cecilio, Granada, Spain
| | - Cristina Saura
- 7Vall d’Hebron Institute of Oncology (VHIO), Vall d’Hebron University Hospital, Barcelona, Spain, Barcelona, Catalonia, Spain
| | | | - Begoña Bermejo
- 9Hospital Clínico Universitario de Valencia, Valencia, Spain
| | - Jose Ponce
- 10Hospital General Universitario Dr. Balmis, ISABIAL, Alicante, Spain, Comunidad Valenciana, Spain
| | - Maria Gión
- 11Hospital Ruber Internacional, Madrid, Spain, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | | | | | - Ana López
- 15Complejo Asistencia Universitario de Leon, Leon, Spain
| | - José L Alonso-Romero
- 16Hospital Clínico Universitario Virgen de la Arrixaca. GEICAM Spanish Breast Cancer Group
| | | | | | | | - Eva Ciruelos
- 20SOLTI Breast Cancer Research Group, Barcelona, Spain/Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain, Madrid, Spain
| | | | - Antonio Llombart-Cussac
- 22Hospital Arnau de Vilanova; FISABIO, Valencia, Spain. Catholic University, Valencia, Spain. Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey, US., Spain
| | - Javier Cortés
- 23International Breast Cancer Center (IBCC), Pangaea Oncology, Quironsalud Group, Madrid and Barcelona, Spain & Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
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Prat A, Pascual T, Muñoz M, Hernando C, Vazquez S, Blanch S, Alva M, Oliveira M, Sanfeliu E, Villanueva L, Brasó-Maristany F, Chic N, Ciruelos E. Abstract P3-06-02: TATEN TRIAL (SOLTI-1716) Targeting non-Luminal disease by PAM50 with pembrolizumab + paclitaxel in Hormone Receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer (MBC): interim analysis. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-p3-06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background Within HR+/HER2- disease, patients with non-luminal subtypes of breast cancer (HER2-enriched [HER2-E] and Basal-like) have poorer prognosis than those with luminal subtypes, may be more sensitive to chemotherapy, and have higher expression of immune-related genes and tumor infiltrating lymphocytes (TILs). Here, we report the interim efficacy and safety data of the TATEN trial (NCT04251169), the first study designed to evaluate pembrolizumab and paclitaxel in HR+/HER2-negative, PAM50 non-luminal, metastatic breast cancer (MBC). Methods TATEN is a single-arm, multicenter phase II study evaluating pembrolizumab in combination with paclitaxel in patients with HR+/HER2-, PAM50 non-luminal, MBC. Key inclusion criteria include progression to prior CDK4/6 inhibitors, presence of measurable disease by RECIST V1.1, no prior chemotherapy for MBC, and ECOG 0-1. Patients receive pembrolizumab at 200 mg every 3 weeks (on D1 of each 21-day cycle, beginning at cycle 1) in combination with weekly paclitaxel at 80 mg/m2, beginning at cycle 2. The primary endpoint is to evaluate overall response rate (ORR), defined as the rate of complete (CR) and partial response (PR) according to RECIST V1.1. Secondary endpoints include clinical benefit rate (CBR; CR + PR + stable disease >24 weeks), progression free survival, overall survival, safety, and predictive biomarkers. Tumor samples collected during advanced/metastatic disease are mandatory to assess PAM50 and other translational endpoints. This study had a planned interim analysis after 15 patients were evaluable for ORR based on a Simon’s two stage design with 80% power and a type I error rate of 0.05. Stage I of the trial would be considered successful if at least 6 patients achieved a PR and/or CR. In that case, the trial would recruit up to 46 evaluable patients for a target ORR ≥ 41. Here we report results from the patients who received at least one dose of combination treatment and had a first, post-baseline, tumor assessment according to RECIST v1.1 (evaluable population). Results From July 2020 to December 2021, 119 patients were screened, and 25 PAM50 non-luminal tumors were identified (21%). From these, 17 (68%) patients were recruited, and 15 were evaluable for primary endpoint. Two patients discontinued the trial before the first dose of pembrolizumab and paclitaxel, because of clinical progressive disease (PD). Baseline patient characteristics were as follows: median age 53 years (range: 40-77), ECOG 0 52.9%, de novo MBC at diagnosis 29.4%, and visceral disease 64.7% (including 53.3% with liver metastasis). Ten patients had received paclitaxel treatment in the adjuvant setting. Regarding PAM50 intrinsic subtype, two patients had basal-like and 13 HER2-E tumors. At the time of data cut-off (May 17,2022), 8 patients (53.3%) had stopped their treatment because of PD and 2 (13.3%) due to toxicity. Five patients (33.3%) were still on treatment. The ORR was 53.3 % (8 of 15, 95% CI 26.6-78.7), meeting the pre-specified ORR for the first stage of the trial. The CBR was 86.6% (13 of 15, 95%CI 59.5-98.34), and median PFS was 7.5 months (95% CI: 5.6 – 10.2). Overall, all patients experienced treatment-related adverse events (TRAEs) of any grade, while 53.3% of patients experienced grade 3 TRAEs. No grade 4 or 5 TRAEs were reported in the evaluable population. Correlative analysis including gene expression analysis and centralized TILs scoring and PD-L1 IHC will be presented. Conclusions The first stage of TATEN combining pembrolizumab with paclitaxel after progression to CDK4/6 inhibitors in patients with HR+/HER2-negative, PAM50 non-luminal MBC met its pre-specified endpoint. Completion of the stage II part of the trial with the inclusion of up to 46 patients is warranted to assess the activity of this combination in this group of patients. Correlative studies to find predictive biomarkers of response to this regimen are ongoing and will be presented at the meeting. This study was funded by MSD.
Citation Format: Aleix Prat, Tomás Pascual, Montserrat Muñoz, Cristina Hernando, Silvia Vazquez, Salvador Blanch, Manuel Alva, Mafalda Oliveira, Esther Sanfeliu, Lorea Villanueva, Fara Brasó-Maristany, Nuria Chic, Eva Ciruelos. TATEN TRIAL (SOLTI-1716) Targeting non-Luminal disease by PAM50 with pembrolizumab + paclitaxel in Hormone Receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer (MBC): interim analysis [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P3-06-02.
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Affiliation(s)
| | - Tomás Pascual
- 2Medical Oncology Department, Hospital Clínic of Barcelona, Barcelona, Spain; Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain, Catalonia, Spain
| | - Montserrat Muñoz
- 3SOLTI Breast Cancer Research Group, Hospital Clínic of Barcelona, Translational Genomics and Targeted Therapies in Solid Tumors, August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain, Catalonia, Spain
| | | | - Silvia Vazquez
- 5Hospital Duran i Reynals-Institut Català d’Oncologia. Hospitalet de Llobregat, Barcelona, Spain
| | - Salvador Blanch
- 6Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey, US. Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Manuel Alva
- 7Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
| | - Mafalda Oliveira
- 8Department of Medical Oncology, Vall d’Hebron University Hospital; Breast Cancer Group, Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Esther Sanfeliu
- 9SOLTI Breast Cancer Research Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Faculty of Medicine and Pathology Department, Hospital Clínic of Barcelona, University of Barcelona, Barcelona, Spain., Catalonia, Spain
| | | | - Fara Brasó-Maristany
- 11Translational Genomics and Targeted Therapies in Solid Tumors, August Pi i Sunyer Biomedical Research Institute (IDIBAPS)
| | - Nuria Chic
- 12Hospital Clínic of Barcelona, Barcelona, Spain; August Pi I Sunyer Biomedical Research Institute, Barcelona, Spain, Catalonia, Spain
| | - Eva Ciruelos
- 13SOLTI Breast Cancer Research Group, Barcelona, Spain/Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain, Madrid, Spain
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Pérez-García JM, Batista MV, Cortez-Castedo P, Borrego MR, Cejalvo JM, de la Haba-Rodríguez J, Garrigós L, Racca F, Servitja S, Blanch S, Gión M, Nave M, Fernández A, Martínez-Bueno A, Llombart-Cussac A, Sampayo-Cordero M, Malfettone A, Cortés J, Braga S. Abstract PD7-02: Trastuzumab Deruxtecan in patients with Unstable Central Nervous System Involvement from HER2-Low Advanced Breast Cancer: The DEBBRAH Trial. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd7-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: The antibody-drug conjugate trastuzumab deruxtecan (T-DXd) significantly improved survival outcomes of HER2-low advanced breast cancer (ABC) patients (pts) compared to standard chemotherapy in the DESTINY-Breast04 trial. DEBBRAH is assessing the efficacy and safety of T-DXd in HER2[+] and HER2-low ABC pts with a history of brain metastases (BM) and/or leptomeningeal carcinomatosis (LMC); here, we report results of HER-low ABC pts. Methods: DEBBRAH (NCT04420598) is a multicenter, open-label, five-cohort, non-comparative, phase 2 study across 18 hospitals in 2 countries. A total of 39 pts aged ≥18 years with pretreated HER2[+] or HER2-low ABC with stable, progressing, or untreated BM and/or LMC, were enrolled in 5 cohorts: (1) HER2[+] ABC with non-progressing BM after radiotherapy and/or surgery; (2) HER2[+] or HER2-low ABC with asymptomatic untreated BM; (3) HER2[+] ABC with progressing BM after local treatment; (4) HER2-low ABC with progressing BM after local treatment; (5) HER2[+] or HER2-low ABC with LMC. Pts received 5.4 mg/kg T-DXd intravenously once every 21 days until disease progression, unacceptable toxicity, or consent withdrawal. Primary endpoint for cohorts 2 and 4 was intracranial overall response rate (ORR-IC) according to RANO-BM. Secondary endpoints included overall response (ORR) according to RECIST v1.1, progression-free survival (PFS), duration of response (DoR), clinical benefit rate (CBR); and safety and tolerability as per NCI-CTCAE v.5.0. Primary analysis is the estimation of ORR-IC (H0: ORR-IC ≤5%; H1: ORR-IC ≥40%) based on the one-sided binomial exact test. Sample size was planned to attain an 80% power at a nominal α level of 0.05 in each cohort. Results from cohort 2 should be considered descriptive since formal testing has to be performed in the whole cohort of pts with HER2[+] or HER2-low ABC and asymptomatic untreated BM. Results: From Oct 23, 2020, through Feb 15, 2022, 6 pts and 7 pts were allocated into cohorts 2 and 4, respectively. One patient with LMC included in cohort 4 was excluded from analysis. Median age was 54 (range 40–73) years. Median number of previous lines of therapy for advanced disease was 7 (range, 4-8) and 3 (range, 2-4) for cohorts 2 and 4, respectively. Median follow-up was 9.5 months (range, 1.6-15.7). At data cutoff (Apr 29, 2022), no patient of cohort 2 and 3 (50.0%) pts of cohort 4 remained on therapy. In cohort 2, ORR-IC was 66.7% (4 of 6 pts had intracranial partial response [PR]; 95% CI, 22.3–95.7). In cohort 4, ORR-IC was 33.3% meeting the primary endpoint (2 of 6 pts had intracranial PR; 95% CI, 4.3–77.7; P = .033). Overall, ORR-IC in all pts was 50% (6 of 12 pts; 95% CI, 21.1-78.9) and CBR was 66.7% (8 of 12 pts; 95% CI, 34.9-90.1). Combining pts with measurable intracranial or extracranial disease from cohorts 2 and 4, ORR, CBR and median DoR were 41.7% (5 of 12 pts; 95% CI, 15.2–72.3), 50.0% (6 of 12 pts; 95% CI, 21.1–78.9), and 7.2 months (95% CI, 2.5-16.4), respectively. Median PFS was 5.7 months (95% CI, 4.7-NA) among these pts. The most common treatment emergent adverse events (TEAEs) of any grade (G) were fatigue (58.3%; 8.3% G≥3) and nausea (50.0%; 0% G≥3). Two (16.7%; 0% G≥3) cases of interstitial lung disease/pneumonitis were reported. Serious unrelated TEAEs occurred in 2 (16.7%) of 12 pts; 1 case of general pain (G3) and 1 case of venous embolism (G5) that led to death. There were no drug-related deaths due to TEAEs. Conclusions: T-DXd showed a preliminary antitumor activity in pretreated HER2-low ABC pts with asymptomatic untreated or progressing BM after local treatment. The substantial response of BM to T-DXd in this setting is promising and warrants further investigation.
Citation Format: José Manuel Pérez-García, Marta Vaz Batista, Patricia Cortez-Castedo, Manuel Ruiz Borrego, Juan Miguel Cejalvo, Juan de la Haba-Rodríguez, Laia Garrigós, Fabriccio Racca, Sonia Servitja, Salvador Blanch, Maria Gión, Mónica Nave, Adela Fernández, Alejandro Martínez-Bueno, Antonio Llombart-Cussac, Miguel Sampayo-Cordero, Andrea Malfettone, Javier Cortés, Sofía Braga. Trastuzumab Deruxtecan in patients with Unstable Central Nervous System Involvement from HER2-Low Advanced Breast Cancer: The DEBBRAH Trial [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD7-02.
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Affiliation(s)
| | - Marta Vaz Batista
- 2Hospital Professor Doutor Fernando Fonseca EPE, Lisbon, Portugal. Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey, US., Portugal
| | | | | | | | - Juan de la Haba-Rodríguez
- 6Instituto Maimonides de Investigacion Biomedica, Hospital Reina Sofia, Universidad de Córdoba. GEICAM Spanish Breast Cancer Group., Spain
| | - Laia Garrigós
- 7International Breast Cancer Center (IBCC), Quiron Group, Barcelona, Spain. Hospital Universitari Dexeus, Barcelona, Spain
| | - Fabriccio Racca
- 8IOB Institute of Oncology, Quiron Group, Madrid and Barcelona, Spain
| | | | - Salvador Blanch
- 10Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey, US. Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - Maria Gión
- 11Hospital Ruber Internacional, Madrid, Spain, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Mónica Nave
- 12Hospital da Luz, Lisbon, Portugal., Portugal
| | - Adela Fernández
- 13Medical Oncology Department, Hospital Ramon y Cajal, Madrid, Spain; Alcalá de Henares University, Faculty of Medicine, Madrid, Spain
| | | | - Antonio Llombart-Cussac
- 15Hospital Arnau de Vilanova; FISABIO, Valencia, Spain. Catholic University, Valencia, Spain. Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey, US., Spain
| | - Miguel Sampayo-Cordero
- 16Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey, US., Catalonia, Spain
| | - Andrea Malfettone
- 17Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain and Ridgewood, New Jersey, US., Catalonia, Spain
| | - Javier Cortés
- 18International Breast Cancer Center (IBCC), Pangaea Oncology, Quironsalud Group, Madrid and Barcelona, Spain & Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid, Spain
| | - Sofía Braga
- 19Hospital Professor Doutor Fernando Fonseca EPE, Lisbon, Portugal, Portugal
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Pimentel I, Lema Roso L, Ramos Vazquez M, García Saenz J, Palacios-Ozores P, De la Haba Rodriguez J, Blanch S, Prat A, Ales Martínez J, Alba Conejo E, Balmaña J, Perez Garcia J, Sampayo-Cordero M, Malfettone A, Cortés J, Llombart Cussac A. 262P Niraparib plus aromatase inhibitors (AI) for germinal mutated BRCA1/2 (gBRCAm) or homologous recombination-deficient (HRd), hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) advanced breast cancer (ABC): LUZERN interim analysis. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.301] [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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Cortes M, Cortés Salgado A, Morales Murillo S, Blancas I, Cortez P, Calvo Plaza I, Diaz Fernandez N, Martinez-Bueno A, Ruiz-Borrego M, Blanch S, Llabres E, Marmé F, Schmid P, Guarneri V, Gligorov J, Pérez-García JM, Sampayo-Cordero M, Malfettone A, Llombart Cussac A, Cortes J. Safety interim analysis (SIA) of atractib: A phase 2 trial of first-line (1L) atezolizumab (A) in combination with paclitaxel (P) and bevacizumab (B) in metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1084 Background: A substantial benefit from adding an immune checkpoint inhibitor to chemotherapy (CT) was reported in mTNBC patients (pts) with PD-L1+ tumors. However, many pts still have a poor outcome. ATRACTIB is exploring the synergism between A (anti-PD-L1 antibody) and B (a VEGF-targeted antibody) with P in mTNBC irrespective of PD-L1 status. We report results from protocol-specified SIA. Methods: ATRACTIB is an open-label, single-arm, phase 2 trial (NCT04408118). Pts aged ≥18 years, with unresectable locally advanced or mTNBC, ECOG performance status of 0–1, who had received no prior systemic therapy or ≥12 months since (neo)adjuvant taxane-based CT are eligible. Pts receive A (840 mg IV, days 1, 15) with P (90 mg/m2 IV, days 1, 8, 15), and B (10 mg/kg IV, days 1, 15) on each 28-day cycle until disease progression, unacceptable toxicity, or patient withdrawal. Primary endpoint is investigator-assessed progression-free survival (PFS) as per RECIST v.1.1. Secondary endpoints include objective response and clinical benefit rates, overall survival, and safety. The trial was designed to detect a treatment effect in terms of median PFS (H0: ≤7 months; H1: ≥9.5 months) and 100 pts are needed to attain 80% power at a nominal one-sided α level of 5%. One SIA was planned for evaluating safety as per CTCAE v.5.0 on the first 20 pts who had completed a 3-month follow-up or reached the end of study. Results: From Oct 5, 2020, through Nov 21, 2021, 34 pts were enrolled at 13 sites in Spain and Germany and received at least 1 dose of study treatment. Median age was 57.5 (range 40–84) years, 23 (67.6%) pts had received prior CT for early disease, and 19 (56.0%) had visceral disease. At data cutoff (Sep 30, 2021), 25 (71.4%) pts were still receiving the drug regimen. Adverse events (AEs) led to drug discontinuation in 3 (8.8%) pts. Mean relative dose intensity was 90.2% for A, 96.5% for P, and 95.7% for B. P dose reduction was reported in 7 (20.6%) pts. Five (14.7) pts required a dose delay due to AEs (11.8% for A, 11.8% for P, and 8.8% for B). The most common AEs of any grade (G) were fatigue (47.1%; 8.8% G≥3), diarrhea (38.2%; 0% G≥3), and neurotoxicity (35.3%; 8.8% G≥3). Anemia (20.6%; 0% G≥3) and neutropenia (17.6%; 8.8% G≥3) were the most frequent hematological AEs. AEs of clinical interest (AECI) for B were hypertension (17.6%; 5.9% G≥3) and pulmonary embolism (2.9%; 0% G≥3). AECI for A were pneumonitis (2.9%; 0% G≥3), autoimmune hepatitis (2.9%; 2.9% G≥3), and alanine aminotransferase increased (2.9%; 2.9% G≥3). No treatment-related deaths were reported. Conclusions: The addition of A to P and B as 1L therapy for mTNBC shows a tolerable safety profile which is consistent with known safety profile of each agent without a significant synergistic toxicity. Based on the independent data monitoring committee recommendation, patient recruitment is ongoing. Clinical trial information: NCT04408118.
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Affiliation(s)
| | | | - Serafin Morales Murillo
- Medical Oncology Department, Hospital Universitario Arnau de Vilanova de Lleida, Lleida, Spain
| | - Isabel Blancas
- Hospital Universitario Clínico San Cecilio, Granada, Spain
| | - Patricia Cortez
- International Breast Cancer Center (IBCC), Quiron Group, Barcelona, Spain
| | | | | | | | | | - Salvador Blanch
- Instituto Valenciano de Oncologia, Medica Scientia Innovation Research (MEDSIR), Valencia, Spain
| | | | | | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, and Oncology 2, Veneto Insittute of Oncology IOV-IRCCS, Padua, Italy
| | - Joseph Gligorov
- Institut Universitaire de Cancérologie AP-HP, Sorbonne Université, Paris, France
| | - José Manuel Pérez-García
- International Breast Cancer Center (IBCC), Quiron Group, Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | | | | | | | - Javier Cortes
- International Breast Cancer Center, Quironsalud Group, Barcelona, Spain and Universidad Europea de Madrid, Madrid, Spain
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Pérez-García JM, Vaz Batista M, Cortez P, Ruiz-Borrego M, Cejalvo JM, de la Haba-Rodriguez J, Garrigós L, Racca F, Servitja S, Blanch S, Gion M, Nave M, Fernández-Abad M, Martinez-Bueno A, Llombart-Cussac A, Sampayo-Cordero M, Malfettone A, Cortés J, Braga S. Trastuzumab deruxtecan in patients with central nervous system involvement from HER2-positive breast cancer: The DEBBRAH trial. Neuro Oncol 2022; 25:157-166. [PMID: 35639825 PMCID: PMC9825345 DOI: 10.1093/neuonc/noac144] [Citation(s) in RCA: 77] [Impact Index Per Article: 38.5] [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: 03/31/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Trastuzumab deruxtecan (T-DXd) has shown durable antitumor activity in pretreated patients with HER2-positive advanced breast cancer (ABC), but its efficacy has not yet been evaluated in patients with active brain metastases (BMs). DEBBRAH aims to assess T-DXd in patients with HER2-positive or HER2-low ABC and central nervous system involvement. METHODS This ongoing, five-cohort, phase II study (NCT04420598) enrolled patients with pretreated HER2-positive or HER2-low ABC with stable, untreated, or progressing BMs, and/or leptomeningeal carcinomatosis. Here, we report findings from HER2-positive ABC patients with non-progressing BMs after local therapy (n = 8; cohort 1), asymptomatic untreated BMs (n = 4; cohort 2), or progressing BMs after local therapy (n = 9; cohort 3). Patients received 5.4 mg/kg T-DXd intravenously once every 21 days. The primary endpoint was 16-week progression-free survival (PFS) for cohort 1 and intracranial objective response rate (ORR-IC) for cohorts 2 and 3. RESULTS As of October 20, 2021, 21 patients received T-DXd. In cohort 1, 16-week PFS rate was 87.5% (95%CI, 47.3-99.7; P < .001). ORR-IC was 50.0% (95%CI, 6.7-93.2) in cohort 2 and 44.4% (95%CI, 13.7-78.8; P < .001) in cohort 3. Overall, the ORR-IC in patients with active BMs was 46.2% (95%CI, 19.2-74.9). Among patients with measurable intracranial or extracranial lesions at baseline, the ORR was 66.7% (12 out of 18 patients; 95%CI, 41.0-86.7), 80.0% (95%CI, 28.4-99.5) in cohort 1, 50.0% (95%CI, 6.7-93.2) in cohort 2, and 66.7% (95%CI, 29.9-92.5) in cohort 3. All responders had partial responses. The most common adverse events included fatigue (52.4%; 4.8% grade ≥3), nausea (42.9%; 0% grade ≥3), neutropenia (28.6%; 19% grade ≥3), and constipation (28.6%; 0% grade ≥3). Two (9.5%) patients suffered grade 1 interstitial lung disease/pneumonitis. CONCLUSIONS T-DXd showed intracranial activity with manageable toxicity and maintained the quality of life in pretreated HER2-positive ABC patients with stable, untreated, or progressing BMs. Further studies are needed to validate these results in larger cohorts.
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Affiliation(s)
- José Manuel Pérez-García
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona, Spain,Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain,Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA
| | - Marta Vaz Batista
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain,Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA,Hospital Professor Doutor Fernando Fonseca EPE, Lisbon, Portugal
| | - Patricia Cortez
- IOB Institute of Oncology, Hospital Ruber Internacional, Quiron Group, Madrid, Spain
| | | | - Juan Miguel Cejalvo
- Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | - Juan de la Haba-Rodriguez
- Instituto Maimonides de Investigacion Biomedica, Hospital Reina Sofia, Universidad de Córdoba, Córdoba, Spain
| | - Laia Garrigós
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona, Spain,Hospital Universitari Dexeus, Barcelona, Spain
| | - Fabricio Racca
- IOB Institute of Oncology, Quiron Group, Madrid and Barcelona, Spain
| | | | - Salvador Blanch
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain,Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA,Hospital Professor Doutor Fernando Fonseca EPE, Lisbon, Portugal,Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | - María Gion
- University Hospital Ramon y Cajal, Madrid, Spain
| | | | | | | | - Antonio Llombart-Cussac
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain,Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA,Hospital Arnau de Vilanova, FISABIO, Valencia, Spain,Universidad Católica de Valencia, Valencia, Spain
| | - Miguel Sampayo-Cordero
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain,Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA
| | - Andrea Malfettone
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain,Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA
| | - Javier Cortés
- Corresponding Author: Javier Cortés, MD, PhD, International Breast Cancer Center (IBCC), Quironsalud Group, Carrer de Vilana 12, 08022 Barcelona, Spain ()
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Cortés Salgado A, Perez Garcia J, Cortez Castedo S, Gion Cortes M, Morales Murillo S, Blancas López-Barajas I, Blanch S, Calvo Plaza I, Diaz Fernandez N, Marmé F, Martinez Bueno A, Taberner Bonastre M, De Laurentiis M, Ruiz Borrego M, Schmid P, Guarneri V, Gligorov J, Sampayo-Cordero M, Llombart Cussac A, Cortés J. 205TiP ATRACTIB: A phase II trial of first-line (1L) atezolizumab (A) in combination with paclitaxel (P) and bevacizumab (B) in metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.224] [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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Ciruelos E, Muñoz M, Oliveira M, Chic N, Hernando C, Viruzuela JA, Vázquez S, Blanch S, Paré L, Salvador F, Villagrasa P, Pascual T, Prat A. Abstract OT1-17-01: Solti-1716. Targeting with pembrolizumab + paclitaxel non-luminal by PAM50 hormone receptor-positive/HER2-negative advanced/metastatic breast cancer patients who have progressed on or after CDK4/6 inhibitor treatment (TATEN trial). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot1-17-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background.Patients with metastatic hormone receptor-positive/HER2-negative (HR+/HER2-) breast cancer (BC) are usually treated with CDK4/6 inhibitors combined with endocrine therapy (ET) as first line treatment. The addition of CDK4/6 inhibitors to endocrine therapy has demonstrated improved progression free survival (PFS), overall response rate (ORR) and, more recently, overall survival (OS). However, there is a 20% of patients who do not benefit from these drugs and those who respond eventually progress to the treatment, for whom no standard treatment exists. The information provided by the intrinsic subtypes (PAM50) highlight the potential value of BC molecular classification as a prognosis and predictive marker. Within HR+/HER2- disease, patients with non-luminal subtypes (HER2-enriched and Basal-like) present poorer prognosis than those with luminal subtypes, may be more sensitive to chemotherapy, and have higher expression of immune-related genes and tumor infiltrating lymphocytes (TILs). Recently, immunotherapy has been approved for treating metastatic triple negative (TN) BC and several trials evaluating the action of immune checkpoint inhibitors are ongoing both in TN and in HR+/HER2- BC. TATEN study aims to evaluate the combination of pembrolizumab and chemotherapy in metastatic HR+/HER2-negative, PAM50 non-luminal BC.Study design. TATEN is an open-label, single arm, multicenter phase II study evaluating pembrolizumab in combination with paclitaxel in patients with locally advanced or metastatic PAM50 non-luminal HR+/HER2- BC who had recurrence or progression after therapy with a CDK4/6 inhibitor plus endocrine therapy. Tumor samples collected during advanced/metastatic disease are mandatory. No prior chemotherapy for inoperable locally advanced or metastatic BC is permitted. Eligible patients will receive pembrolizumab 200 mg every 3 weeks (on day 1 of each 21-day cycle, beginning in Cycle 1) in combination with paclitaxel 80 mg/m2 administered at days 1, 8, 15 of each 21-day cycle beginning at cycle 2. The primary endpoint of the study is to evaluate ORR according to RECIST V1.1. The study will use a Simon’s 2-stage design and will include up to 46 evaluable patients. If 6 or more responses are observed in up to 15 patients in the first stage, the trial will continue to the second stage and 31 additional patients may be evaluated for a total of 46 evaluable patients. The null hypothesis will be rejected if 19 or more responses are observed. Tumor assessments will be performed every 9 weeks. Secondary endpoints include clinical benefit rate (CBR), PFS, duration of response (DoR), time to response (TtR), OS, as well as the correlation of clinical benefit (ORR, PFS) with PD1 mRNA expression and early dynamic changes in ctDNA after 1 cycle of pembrolizumab (collection of blood samples at Cycle 1 Day 1, Cycle 2 Day 1 and end of treatment are mandatory). Safety and tolerability of the combination will also be assessed. Exploratory objectives include to determine ORR, PFS, DoR and TtR based on iRECIST and to identify predictive biomarkers of response to pembrolizumab plus paclitaxel. As of July 2021, 10 patients have been enrolled in 7 sites in Spain. Clinical trial identification: NCT04251169. Acknowledgements:This study is financially supported by MSD
Citation Format: Eva Ciruelos, Montserrat Muñoz, Mafalda Oliveira, Nuria Chic, Cristina Hernando, Juan Antonio Viruzuela, Silvia Vázquez, Salvador Blanch, Laia Paré, Fernando Salvador, Patricia Villagrasa, Tomás Pascual, Aleix Prat. Solti-1716. Targeting with pembrolizumab + paclitaxel non-luminal by PAM50 hormone receptor-positive/HER2-negative advanced/metastatic breast cancer patients who have progressed on or after CDK4/6 inhibitor treatment (TATEN trial) [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 OT1-17-01.
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Affiliation(s)
- Eva Ciruelos
- SOLTI Breast Cancer Research Group/Hospital 12 de Octubre, Barcelona/Madrid, Spain
| | - Montserrat Muñoz
- SOLTI Breast Cancer Research Group/Hospital Clinic de Barcelona/August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Mafalda Oliveira
- Vall d'Hebron University Hospital/SOLTI Breast Cancer Research Group/Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Nuria Chic
- Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Silvia Vázquez
- Hospital Duran i Reynals-Institut Català d’Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Laia Paré
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | | | | | - Tomás Pascual
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Aleix Prat
- Hospital Clinic de Barcelona/SOLTI Breast Cancer Research Group/August Pi i Sunyer Biomedical Research Institute (IDIBAPS)/Medicine Department, University of Barcelona, Barcelona, Spain
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Batista MV, Cortez P, Ruiz M, Cejalvo JM, de la Haba J, Garrigós L, Racca F, Servitja S, Blanch S, Teruel I, Pérez-García JM, Gion M, Nave M, Llombart-Cussac A, Sampayo-Cordero M, Malfettone A, Cortes J, Braga S. Abstract PD4-06: Trastuzumab deruxtecan in patients with HER2[+] or HER2-low-expressing advanced breast cancer and central nervous system involvement: Preliminary results from the DEBBRAH phase 2 study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd4-06] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Approximately 30% to 40% of patients (pts) with HER2[+] advanced breast cancer (ABC) will develop brain metastases (BM) during the course of their disease. Trastuzumab deruxtecan (T-DXd; DS-8201) is an antibody-drug conjugate containing an anti-HER2 antibody, a cleavable tetrapeptide-based linker, and a topoisomerase I inhibitor payload. In the phase 2 DESTINY-Breast01 trial, T-DXd showed efficacy in the subgroup of HER2[+] ABC pts with stable BM at baseline. DEBBRAH is assessing the efficacy and safety of T-DXd in HER2[+] and HER2-low-expressing ABC pts with a history of BM and/or leptomeningeal carcinomatosis (LMC). Here, we report primary results from cohorts A and C. Methods: This is an ongoing, multicenter, open-label, 5-cohort, non-comparative, phase 2 study across 18 hospitals in 2 countries. A total of 39 pts aged ≥18 years with pretreated HER2[+] or HER2-low-expressing ABC with stable, progressing, or untreated BM and/or LMC are being enrolled in 5 cohorts: (A) HER2[+] ABC with non-progressing BM after radiotherapy and/or surgery; (B) HER2[+] or HER2-low-expressing ABC with asymptomatic untreated BM; (C) HER2[+] ABC with progressing BM after local treatment; (D) HER2-low-expressing ABC with progressing BM after local treatment; (E) HER2[+] or HER2-low-expressing ABC with LMC. In cohorts A and C, pts must have received prior taxane and ≥1 HER2-targeted therapy for ABC. Pts received 5.4 mg/kg T-DXd intravenously on day 1 of a 21-day cycle until disease progression, unacceptable toxicity, or consent withdrawal. The primary endpoint for cohort A is 16-week progression-free survival (PFS) per local assessment using RANO-BM for central nervous system (CNS) lesions and RECIST v.1.1 for extracranial lesions (H0: 5%); for cohort C, CNS overall response rate (ORR; H0: 10%). A single-arm binomial design is used for cohorts A and C. A futility interim analysis has been planned in cohort A after accrual of 4 pts. Sample size was planned to attain an 80% power at nominal level of one-sided α of 0.05 in each cohort. Results: Between Jun 29, 2020, and Feb 18, 2021, 26 pts were allocated in the study. Enrollment is complete in cohorts A (n=8 pts) and C (n=9 pts), and ongoing in the remaining cohorts. At data cutoff (May 21, 2021), median follow-up for the cohort A was 5.5 months (IQR 4.4-6.9) and 6.2 months (IQR 5.1-6.4) for the cohort C. In the cohort A, 6 (75.0%) of 8 pts were alive without disease progression at 16 weeks, reaching the primary endpoint (p<0.01). In the cohort C, the CNS ORR was 55.6% (5 pts with partial response), also meeting the primary endpoint (p<0.01). At the time of this analysis, 75.0% of pts of the cohort A and 55.6% of the cohort C remained on therapy. The most frequent adverse events of any grade in 26 pts who received at least 1 dose of T-DXd were fatigue (11 [42.3%]; 3.8% of grade 3), nausea (10 [38.5%]), a decreased neutrophil count (9 [34.6%]; 11.5% of grade 3), and anemia (6 [23.1%]). Treatment-related serious adverse events occurred in 1 (3.8%) of 26 pts due to grade 1 pneumonitis. No treatment-related deaths were reported. Conclusions: T-DXd demonstrated preliminary efficacy with manageable toxicity in pretreated pts with HER2[+] ABC with stable and progressing BM after local treatment. Further investigation is required in larger cohorts to validate these findings. The assessment of the T-DXd antitumor activity in cohorts B, D, and E is currently ongoing.
Citation Format: Marta Vaz Batista, Patricia Cortez, Manuel Ruiz, Juan Miguel Cejalvo, Juan de la Haba, Laia Garrigós, Fabricio Racca, Sonia Servitja, Salvador Blanch, Iris Teruel, José Manuel Pérez-García, María Gion, Monica Nave, Antonio Llombart-Cussac, Miguel Sampayo-Cordero, Andrea Malfettone, Javier Cortes, Sofia Braga. Trastuzumab deruxtecan in patients with HER2[+] or HER2-low-expressing advanced breast cancer and central nervous system involvement: Preliminary results from the DEBBRAH phase 2 study [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 PD4-06.
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Affiliation(s)
- Marta Vaz Batista
- Hospital da Luz, Lisboa, Portugal; Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | - Patricia Cortez
- IOB Institute of Oncology, Hospital Ruber Internacional, Quiron Group, Madrid, Spain
| | - Manuel Ruiz
- Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Juan Miguel Cejalvo
- Hospital Clínico Universitario de Valencia, Biomedical Research Institute INCLIVA, Valencia, Spain
| | | | - Laia Garrigós
- Hospital Universitari Dexeus, Barcelona; International Breast Cancer Center (IBCC), Quiron Group, Barcelona, Spain
| | - Fabricio Racca
- IOB Institute of Oncology, Quiron Group, Madrid and, Barcelona, Spain
| | | | - Salvador Blanch
- Fundación Instituto Valenciano de Oncología, Valencia; MEDSIR, Barcelona, Spain
| | - Iris Teruel
- Institut Català d'Oncologia Badalona, Badalona, Spain
| | - José Manuel Pérez-García
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | - María Gion
- University Hospital Ramon y Cajal, Madrid, Spain
| | - Monica Nave
- Hospital Professor Doutor Fernando Fonseca EPE, Lisbon, Portugal
| | - Antonio Llombart-Cussac
- Hospital Arnau de Vilanova; FISABIO; Universidad Católica de Valencia, Valencia; Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain
| | | | | | - Javier Cortes
- International Breast Cancer Center (IBCC), Quironsalud Group; Medica Scientia Innovation Research (MEDSIR); Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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Manso L, Pernas S, Margelí M, Blanch S, Adamo B, Salvador Bofill F, Moreno D, González X, Pascual T, Ferrero-Cafiero J, Perou C, Prat A, Oliveira M. 339TiP SOLTI-1502 ARIANNA: Targeting PAM50 HER2-enriched intrinsic subtype with enzalutamide in hormone receptor-positive/HER2-negative metastatic breast cancer. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.622] [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] Open
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Vaz Batista M, Pérez-Garcia J, Llombart Cussac A, Cortez P, Ruiz Borrego M, De La Haba J, Cejalvo J, Racca F, Servitja S, Blanch S, Lema L, Galàn Garmaje M, Fernández-Abad M, Fernández A, Iranzo V, González-Santiago S, Gion M, Nave M, Cortés J, Braga S. 330TiP Trastuzumab deruxtecan (T-DXd; DS-8201) in HER2-positive (HER2+) and HER2-low expressing (HER-LE) metastatic breast cancer (MBC) with brain metastases (BM) and/or leptomeningeal carcinomatosis (LMC): DEBBRAH. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.613] [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: 11/17/2022] Open
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Manso L, Salvador F, Villagrasa P, Chic N, Bermejo B, Cejalvo JM, Izarzugaza Y, Cantos B, Blanch S, Margeli M, Alonso JL, Martínez A, Villanueva R, Guerra JA, Andrés R, Zamora P, Nogales E, Juan M, Gonzalez-Farre B, Wilkinson GA, Heineman TC, Nuovo G, Loghmani H, Coffey M, Gonzalez A, Martínez D, Paré L, Pascual T, Gonzalez X, Prat A, Gavilá J. Abstract CT191: A window-of-opportunity study with atezolizumab and the oncolytic virus pelareorep in early breast cancer (AWARE-1). Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-ct191] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A previous phase 2 study in metastatic breast cancer demonstrated a statistically significant improvement in overall survival (OS) in patients treated with pelareorep (pela), an intravenously delivered immuno-oncolytic reovirus, given in combination with paclitaxel (PTX) versus PTX alone [1]. We hypothesized that the OS benefit from pela + PTX may be attributed to an adaptive T cell response triggered by pela. To examine if pela can mediate the priming of an anti-tumor immune response, and the impact of checkpoint blockade therapy on this response, we and SOLTI research group are conducting the AWARE-1 study (NCT04102618) in patients with early breast cancer. The initial translational research results from this study are presented here. Methods: AWARE-1 is a window-of-opportunity study to evaluate the safety and effect of pela ± atezolizumab on the tumor microenvironment (TME) in 38 women with early breast cancer. Patients are treated with pela on days 1, 2, 8, and 9, and atezolizumab is administered on day 3. Tumor biopsies are collected at diagnosis, day 3, and day ~21. Five patient cohorts are being examined: Cohort 1: HR+/HER2-neg (10 patients) receiving pelareorep + letrozole (without atezolizumab); Cohort 2: HR+/HER2-neg (10 patients) receiving pelareorep + letrozole + atezolizumab; Cohort 3: TNBC (6 patients) receiving pelareorep + atezolizumab; Cohort 4: HR+/HER2+ (6 patients) receiving pelareorep + trastuzumab + atezolizumab; Cohort 5: HR-neg/HER+ (6 patients) receiving pelareorep + trastuzumab + atezolizumab. The primary endpoint is CelTIL score [2], a metric for quantifying changes in tumor cellularity and the number of tumor infiltrating lymphocytes (TILs), where an increase in CelTIL score has been associated with a favorable response to treatment. Tumor tissue is being examined for pela replication, changes to the TME by immunohistochemistry (IHC), PD-L1 expression by the Ventana SP142 assay used as the atezolizumab companion diagnostic, and T cell clonality by T cell receptor sequencing (TCR-seq). Peripheral blood is also being examined by TCR-seq. Results: Changes in the TME by IHC demonstrate that treatment with pela in the presence of atezolizumab increases the CD8/Treg ratio, a predictor of greater therapeutic efficacy, similar to preclinical breast cancer mouse models [3, 4]. Detailed TCR-seq, Ventana PD-L1 assay results, and IHC analysis will be presented, focusing on differences between patients receiving pela in the absence or presence of atezolizumab (Cohorts 1 and 2, respectively), and between CelTIL scores of responders and non-responders. Overall, these data demonstrate that pela can promote an inflamed tumor phenotype that allows for synergy with checkpoint blockade therapy in breast cancer.
References: [1] Bernstein, V., et al. Breast Cancer Res Treat, 2018. 167(2): p. 485-493. [2] Nuciforo, P., et al. Ann Oncol, 2018. 29(1): p. 170-177. [3] Mostafa, A.A., et al. Cancers (Basel), 2018. 10(6). [4] Lee, J., et al. Cancer Research, 2020. 80(16 Supplement): p. 2206-2206.
Citation Format: Luis Manso, Fernando Salvador, Patricia Villagrasa, Nuria Chic, Begoña Bermejo, Juan M. Cejalvo, Yann Izarzugaza, Blanca Cantos, Salvador Blanch, Mireia Margeli, Jose L. Alonso, Alejandro Martínez, Rafael Villanueva, Juan A. Guerra, Raquel Andrés, Pilar Zamora, Esteban Nogales, Manel Juan, Blanca Gonzalez-Farre, Grey A. Wilkinson, Thomas C. Heineman, Gerard Nuovo, Houra Loghmani, Matt Coffey, Azucena Gonzalez, Débora Martínez, Laia Paré, Tomás Pascual, Xavier Gonzalez, Aleix Prat, Joaquín Gavilá. A window-of-opportunity study with atezolizumab and the oncolytic virus pelareorep in early breast cancer (AWARE-1) [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr CT191.
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Affiliation(s)
- Luis Manso
- 1Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | - Nuria Chic
- 3Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Begoña Bermejo
- 4Hospital Clínico Universitario de Valencia, INCLIVA (Instituto de investigación sanitaria) and CIBERONC, Valencia, Spain
| | - Juan M. Cejalvo
- 4Hospital Clínico Universitario de Valencia, INCLIVA (Instituto de investigación sanitaria) and CIBERONC, Valencia, Spain
| | - Yann Izarzugaza
- 5Oncolytics Biotech Inc.Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Blanca Cantos
- 6Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Mireia Margeli
- 8Medical Oncology Department, ICO Badalona, Institut Català d'Oncologia, Barcelona, Spain
| | - Jose L. Alonso
- 9Oncolytics Biotech Inc.Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | - Alejandro Martínez
- 10Medical Oncology Department, Hospital Universitari Quirón Dexeus, Barcelona, Spain
| | | | | | - Raquel Andrés
- 13Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Pilar Zamora
- 14Medical Oncology Department, Hospital Universitario La Paz, Madrid, Spain
| | | | - Manel Juan
- 3Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | | | - Gerard Nuovo
- 19Ohio State University Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, OH
| | | | - Matt Coffey
- 17Oncolytics Biotech Inc., Calgary, Alberta, Canada
| | - Azucena Gonzalez
- 3Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Débora Martínez
- 20Medical Oncology Department, Hospital Clinic de Barcelona and August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laia Paré
- 3Medical Oncology Department, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Tomás Pascual
- 2SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Xavier Gonzalez
- 21Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Spain
| | - Aleix Prat
- 22SOLTI Breast Cancer Research Group; Medical Oncology Department, Hospital Clinic de Barcelona; August Pi i Sunyer Biomedical Research Institute (IDIBAPS); Medicine Department, University of Barcelona, Barcelona, Spain
| | - Joaquín Gavilá
- 7Instituto Valenciano de Oncología (IVO), Valencia, Spain
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Llombart Cussac A, Pérez-Garcia J, Blanch S, Tolosa P, Ruiz Borrego M, Gion Cortes M, Fernádez A, Urruticoechea A, Galve E, Cueva Banuelos J, Ponce J, Alonso J, Capelán M, Martínez E, Bermejo De Las Heras B, Rojas B, Martos T, López A, Gómez-Peralta F, Cortés J. 129TiP Metformin (MF) in the prevention of hyperglycemia (HG) in patients (pts) with PIK3CA-mutated, hormone receptor (HR)[+]/HER2[–] advanced breast cancer (ABC) treated with alpelisib (ALP) plus fulvestrant (F): METALLICA. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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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Manso L, Villagrasa P, Chic N, Bermejo B, Cejalvo JM, Izarzugaza Y, Cantos B, Blanch S, Margeli M, Alonso JL, Martínez A, Villanueva R, Guerra JA, Andrés R, Zamora P, Nogales E, Juan M, González B, Laeufle R, Nuovo G, Wilkinson G, Coffey M, González A, Martínez D, Paré L, Salvador F, Gonzalez X, Prat A, Gavilá J. Abstract PS12-08: A window-of-opportunity study with atezolizumab and the oncolytic virus pelareorep in early breast cancer (REO-027, AWARE-1). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps12-08] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A previous phase 2 study in metastatic breast cancer compared treatment with intravenously delivered oncolytic reovirus, pelareorep (pela), in combination with paclitaxel (PTX) versus PTX alone. This study demonstrated a statistically significant improvement in overall survival (OS), without differences in objective response or progression-free survival. We hypothesized that the OS benefit from pela + PTX may be attributed to an adaptive immune response triggered by pela. To test this hypothesis, and examine if pela can mediate the priming of an anti-tumor immune response, we designed a study called AWARE-1 (A window-of-opportunity study of pela in Early Breast Cancer), which is currently enrolling and for which initial translational research results are presented.
Methods: AWARE-1 is evaluating the safety and effect of pela ± atezolizumab on the tumor microenvironment (TME) in 38 women with early breast cancer. Patients are treated with pela on days 1, 2, 8, and 9, while atezolizumab is administered on day 3. Tumor biopsies are collected at diagnosis, day 3, and day ~21. Five cohorts will be examined: Cohort 1: Hormone Receptor-positive/HER2-negative (HR+/HER2-neg) (10 patients), pelareorep + letrozole. Cohort 2: HR+/HER2-neg (10 patients), pelareorep + letrozole + atezolizumab. Cohort 3: Triple Negative Breast Cancer (TNBC) (6 patients), pelareorep + atezolizumab. Cohort 4: Hormone Receptor-positive/HER2-positive (HR+/HER2+) (6 patients), pelareorep + trastuzumab + atezolizumab. Cohort 5: Hormone Receptor-negative/HER2-positive (HR-/HER2+) (6 patients), pelareorep + trastuzumab + atezolizumab. The primary endpoint of the study is CelTIL score, a metric for quantifying the changes in tumor cellularity and infiltration of TILs, where an increase in CelTIL is associated with a favorable response to treatment. Tumor tissue was examined for pela replication, and changes to the TME were assessed by imaging mass cytometry (IMC), immunohistochemistry, and T cell receptor sequencing (TCR-seq). Peripheral blood was also examined by TCR-seq.
Results: Detailed translational research results will be presented from patients in cohort 1, who received just pelareorep and letrozole. CelTIL score increased in 5/10 patients at day 3 biopsies and 6/10 patients at day 21 biopsies. Preliminary results show high levels of viral replication (>50% of tumor cells) while immunohistochemistry and IMC analysis revealed changes to the TME, with increases in CD8+ T cells and upregulation of PD-L1 at both day 3 and day 21 biopsies. Overall, preliminary data from cohort 1 of AWARE-1 demonstrate pela-mediated priming of an adaptive immune response. (NCT04102618)
Citation Format: Luis Manso, Patricia Villagrasa, Nuria Chic, Begoña Bermejo, Juan Miguel Cejalvo, Yann Izarzugaza, Blanca Cantos, Salvador Blanch, Mireia Margeli, Jose Luis Alonso, Alejandro Martínez, Rafael Villanueva, Juan Antonio Guerra, Raquel Andrés, Pilar Zamora, Esteban Nogales, Manel Juan, Blanca González, Rita Laeufle, Gerard Nuovo, Grey Wilkinson, Matt Coffey, Azucena González, Débora Martínez, Laia Paré, Fernando Salvador, Xavier Gonzalez, Aleix Prat, Joaquín Gavilá. A window-of-opportunity study with atezolizumab and the oncolytic virus pelareorep in early breast cancer (REO-027, AWARE-1) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS12-08.
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Affiliation(s)
- Luis Manso
- 1Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Nuria Chic
- 3Hospital Clinic de Barcelona, Barcelona, Spain
| | - Begoña Bermejo
- 4Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Yann Izarzugaza
- 5Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Blanca Cantos
- 6Hospital Universitario Puerta de Hierro-Majadahonda, Madrid, Spain
| | | | - Mireia Margeli
- 8Institut Català d’Oncologia, ICO Badalona, Barcelona, Spain
| | - Jose Luis Alonso
- 9Hospital Clínico Universitario Virgen de la Arrixaca-IMIB, Murcia, Spain
| | | | | | | | - Raquel Andrés
- 13Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | | | | | - Manel Juan
- 3Hospital Clinic de Barcelona, Barcelona, Spain
| | | | | | - Gerard Nuovo
- 17Ohio State University Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Colombus, OH
| | | | | | | | - Débora Martínez
- 18Hospital Clinic de Barcelona/August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Laia Paré
- 2SOLTI Breast Cancer Research Group, Barcelona, Spain
| | | | - Xavier Gonzalez
- 19Hospital Universitari General de Catalunya, San Cugat del Vallés, Barcelona, Spain
| | - Aleix Prat
- 20Hospital Clinic de Barcelona/SOLTI Breast Cancer Research Group/August Pi i Sunyer Biomedical Research Institute (IDIBAPS)/Medicine Department, University of Barcelona, Barcelona, Spain
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Oliveira M, Pernas S, Margelí M, Blanch S, Adamo B, Bofill JS, Moreno D, Gonzalez-Farré X, Rios J, Perou CM, Prat A, Pascual T, Ferrero-Cafiero JM, Villagrasa P, Manso L. Abstract OT-09-08: Solti-1502 aRIANNA: Targeting PAM50 HER2-enriched intrinsic subtype with enzalutamide in hormone receptor-positive/HER2-negative metastatic breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-09-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Pre-clinical evidence and retrospective studies suggest that PAM50 HER2-Enriched (HER2-E), hormone receptor-positive (HR+)/HER2-negative tumors have estrogen receptor (ER)-independency and poor prognosis, but seem to have androgen receptor (AR)-addiction (1). Enzalutamide (EZM) is a potent inhibitor of androgen receptor signaling (3). AR expression has been shown to induce resistance to both tamoxifen and aromatase inhibitors in estrogen receptor HR-expressing cell lines (4,5) The hypothesis of the ARIANNA trial is that EZM induces a significant proliferative arrest in PAM50 HER2-E, HR+/HER2-negative advanced breast cancer (BC), leading to clinical benefit in this poor prognosis population. Methods ARIANNA is an exploratory, phase II clinical trial in two independent cohorts evaluating the effect of EZM on proliferation after 2 weeks (+7 days window) on treatment in pre- or post-menopausal female or male patients with endocrine-resistant, locally advanced or metastatic HR+/HER2-negative BC. Cohort A will include 22 patients with PAM50 HER2-E HR+/HER-negative tumors and Cohort B (control group) will include 22 patients with PAM50 Luminal A/B HR+/HER2-negative tumors. Fresh tumor biopsy will be obtained at screening and sent to central laboratory for PAM50 subtyping determination to confirm the molecular subtype status prior to study treatment initiation, and to determine PAM50 11-gene proliferation-related signature. Patients with PAM50 Basal-like or Normal-like tumors will be excluded. Patients will receive EZM 160 mg once a day (QD). After 2 weeks on treatment, a tumor biopsy from the same baseline lesion (or, if not feasible, a lesion in the same organ) will be obtained for the purpose of the primary endpoint analysis. After this on-treatment biopsy, exemestane 50mg QD can be added to EZM at physician’s discretion. Tumor assessment will be performed at screening and every 8 weeks thereafter. Treatment will be continued until disease progression, unacceptable toxicity, investigator’s decision or withdrawal of consent. An optional tumor biopsy will be collected at the end of treatment. The primary objective is to evaluate the anti-proliferative effect of EZM after 2 weeks of treatment in patients with HER2-E HR+/HER2-negative tumors, measured as relative changes in the PAM50 11-gene proliferation-related signature by the PAM50 nCounter-based assay between baseline and on-treatment tumor biopsies. Secondary objectives include: anti-proliferative effect of EZM after 2 weeks of treatment in patients included in Cohort B (control group), safety, overall response rate, progression-free survival, and further correlative molecular analyses both at the tumor tissue (IHC, RNA and DNA) and ctDNA level for both cohorts. The trial will enroll patients in 8 Spanish sites and recruitment period will be 18 months. Funding was granted by Breast Cancer Research Foundation and drug was supplied by Astellas Pharma Global Development, Inc./Pfizer, Inc. Trial identification: NCT04142060 1. Cochrane DR, Bernales S, Jacobsen BM, Cittelly DM, Howe EN, D’Amato NC, et al. Role of the androgen receptor in breast cancer and preclinical analysis of enzalutamide. Breast Cancer Res. 2014;16:R7. 3. Tran C, Ouk S, Clegg NJ, Chen Y, Watson PA, Arora V, et al. Development of a Second-Generation Antiandrogen for Treatment of Advanced Prostate Cancer. Science. 2009;324:787-90. 4. Rechoum Y, Rovito D, Iacopetta D, Barone I, Andò S, Weigel NL, et al. AR collaborates with ERα in aromatase inhibitor-resistant breast cancer. Breast Cancer Res Treat. 2014;147:473-85. 5. De Amicis F, Thirugnansampanthan J, Cui Y, Selever J, Beyer A, Parra I, et al. Androgen receptor overexpression induces tamoxifen resistance in human breast cancer cells. Breast Cancer Res Treat. 2010;121:1-11
Citation Format: Mafalda Oliveira, Sonia Pernas, Mireia Margelí, Salvador Blanch, Barbara Adamo, Javier Salvador Bofill, Diana Moreno, Xavier Gonzalez-Farré, José Rios, Charles M Perou, Aleix Prat, Tomás Pascual, Juan M Ferrero-Cafiero, Patricia Villagrasa, Luis Manso. Solti-1502 aRIANNA: Targeting PAM50 HER2-enriched intrinsic subtype with enzalutamide in hormone receptor-positive/HER2-negative metastatic breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-09-08.
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Affiliation(s)
- Mafalda Oliveira
- 1Medical Oncology Department, Vall d'Hebron University Hospital / SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Sonia Pernas
- 2Medical Oncology Department, Institut Català d’Oncologia L’Hospitalet / SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Mireia Margelí
- 3Medical Oncology Department, Institut Català d’Oncologia Badalona, Barcelona, Spain
| | - Salvador Blanch
- 4Medical Oncology Department, IVO Instituto Valenciano de Oncología, Barcelona, Spain
| | - Barbara Adamo
- 5Medical Oncology Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | - Diana Moreno
- 7Medical Oncology Department Hospital Universitario Fundación Alcorcon, Madrid, Spain
| | - Xavier Gonzalez-Farré
- 8Medical Oncology Department, Hospital Universitari General de Catalunya, Sant Cugat del Vallès, Spain
| | - José Rios
- 9August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain
| | - Charles M Perou
- 10Lineberger Comprehensive Cancer Center University of North Carolina, Chapel Hill, NC
| | - Aleix Prat
- 11Medical Oncology Department, Hospital Clínic de Barcelona / SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Tomás Pascual
- 11Medical Oncology Department, Hospital Clínic de Barcelona / SOLTI Breast Cancer Research Group, Barcelona, Spain
| | | | | | - Luis Manso
- 13Medical Oncology Department, Hospital 12 de Octubre, Madrid, Spain
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Ciruelos E, Pascual T, Chic N, Muñoz M, Bermejo B, Virizuela JA, Oliveira M, Vázquez S, Blanch S, Paré L, Salvador F, Villagrasa P, Prat A. Abstract OT-13-04: Solti-1716. Targeting non-Luminal disease by PAM50 with pembrolizumab + paclitaxel in Hormone Receptor-positive/HER2-negative advanced/metastatic breast cancer patients who have progressed on or after CDK 4/6 inhibitor treatment (TATEN trial). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-13-04] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background. Patients with metastatic Hormone Receptor-positive/HER2-negative (HR+/HER2-) breast cancer (BC) are usually treated with CDK4/6 inhibitors combined with endocrine therapy (ET) as first line treatment. The addition of CDK4/6 inhibitors to endocrine therapy has demonstrated improved progression free survival (PFS), overall response rate (ORR) and more recently overall survival (OS). However, there is a 20% of patients who do not benefit from these drugs and those who respond eventually progress to the treatment. Notably, there is no standard treatment for patients progressing to CDK4/6 inhibitors. The information provided by the intrinsic subtypes (PAM50) highlight the potential value of BC molecular classification as a prognosis and predictive marker. Within HR+/HER2- disease, patients with non-luminal subtypes (HER2-enriched and Basal-like) present poorer prognosis than those with luminal subtypes, may be more sensitive to chemotherapy, and have higher expression of immune-related genes and tumor infiltrating lymphocytes (TILs). Recently, immunotherapy has been approved for treating metastatic triple negative breast cancer and several trials evaluating the action of immune checkpoint inhibitors are ongoing, including HR+/HER2- BC patients. TATEN study aims to evaluate the combination of pembrolizumab and chemotherapy in metastatic HR+/HER2-, PAM50 non-luminal BC.
Study design. TATEN is an open-label, single arm, multicenter phase II study evaluating treatment with pembrolizumab in combination with paclitaxel in patients with locally advanced or metastatic non-luminal HR+/HER2- BC who had recurrence or progression while receiving previous therapy with a CDK4/6 inhibitor plus endocrine therapy in the adjuvant and/or metastatic setting. Tumor samples collected during advanced/metastatic disease are mandatory. No prior chemotherapy for inoperable locally advanced or metastatic BC is permitted. Eligible patients will receive pembrolizumab 200 mg every 3 weeks (on day 1 of each 21-day cycle, beginning in Cycle 1) in combination with paclitaxel 80 mg/m2 administered at days 1, 8, 15 of each 21-day cycle beginning at cycle 2. The primary endpoint of the study is to evaluate ORR according to RECIST V1.1. The study will use a Simon’s 2-stage design and will include up to 46 patients. If 6 or more responses are observed in up to 15 patients in the first stage, the trial will continue to the second stage and 31 additional patients may be evaluated for a maximum total of 46 evaluable patients. The null hypothesis will be rejected if 19 or more responses are observed. Tumor assessments will be performed every 9 weeks. Secondary endpoints include clinical benefit rate (CBR), PFS, duration of response (DoR), time to response (TtR), OS, as well as to assess the correlation of clinical benefit (ORR, PFS) with PD1 mRNA expression and early dynamic changes in ctDNA after 1 cycle of pembrolizumab (collection of blood samples at Cycle 1 Day 1, Cycle 2 Day 1 and end of treatment are mandatory). Safety and tolerability of the combination will also be assessed. Exploratory objectives include to determine ORR, PFS, DoR and TtR based on iRECIST and to identify predictive biomarkers of response to pembrolizumab plus paclitaxel.
Patients will be enrolled in 7 sites in Spain. Recruitment started in July 2020. This study is financially supported by MSD. NCT04251169.
Citation Format: Eva Ciruelos, Tomás Pascual, Nuria Chic, Montserrat Muñoz, Begoña Bermejo, Juan Antonio Virizuela, Mafalda Oliveira, Silvia Vázquez, Salvador Blanch, Laia Paré, Fernando Salvador, Patricia Villagrasa, Aleix Prat. Solti-1716. Targeting non-Luminal disease by PAM50 with pembrolizumab + paclitaxel in Hormone Receptor-positive/HER2-negative advanced/metastatic breast cancer patients who have progressed on or after CDK 4/6 inhibitor treatment (TATEN trial) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-13-04.
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Affiliation(s)
- Eva Ciruelos
- 1Hospital Universitario 12 de Octubre/SOLTI Breast Cancer Research Group, Madrid/Barcelona, Spain
| | - Tomás Pascual
- 2Hospital Clinic de Barcelona/SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Nuria Chic
- 3Hospital Clinic de Barcelona, Barcelona, Spain
| | - Montserrat Muñoz
- 2Hospital Clinic de Barcelona/SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Begoña Bermejo
- 4Hospital Clínico Universitario de Valencia, Valencia, Spain
| | | | - Mafalda Oliveira
- 6Vall d'Hebron University Hospital/SOLTI Breast Cancer Research Group/Vall d’Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Silvia Vázquez
- 7Hospital Duran i Reynals-Institut Català d’Oncologia, Hospitalet de Llobregat, Barcelona, Spain
| | | | - Laia Paré
- 9SOLTI Breast Cancer Research Group, Barcelona, Spain
| | | | | | - Aleix Prat
- 10Hospital Clinic de Barcelona/SOLTI Breast Cancer Research Group/August Pi i Sunyer Biomedical Research Institute (IDIBAPS)/Medicine Department, University of Barcelona, Barcelona, Spain
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Blanch S, Pérez-García J, Balmaña J, Prat A, Alés-Martínez J, de la Haba J, Alba E, Palacios-Ozores P, Ramos M, Lema L, García Sáenz J, Sampayo-Cordero M, Malfettone A, Cortés J, Llombart Cussac A. 182TiP Effectiveness of niraparib plus aromatase inhibitors (AI) for germinal BRCA1/2-mutated (gBRCAm) or homologous recombination deficient (HRD), hormone receptor (HR)+/human epidermal growth factor receptor 2 (HER2)- advanced breast cancer (ABC). The LUZERN Strategy. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.282] [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: 10/24/2022] Open
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Manso L, Villagrasa P, Chic N, Cejalvo J, Izarzugaza Y, Cantos B, Blanch S, Juan M, González-Farré B, Laeufle R, Nuovo G, Wilkinson G, Coffey M, González A, Martínez D, Paré L, Salvador F, González-Farré X, Prat A, Gavila Gregori J. 41P A window-of-opportunity study with atezolizumab and the oncolityc virus pelareorep in early breast cancer (REO-027, AWARE-1). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Adamo B, Bellet M, Paré L, Pascual T, Vidal M, Pérez Fidalgo JA, Blanch S, Martinez N, Murillo L, Gómez-Pardo P, López-González A, Amillano K, Canes J, Galván P, González-Farré B, González X, Villagrasa P, Ciruelos E, Prat A. Oral metronomic vinorelbine combined with endocrine therapy in hormone receptor-positive HER2-negative breast cancer: SOLTI-1501 VENTANA window of opportunity trial. Breast Cancer Res 2019; 21:108. [PMID: 31533777 PMCID: PMC6751874 DOI: 10.1186/s13058-019-1195-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 02/16/2019] [Accepted: 09/02/2019] [Indexed: 12/17/2022] Open
Abstract
Background The biological effect of oral metronomic vinorelbine (mVNB) alone or in combination with endocrine therapy in patients with hormone receptor-positive (HR+)/HER2-negative breast cancer has been scarcely addressed. Methods Postmenopausal women with untreated stage I–III HR+/HER2-negative breast cancer were randomized (1:1:1) to receive 3 weeks of letrozole (LTZ) 2.5 mg/day, oral mVNB 50 mg 3 days/week, or the combination. The primary objective was to evaluate, within PAM50 Luminal A/B disease, if the anti-proliferative effect of LTZ+mVNB was superior to monotherapy. An anti-proliferative effect was defined as the mean relative decrease of the PAM50 11-gene proliferation score in combination arm vs. both monotherapy arms. Secondary objectives included the evaluation of a comprehensive panel of breast cancer-related genes and safety. An unplanned analysis of stromal tumor-infiltrating lymphocytes (sTILs) was also performed. PAM50 analyses were performed using the nCounter®-based Breast Cancer 360™ gene panel, which includes 752 genes and 32 signatures. Results Sixty-one patients were randomized, and 54 paired samples (89%) were analyzed. The main patient characteristics were mean age of 67, mean tumor size of 1.7 cm, mean Ki67 of 14.3%, stage I (55.7%), and grades 1–2 (90%). Most baseline samples were PAM50 Luminal A (74.1%) or B (22.2%). The anti-proliferative effect of 3 weeks of LTZ+mVNB (− 73.2%) was superior to both monotherapy arms combined (− 49.9%; p = 0.001) and mVNB (− 19.1%; p < 0.001). The anti-proliferative effect of LTZ+mVNB (− 73.2%) was numerically higher compared to LTZ (− 65.7%) but did not reach statistical significance (p = 0.328). LTZ+mVNB induced high expression of immune-related genes and gene signatures, including CD8 T cell signature and PDL1 gene and low expression of ER-regulated genes (e.g., progesterone receptor) and cell cycle-related and DNA repair genes. In tumors with ≤ 10% sTILs at baseline, a statistically significant increase in sTILs was observed following LTZ (paired analysis p = 0.049) and LTZ+mVNB (p = 0.012). Grade 3 adverse events occurred in 3.4% of the cases. Conclusions Short-term mVNB is well-tolerated and presents anti-proliferative activity alone and in combination with LTZ. The high expression of immune-related biological processes and sTILs observed with the combination opens the possibility of studying this combination with immunotherapy. Further investigation comparing these biological results with other metronomic schedules or drug combinations is warranted. Trial registration NCT02802748, registered 16 June 2016. Supplementary information Supplementary information accompanies this paper at 10.1186/s13058-019-1195-z.
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Affiliation(s)
- Barbara Adamo
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain
| | - Meritxell Bellet
- Vall d'Hebrón University Hospital/Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain.,SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Laia Paré
- Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain.,SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Tomás Pascual
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain.,SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Maria Vidal
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain.,Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain
| | | | - Salvador Blanch
- Fundación Instituto Valenciano de Oncología, Valencia, Spain
| | | | - Laura Murillo
- Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain
| | - Patricia Gómez-Pardo
- Vall d'Hebrón University Hospital/Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | | | - Jordi Canes
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Patricia Galván
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain
| | | | | | | | - Eva Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clínic de Barcelona, Barcelona, Spain. .,Translational Genomics and Targeted Therapeutics in Solid Tumors, IDIBAPS, Villarroel 170, 08035, Barcelona, Spain. .,SOLTI Breast Cancer Research Group, Barcelona, Spain.
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Prat A, Adamo B, Pascual T, Perez Fidalgo JA, Blanch S, Martínez N, Gomez Pardo P, Lopez Gonzalez A, Murillo Jaso L, Amillano K, Vidal M, Paré L, Canes J, Galvan P, Gonzalez Farre B, Ortega Cebrián V, Gonzalez X, Bellet Ezquerra M, Villagrasa P, Ciruelos E. Abstract P5-11-04: Anti-proliferative effect of oral metronomic vinorelbine (mVNB) in PAM50 Luminal/HER2-negative early breast cancer (SOLTI-1501 VENTANA): A randomized, three-arm, window-of-opportunity study. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p5-11-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: The anti-proliferative effect of mVNB alone or in combination with endocrine therapy in patients with hormone receptor-positive/HER2- breast cancer (BC) has been scarcely addressed.
METHODS: Postmenopausal women with untreated stage I-III BC were randomized (1:1:1) to receive 3 weeks of letrozole (LTZ) 2.5mg/day, oral mVNB 50mg 3 days/week or the combination. The 1ary objective was to evaluate, within PAM50 Luminal A/B disease, if the anti-proliferative effect of mVNB+LTZ was superior to monotherapy. An anti-proliferative effect was defined as the mean relative decrease of the PAM50 11-gene Proliferation Score in each arm. 2ary objectives included safety and the comparison of the anti-proliferative effect between arms. An unplanned analysis of stromal tumor infiltrating lymphocytes (sTILs) was performed. PAM50 analyses were performed using the nCounter®-based Breast Cancer 360TM panel. Changes in the expression of 790 genes/signatures tracking multiple biological processes from tumor cells and the microenvironment were evaluated within each arm using paired (surgery vs. baseline) univariate analyses. P-values were corrected for multiple comparisons using false discovery rate (FDR).
RESULTS: A total of 61 patients were randomized and 54 paired samples (89%) were analyzed. Main patient characteristics were mean age 67, mean tumor size 1.7 cm, stage I (55.7%) and grade 1-2 (90%). Grade 3 toxicities occurred in 3.3% of cases. Baseline samples were Luminal A (72.3%) or B (27.7%). The anti-proliferative effect of mVNB+LTZ (-73.2%) was superior to both monotherapy arms combined (-49.9%; p=0.001) and mVNB (-19.1%; p<0.001). The anti-proliferative effect of mVNB+LTZ (-73.2%) was higher compared to LTZ (-65.7%) but did not reach statistical significance (p=0.328). Across the mVNB+LTZ, LTZ and VNB arms, 413 (52.3%), 403 (51.0%) and 21 (2.6%) genes/signatures were found differentially expressed (FDR<5%) between baseline and surgery samples. Compared to mVNB+LTZ baseline samples, surgical samples showed higher expression of AP-1 transcription factor subunits FOS and JUN, inflammatory chemokines (e.g. CCL4 and IL6), stromal-related genes (e.g. CAV1 and stroma signature) and immune infiltration (e.g. CD8 T-cell signature) and lower expression of proliferation-related genes (e.g. MKI67 and UBE2C), estrogen receptor-signaling and Risk of Recurrence. Of the 413 genes found differentially expressed in surgical samples compared to baseline samples in the mVNB+LTZ arm, 108 (26.2%) were not found in the LTZ arm. Among them, high expression of LAG3, CD24, CD84 and CCR5. Under the microscope, sTILs (≥10% at week 3) were observed in 6.6% (mVNB), 15% (LTZ) and 26% (mVNB+LTZ) of the cases. In tumors with ≤10% TILs at baseline, an increase in TILs was observed following LTZ (p=0.049) and mVNB+LTZ (p=0.012).
CONCLUSIONS: mVNB is well-tolerated and presents antiproliferative activity alone and in combination with LTZ. The increase of activated CD8 T-cells or TILs observed with LTZ+mVNB opens the possibility of studying combinations with immunotherapy. Further investigation comparing these biological results with other metronomic schedules or combinations is warranted.
Citation Format: Prat A, Adamo B, Pascual T, Perez Fidalgo JA, Blanch S, Martínez N, Gomez Pardo P, Lopez Gonzalez A, Murillo Jaso L, Amillano K, Vidal M, Paré L, Canes J, Galvan P, Gonzalez Farre B, Ortega Cebrián V, Gonzalez X, Bellet Ezquerra M, Villagrasa P, Ciruelos E. Anti-proliferative effect of oral metronomic vinorelbine (mVNB) in PAM50 Luminal/HER2-negative early breast cancer (SOLTI-1501 VENTANA): A randomized, three-arm, window-of-opportunity study [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P5-11-04.
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Affiliation(s)
- A Prat
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B Adamo
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - T Pascual
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - JA Perez Fidalgo
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - S Blanch
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - N Martínez
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Gomez Pardo
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - A Lopez Gonzalez
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Murillo Jaso
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - K Amillano
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Vidal
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - L Paré
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Canes
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Galvan
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - B Gonzalez Farre
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - V Ortega Cebrián
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - X Gonzalez
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - M Bellet Ezquerra
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - P Villagrasa
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Ciruelos
- Hospital Clinic i Provincial de Barcelona, Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain; IDIBAPS, Barcelona, Spain; Hospital Clínico Universitario de Valencia / INCLIVA / CIBERONC, Valencia, Spain; Fundación Instituto Valenciano de Oncología, Valencia, Spain; Hospital Universitario Ramón y Cajal, Madrid, Spain; Vall d'Hebron University Hospital, Barcelona, Spain; Complejo Asistencial Universitario de León, Leon, Spain; Hospital Clinico Universitario Lozano Blesa, Zaragoza, Spain; University Hospital St. Joan de Reus, Reus, Spain; Hospital General de Granollers, Granollers, Spain; Instituto Oncológico Dr. Rosell / Hospital General de Catalunya, Barcelona, Spain; Vall d'Hebron University Hospital / Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Hospital Universitario 12 de Octubre, Madrid, Spain
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Prat A, Adamo B, Perez Fidalgo J, Blanch S, Martinez N, Gomez Pardo P, López González A, Murillo Juso L, Amillano K, Vidal M, Pascual T, Pare L, Canes J, Galvan P, Gonzalez Farre B, Ortega Cebrian V, Gonzalez X, Bellet Ezquerra M, Villagrasa P, Ciruelos E. Anti-proliferative effect of oral metronomic vinorelbine in PAM50 Luminal/HER2-negative early breast cancer (SOLTI-1501 VENTANA): An open-label, randomized, three-arm, multicenter, window-of-opportunity study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.194] [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: 11/12/2022] Open
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Gavila J, Gozalbo F, Climent MA, Guerrero AL, Sandiego S, Blanch S, Algarra MA, Soriano V, Guillem V, Ruiz A, Lopez Guerrero JA. Abstract P2-09-27: Integrated analysis of PTEN protein expression and PI3KCA mutations as predictors for pathological complete response in HER2-positive breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-09-27] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Anti-HER2 treatment has also influenced the response to neoadjuvant chemotherapy in HER2-positive breast cancer (BC) by increasing the pathologic complete response (pCR) rate. The activation of HER2 signaling causes the downstream activation of the PI3K/AKT/mTOR pathway that plays a crucial role in developing resistance to trastuzumab (T). Therefore, candidate biomarkers with a potential role in the prediction of a pCR and prognosis after anti-HER2 treatment could be selected from this pathway.
Material and Methods: We retrospectively evaluated PTEN protein expression and PI3KCA mutations in core biopsies from HER2-positive patients treated at our institution with neoadjuvant therapy based on anthracyclines, paclitaxel and T. Protein expression was assessed by immunohistochemistry and used as dichotomic variable, PTEN loss was considered if Hscore ≤ 40. The association of PTEN status, PI3KCA mutation and PI3K activation (defined as either PTEN loss and/or presence of PI3KCA) with pathological complete response (ypT0/isN0) and progression-free survival (PFS) was evaluated.
Results: In our database 86 patients with HER2-positive clinical stage II-III BC were identified. Median follow-up was 75.85 months. PTEN was available from 84 (97.7%) and PI3KCA genotype from 67 patients (77.9%). Median age was 47.34, stage III 58.8% and 50% were hormonal receptor (HR) positive. Low PTEN was described in 29.8% tumors and was statistically associated with Grade1-2 and HR positive tumors. PI3KCA mutations (exon 9 and 20) were observed in 23.9% tumors. PI3K activation was detected in 37.5% tumors. Overall, the pCR rate was 53.5%. In low PTEN tumors pCR was 12% and in PTEN-high tumors, it was 72.1% (p<.0001). pCR rate was statistically different between PIK3CA mutant and wild-type tumors (6.3% vs. 51.9%; p<.0001). PI3K activation was statistically associated with lower pCR rate (12.5 vs. 72.9%; p<.0001). In multivariable analysis adjusted for baseline parameters, HR expression (OR 4.170; 95% CI 0.975-17.829;p=0.054) and PI3K activation (OR 45.87; 95% CI8.059-261.101; p<.0001) independently predicted pCR. In univariable analysis clinical, stage III, non-pCR and PI3K activation were correlated with worse PFS. PI3K activation was statistically associated with lower PFS at 5 years (OR 3.813;CI 95%1.369-10.347; p=0.009) in the multivariable analysis.
Conclusions: The study showed the potential role of PIK3CA Genotype and PTEN expression in predicting pCR and prognosis after anthracycline–taxane-based chemotherapy and anti-HER2 treatment.
Citation Format: Gavila J, Gozalbo F, Climent MA, Guerrero AL, Sandiego S, Blanch S, Algarra MA, Soriano V, Guillem V, Ruiz A, Lopez Guerrero JA. Integrated analysis of PTEN protein expression and PI3KCA mutations as predictors for pathological complete response in HER2-positive breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-09-27.
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Affiliation(s)
- J Gavila
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - F Gozalbo
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - MA Climent
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - AL Guerrero
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - S Sandiego
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - S Blanch
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - MA Algarra
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - V Soriano
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - V Guillem
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - A Ruiz
- Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
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Adamo B, Perez Fidalgo J, Ciruelos E, Vidal M, Blanch S, Lopez A, Gomez Pardo P, Murillo L, Amillano K, Martínez Jañez N, Gonzalez X, Canes J, Prat A. VENTANA (SOLTI-1501): Antiproliferative effect of the addition of oral metronomic vinorelbine to endocrine therapy in luminal/HER2-negative early breast cancer: A window of opportunity trial. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.063] [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: 11/14/2022] Open
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Herrero-Vicent C, Guerrero A, Gavilá J, Gozalbo F, Blanch S, Hernández A, Sandiego S, Calatrava A, Guillem V, Ruiz A. Prognostic and predictive value of tumor-infiltrating lymphocytes (TILs) in triple-negative breast cancers (TNBC) treated with neoadjuvant chemotherapy (NAC). Ann Oncol 2016. [DOI: 10.1093/annonc/mdw363.32] [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: 11/14/2022] Open
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Blanch S, Fernandez-Serra A, Romero I, Garcia-Casado Z, Illueca C, Mallol P, Lopez-Guerrero JA, Poveda A. Genomic characterization of high-grade serous ovarian Cancer by using targeted RNA and DNAseq gene panels. J Clin Oncol 2016. [DOI: 10.1200/jco.2016.34.15_suppl.e17060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | - Ignacio Romero
- Clinical Area Gynecologic Oncology, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Carmen Illueca
- Area Clinica Oncologia Ginecológica, Instituto Valenciano de Oncologia, Valencia, Spain
| | | | | | - Andres Poveda
- Clinical Area Gynecologic Oncology, Instituto Valenciano de Oncología, Valencia, Spain
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Marti P, Muelas N, Mayordomo F, Azorin I, Blanch S, Millan C, Jaijo T, Vilchez J. Long-term follow up of patients with dystrophin deficiency and isolated hyperCKemia. Neuromuscul Disord 2015. [DOI: 10.1016/j.nmd.2015.06.056] [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: 11/17/2022]
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Romero I, Garcia-Casado Z, Martinez P, Illueca C, Gonzalez-Lopez B, Zorrero C, Bosch JM, Fernandez-Serra A, Blanch S, Mallol P, Minig L, Lopez-Guerrero JA, Poveda A. Perfomance of identification criteria for Lynch syndrome (LS) in a prospective population-based registry of Endometrial Cancer (EC): Prognostic value. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.e16516] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Pedro Martinez
- Area Clinica Oncologia Ginecológica. Instituto Valenciano de Oncologia, Valencia, Spain
| | - Carmen Illueca
- Area Clinica Oncologia Ginecológica. Instituto Valenciano de Oncologia, Valencia, Spain
| | | | - Cristina Zorrero
- Area Clinica Oncologia Ginecológica. Instituto Valenciano de Oncologia, Valencia, Spain
| | - Jose Manuel Bosch
- Area Clinica Oncologia Ginecológica. Instituto Valenciano de Oncologia, Valencia, Spain
| | | | | | - Pedro Mallol
- Instituto Valenciano de Oncologia, Valencia, Spain
| | - Lucas Minig
- Instituto Valenciano de Oncologia, Valencia, MD, Spain
| | | | - Andres Poveda
- Area Clinica de Oncologia Ginecológica, Fundacion Instituto Valenciano de Oncología, Valencia, Spain
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Romero I, Lopez Guerrero J, Palacios J, Ojeda B, Illueca C, Gutierrez Pecharromán A, Blanch S, Cristóbal E, Garcia Casado M, Vieites B, Ruiz Díaz I, Vera Sempere F, Pastor F, Andrada E, Culubret M, Hardisson D, Calvo E, Churruca C, Santaballa A, Poveda A. Genomic Characterization of Early Stages of Ovarian Cancer with Emphasis in Low-Grade Endometroid and Low-Grade Serous Histologies. a Study By Spanish Group for Ovarian Cancer Research (Geico). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu359.2] [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: 11/13/2022] Open
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Zotano AG, Gavilá J, Merck B, Carrascosa M, Gozalbo F, Camps F, Blanch S, Guillem V, Climent M, Ruíz A. 25 Influence of pathologic tumour characteristics on ipsilateral breast tumour recurrences after breast conservation and neoadjuvant chemotherapy. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70056-2] [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: 10/19/2022] Open
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Gavila J, Guerrero-Zotano A, Climent M, Blanch S, Guillem V, Camp J, Tortajada M, Gozalbo F, Vidal P, Ruiz A. 35 High pathologic complete remission rate with liposome-encapsulated doxorubicin + paclitaxel + trastuzumab as primary treatment in HER-2 positive operable breast cancer: clinical experience. EJC Suppl 2010. [DOI: 10.1016/s1359-6349(10)70066-5] [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: 10/19/2022] Open
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Recasens MA, Barenys M, Sola R, Blanch S, Masana L, Salas-Salvadó J. Effect of dexfenfluramine on energy expenditure in obese patients on a very-low-calorie-diet. Int J Obes Relat Metab Disord 1995; 19:162-8. [PMID: 7780491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
AIM To investigate the effect of dexfenfluramine (dF) on Energy Expenditure (EE). DESIGN 20 obese females were studied in a double-blind design. Pre-diet and at 14 and 28 days of VLCD and dF treatment (30 mg/d) or placebo, Resting Metabolic Rate (RMR), 3 h-Thermic Effect of Food (3 h-TEF) and body composition were determined. EE and body composition were measured by indirect calorimetry and bioelectrical impedance, respectively. RESULTS No differences between groups were observed in relation to weight loss, body composition changes or RMR. At 3 h postprandial, the EE was still elevated in both groups. No changes on TEF were observed in the placebo group during VLCD. In contrast, TEF decreased in dF group during VLCD (P < 0.05). No significant differences in TEF at the end of the study were observed between groups. CONCLUSION These results suggest that dF modifies 3 h-TEF but not RMR in obese patients during VLCD administration.
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Affiliation(s)
- M A Recasens
- Human Nutrition Unit, Medical School, Rovira i Virgili University, Reus, Spain
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Valtueña S, Blanch S, Barenys M, Solà R, Salas-Salvadó J. Changes in body composition and resting energy expenditure after rapid weight loss: is there an energy-metabolism adaptation in obese patients? Int J Obes Relat Metab Disord 1995; 19:119-25. [PMID: 7735338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The aim of this study was to assess changes in resting energy expenditure (REE) related to changes in fat free mass (FFM) in nine morbid obese (BMI 43 +/- 5.1 kg/m2) hospitalised females on VLCD. REE was measured by 30 min indirect calorimetry before and after 28 days of hospitalisation. Changes in FFM were assessed by bioelectrical impedance analysis (BIA), hydrostatic weighing (HW) and nitrogen balance (N). REE decreased 11.5% from 7.8 +/- 1.0 to 6.9 +/- 0.8 MJ/d. Total weight loss was 8.4 +/- 1.9 kg or 7.4% with an estimated FFM loss of 3.4 +/- 1.8 (BIA), 2.9 +/- 1.9 (HW) and 1.8 +/- 1.0 (N). As the fall in REE was larger than the loss of FFM, it is concluded that morbid obese patients develop an energy saving adaptation during rapid weight loss.
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Affiliation(s)
- S Valtueña
- Human Nutrition Unit, Sant Joan Hospital, Rovira i Virgili University, Reus, Spain
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Sola´ R, LaVille A, Blanch S, Bargallo´ M, Margalef J, Salas J, Masana L. Total and LDL-cholesterol reduction induced by very low calorie diet (VLCD) is linked to weight loss and not to dietary composition. Atherosclerosis 1994. [DOI: 10.1016/0021-9150(94)93584-x] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Recasens MA, Barenys M, Fernández-Ballart J, Sola R, Blanch S, Salas Salvadó J. [Estimation of energy expenditure in patients with morbid obesity]. Med Clin (Barc) 1994; 102:451-5. [PMID: 8207993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND The equations available for the prediction of basal energy expenditure (BEE) may not be applicable in morbid obese individuals since the contribution of the fat free mass (FFM) over the BEE is not constant. The aim of this study was to obtain new equations for the prediction of BEE which are specific for patients with morbid obesity. METHODS In 26 women with morbid obesity age, weight, body composition by bioelectric impedance and BEE by open circuit indirect calorimetry were determined. The BEE observed was compared with that estimated from the previously described equations. The multiple regression method was used to obtain the BEE prediction equations. RESULTS Upon comparison of the BEE observed with the BEE estimated by the described equations a significant relation was found between both parameters. The differences were also significant except when the Harris-Benedict equation was used. Multiple regression analysis demonstrated that when the variables of body composition were included, the FFM explained 75% of the variation in BEE and on forcing the entrance of fatty mass, the explanation increased to 79%. When only the anthropometric variables were included, weight explained 69% of the variation. CONCLUSIONS In morbid obesity, most of the equations described for estimating basal energy expenditure are not applicable. New equations are reported for the prediction of energy expenditure.
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Affiliation(s)
- M A Recasens
- Unidad de Investigación en Nutrición y Crecimiento Humano, Facultad de Medicina y Ciencias de Salud, Universitat Rovira i Virgili, Tarragona
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Aznar J, Estellés A, Tormo G, Sapena P, Tormo V, Blanch S, España F. Plasminogen activator inhibitor activity and other fibrinolytic variables in patients with coronary artery disease. Heart 1988; 59:535-41. [PMID: 3132963 PMCID: PMC1276893 DOI: 10.1136/hrt.59.5.535] [Citation(s) in RCA: 150] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Several fibrinolytic variables, including plasminogen activator inhibitor activity, were studied before and after exercise in 67 normolipidaemic patients with coronary artery disease and in 25 hyperlipidaemic patients with coronary artery disease. Before exercise plasminogen activator inhibitor activity was higher in the patient groups than in a group of 10 healthy volunteers. For those who were normolipidaemic plasminogen activator inhibitor activity was greater in patients with angina pectoris who had had a myocardial infarction. The concentration of antigenic tissue-type plasminogen activator was similar in all the patients with coronary artery disease and higher than in the control group. After the exercise test fibrinolytic capacity was lower in the patients with angina pectoris and a previous history of myocardial infarction. After exercise both the released immunological tissue-type plasminogen activator and fibrinolytic capacity were lower in the hyperlipidaemic patients than in the normolipidaemic patients. The concentration of plasminogen activator inhibitor was also higher in the hyperlipidaemic patients. Patients with hyperlipidaemia IV had the highest plasminogen activator inhibitor activity. The increase in plasminogen activator inhibitor activity found in the patients was partially inhibited by antiserum against plasminogen activator inhibitor-1 in vitro. The formation of a complex of about 115,000 daltons between plasminogen activator inhibitor and purified tissue-type plasminogen activator was detected by a zymographic fibrin technique. These findings show that in patients with coronary artery disease fibrinolytic activity is impaired by an increase in plasminogen activator inhibitor. Impaired fibrinolysis may be related to the clinical evolution of coronary artery disease in these patients.
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Affiliation(s)
- J Aznar
- Department of Clinical Pathology, Hospital La Fe, Valencia, Spain
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Velasco JA, Tormo V, Ridocci F, Blanch S. Early load-limiting versus symptom-limited exercise testing: prognostic value in 200 myocardial infarction patients. Cardiology 1981; 68 Suppl 2:44-8. [PMID: 7317902 DOI: 10.1159/000173316] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The prognostic value of early load-limited and symptom-limited exercise testing has been compared in 200 men younger than 65 years of age, after myocardial infarction. 164 patients performed both tests and in 79 of the 200 cases who performed the early test the result was positive (40%); the percentage of positive tests was higher with the symptom-limited test (53.6%). The prognostic value of both tests was high. During the follow-up the mortality rate was higher in patients with positive results, but the early test enables the identification of patients in a higher risk group before hospital discharge.
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Blanch S. Dragging religion into Christmas. Nurs Mirror 1977; 145:5. [PMID: 243855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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