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Pearson J, Khan A, Bhogal T, Wong H, Law A, Mills S, Santamaria N, Bishop J, Cliff J, Errington D, Hall A, Hart C, Malik Z, Sripadam R, Innes H, Flint H, Langton G, Ahmed E, Jackson R, Palmieri C. A comparison of the efficacy of trastuzumab deruxtecan in advanced HER2-positive breast cancer: active brain metastasis versus progressive extracranial disease alone. ESMO Open 2023; 8:102033. [PMID: 37866031 PMCID: PMC10774880 DOI: 10.1016/j.esmoop.2023.102033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/29/2023] [Accepted: 09/18/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Trastuzumab deruxtecan (T-DXd) has demonstrated efficacy in patients with brain metastasis (BM), a group historically with poor outcomes. The prevalence of BMs in patients commencing T-DXd is currently unknown. No direct comparisons have been made of the activity of T-DXd in patients with active BM versus those with extracranial progression alone. This real-world study explored the prevalence of BMs in patients commencing T-DXd, the efficacy of T-DXd in active BM versus extracranial progression alone and the safety of T-DXd. PATIENTS AND METHODS Patients with human epidermal growth factor receptor 2-positive advanced breast cancer treated with T-DXd between June 2021 and February 2023 at our specialist cancer hospital were identified and notes reviewed. Clinicopathological information, prior treatment, the presence or absence of central nervous system (CNS) disease, outcomes and treatment-emergent adverse events (TEAEs) were recorded. RESULTS Twenty-nine female patients, with a median age of 52 years (interquartile range 44-62 years), were identified; the prevalence of BM was 41%. Median number of lines of prior therapy was 2 (range 2-6). At a median follow-up of 13.8 months, median progression-free survival (PFS) for the overall population was 13.9 months [95% confidence interval (CI) 12.4 months-not estimable (NE)], 16.1 months (95% CI 15.1 months-NE) for active BMs and 12.4 months (95% CI 8.3 months-NE) for progressive extracranial disease alone. The 12-month overall survival (OS) rate was 74% (95% CI 59% to 95%) in the overall population, and 83% (95% CI 58% to 100%) and 66% (95% CI 45% to 96%) for active BMs and extracranial disease only, respectively. Most common TEAEs were fatigue, alopecia, and constipation. In nine patients (31%, including two deaths), pneumonitis occurred. CONCLUSION In this real-world population, we demonstrate T-DXd to be effective in patients with active BMs and those with progressive extracranial disease alone. PFS and OS were numerically longer in those with active BMs. These data demonstrate that patients with active BM treated with T-DXd have at least comparable outcomes to those with extracranial disease alone. The high rate of pneumonitis warrants further consideration.
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Affiliation(s)
- J Pearson
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - A Khan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - T Bhogal
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - H Wong
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - A Law
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - S Mills
- The Walton NHS Foundation Trust, Liverpool, UK
| | - N Santamaria
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Bishop
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - J Cliff
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - D Errington
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - A Hall
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - C Hart
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - Z Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Sripadam
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - H Innes
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - H Flint
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - G Langton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - E Ahmed
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool
| | - R Jackson
- Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool; Department of Molecular and Clinical Cancer Medicine, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool.
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Lee RJ, Wysocki O, Bhogal T, Shotton R, Tivey A, Angelakas A, Aung T, Banfill K, Baxter M, Boyce H, Brearton G, Copson E, Dickens E, Eastlake L, Gomes F, Hague C, Harrison M, Horsley L, Huddar P, Hudson Z, Khan S, Khan UT, Maynard A, McKenzie H, Palmer D, Robinson T, Rowe M, Thomas A, Tweedy J, Sheehan R, Stockdale A, Weaver J, Williams S, Wilson C, Zhou C, Dive C, Cooksley T, Palmieri C, Freitas A, Armstrong AC. Erratum to 'Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome': [ESMO Open Volume 6, Issue 1, February 2021, 100005]. ESMO Open 2021; 6:100056. [PMID: 33545518 PMCID: PMC7842131 DOI: 10.1016/j.esmoop.2021.100056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- R J Lee
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK; Tumour Cell Biology Laboratory, The Francis Crick Institute, London, UK.
| | - O Wysocki
- The University of Manchester, Manchester, UK; Digital Experimental Cancer Medicine Team, Cancer Research UK Manchester Institute Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - T Bhogal
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - R Shotton
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Tivey
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - A Angelakas
- University Hospitals of Morecambe Bay, Kendal, UK
| | - T Aung
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - K Banfill
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - M Baxter
- University of Dundee, Dundee, UK
| | - H Boyce
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - G Brearton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - E Copson
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Dickens
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - L Eastlake
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - F Gomes
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Hague
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - L Horsley
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Huddar
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Z Hudson
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - S Khan
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK; Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - U T Khan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - A Maynard
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - H McKenzie
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Palmer
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - T Robinson
- Bristol Haematology and Oncology Centre, Bristol, UK; Sunrise Oncology Centre, Royal Cornwall Hospital, Truro, UK
| | - M Rowe
- National Institute for Biological Standards and Control, Potters Bar, UK
| | - A Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK; Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Tweedy
- Institute of Infection and Global Health, University of Liverpool and Tropical and Infectious Diseases Unit, Royal Liverpool Hospital, Liverpool, UK
| | - R Sheehan
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - A Stockdale
- Cancer Research UK Manchester Institute, Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - J Weaver
- The Christie NHS Foundation Trust, Manchester, UK
| | - S Williams
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - C Wilson
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - C Zhou
- The University of Bristol, Bristol, UK
| | - C Dive
- The University of Bristol, Bristol, UK
| | - T Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - A Freitas
- The University of Manchester, Manchester, UK; Digital Experimental Cancer Medicine Team, Cancer Research UK Manchester Institute Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - A C Armstrong
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
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Lee RJ, Wysocki O, Bhogal T, Shotton R, Tivey A, Angelakas A, Aung T, Banfill K, Baxter M, Boyce H, Brearton G, Copson E, Dickens E, Eastlake L, Gomes F, Hague C, Harrison M, Horsley L, Huddar P, Hudson Z, Khan S, Khan UT, Maynard A, McKenzie H, Palmer D, Robinson T, Rowe M, Thomas A, Tweedy J, Sheehan R, Stockdale A, Weaver J, Williams S, Wilson C, Zhou C, Dive C, Cooksley T, Palmieri C, Freitas A, Armstrong AC. Longitudinal characterisation of haematological and biochemical parameters in cancer patients prior to and during COVID-19 reveals features associated with outcome. ESMO Open 2021; 6:100005. [PMID: 33399072 PMCID: PMC7808077 DOI: 10.1016/j.esmoop.2020.100005] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 10/16/2020] [Accepted: 11/02/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Cancer patients are at increased risk of death from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Cancer and its treatment affect many haematological and biochemical parameters, therefore we analysed these prior to and during coronavirus disease 2019 (COVID-19) and correlated them with outcome. PATIENTS AND METHODS Consecutive patients with cancer testing positive for SARS-CoV-2 in centres throughout the United Kingdom were identified and entered into a database following local governance approval. Clinical and longitudinal laboratory data were extracted from patient records. Data were analysed using Mann-Whitney U test, Fisher's exact test, Wilcoxon signed rank test, logistic regression, or linear regression for outcomes. Hierarchical clustering of heatmaps was performed using Ward's method. RESULTS In total, 302 patients were included in three cohorts: Manchester (n = 67), Liverpool (n = 62), and UK (n = 173). In the entire cohort (N = 302), median age was 69 (range 19-93 years), including 163 males and 139 females; of these, 216 were diagnosed with a solid tumour and 86 with a haematological cancer. Preinfection lymphopaenia, neutropaenia and lactate dehydrogenase (LDH) were not associated with oxygen requirement (O2) or death. Lymphocyte count (P < 0.001), platelet count (P = 0.03), LDH (P < 0.0001) and albumin (P < 0.0001) significantly changed from preinfection to during infection. High rather than low neutrophils at day 0 (P = 0.007), higher maximal neutrophils during COVID-19 (P = 0.026) and higher neutrophil-to-lymphocyte ratio (NLR; P = 0.01) were associated with death. In multivariable analysis, age (P = 0.002), haematological cancer (P = 0.034), C-reactive protein (P = 0.004), NLR (P = 0.036) and albumin (P = 0.02) at day 0 were significant predictors of death. In the Manchester/Liverpool cohort 30 patients have restarted therapy following COVID-19, with no additional complications requiring readmission. CONCLUSION Preinfection biochemical/haematological parameters were not associated with worse outcome in cancer patients. Restarting treatment following COVID-19 was not associated with additional complications. Neutropaenia due to cancer/treatment is not associated with COVID-19 mortality. Cancer therapy, particularly in patients with solid tumours, need not be delayed or omitted due to concerns that treatment itself increases COVID-19 severity.
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Affiliation(s)
- R J Lee
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK; Tumour Cell Biology Laboratory, The Francis Crick Institute, London, UK.
| | - O Wysocki
- The University of Manchester, Manchester, UK; Digital Experimental Cancer Medicine Team, Cancer Research UK Manchester Institute Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - T Bhogal
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - R Shotton
- The Christie NHS Foundation Trust, Manchester, UK
| | - A Tivey
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - A Angelakas
- University Hospitals of Morecambe Bay, Kendal, UK
| | - T Aung
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - K Banfill
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
| | - M Baxter
- University of Dundee, Dundee, UK
| | - H Boyce
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - G Brearton
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK
| | - E Copson
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - E Dickens
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK
| | - L Eastlake
- University Hospitals Plymouth NHS Trust, Plymouth, UK
| | - F Gomes
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Hague
- The Christie NHS Foundation Trust, Manchester, UK
| | | | - L Horsley
- The Christie NHS Foundation Trust, Manchester, UK
| | - P Huddar
- Lancashire Teaching Hospitals NHS Trust, Preston, UK
| | - Z Hudson
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - S Khan
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK; Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - U T Khan
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - A Maynard
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - H McKenzie
- Cancer Sciences Academic Unit, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - D Palmer
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - T Robinson
- Bristol Haematology and Oncology Centre, Bristol, UK; Sunrise Oncology Centre, Royal Cornwall Hospital, Truro, UK
| | - M Rowe
- National Institute for Biological Standards and Control, Potters Bar, UK
| | - A Thomas
- Leicester Cancer Research Centre, University of Leicester, Leicester, UK; Oncology Department, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - J Tweedy
- Institute of Infection and Global Health, University of Liverpool and Tropical and Infectious Diseases Unit, Royal Liverpool Hospital, Liverpool, UK
| | - R Sheehan
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - A Stockdale
- Cancer Research UK Manchester Institute, Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - J Weaver
- The Christie NHS Foundation Trust, Manchester, UK
| | - S Williams
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - C Wilson
- Weston Park Cancer Centre, Sheffield Teaching Hospitals NHS Trust, Sheffield, UK
| | - C Zhou
- The University of Bristol, Bristol, UK
| | - C Dive
- The University of Bristol, Bristol, UK
| | - T Cooksley
- The Christie NHS Foundation Trust, Manchester, UK
| | - C Palmieri
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, UK; The University of Liverpool, Liverpool, UK
| | - A Freitas
- The University of Manchester, Manchester, UK; Digital Experimental Cancer Medicine Team, Cancer Research UK Manchester Institute Cancer Biomarker Centre, The University of Manchester, Alderley Park, UK
| | - A C Armstrong
- The Christie NHS Foundation Trust, Manchester, UK; The University of Manchester, Manchester, UK
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