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Wild PJ, Denkert C, Jackisch C. [Predictive molecular diagnostics in breast cancer : What are the requirements for pathology today and in the future?]. Pathologie (Heidelb) 2022; 43:388-398. [PMID: 35969265 PMCID: PMC9402728 DOI: 10.1007/s00292-022-01096-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/07/2022] [Indexed: 06/15/2023]
Abstract
With an increasing number of targeted therapy options for the treatment of solid tumors, the demands on predictive molecular diagnostics for pathology are growing. In breast cancer the need to determine genomic predictive markers for available targeted therapies has so far been manageable (detection of PIK3CA mutations in endocrine pretreated luminal tumors and the search for NTRK fusions indicated only in secretory breast cancer). At the latest in cases of nonresponse to first-line or second-line standard treatment, more comprehensive diagnostics using next generation sequencing (NGS) panel diagnostics makes sense. This should be suitable for clarifying resistance mechanisms, e.g. against endocrine therapy or cyclin-dependent kinase 4/cyclin-dependent kinase 6 (CDK4/6) inhibitors and to identify indications for therapies currently in development. The interpretation should be carried out in a quality assured manner in accordance with international standards and the interdisciplinary tumor board should make a transparent and standardized report available in a timely manner.
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Affiliation(s)
- Peter J Wild
- Dr. Senckenbergisches Institut für Pathologie, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland.
| | - Carsten Denkert
- Institut für Pathologie, Universitätsklinikum Gießen-Marburg, Standort Marburg, Baldingerstraße, 35033, Marburg, Deutschland
| | - C Jackisch
- Klinik für Gynäkologie und Geburtshilfe, Sana Klinikum Offenbach, Starkenburgring 66, 63069, Offenbach, Deutschland
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Huober J, Janni W, Untch M, Blohmer JU, Zahm DM, Hanusch C, Jackisch C, Heinrich G, Schneeweiss A, Denkert C, Link T, Rhiem K, Furlanetto J, Solbach C, Klare P, Nekljudova V, Filmann N, Loibl S. 168P Long-term survival of a randomised, open-label, phase II study comparing the efficacy and safety of cabazitaxel versus weekly paclitaxel given as neoadjuvant treatment in patients with operable triple-negative or luminal B/HER2-negative breast cancer (GENEVIEVE). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Jackisch C, Pronin D, Dimpfl T, Büttner R, Kunz G, Langwieder C, Rees M, Anzeneder T. 162P MammaPrint 10-year follow up results from a German breast cancer cohort study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Hägele M, Müller KR, Denkert C, Schneeweiss A, Sinn B, Untch M, Van Mackelenbergh M, Jackisch C, Nekljudova V, Karn T, Alber M, Marmé F, Schem C, Stickeler E, Fasching P, Mueller V, Weber K, Lederer B, Loibl S, Klauschen F. 68MO Generalization of a deep learning model for HER2 status predictions on H&E-stained whole slide images derived from 3 neoadjuvant clinical studies. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Loibl S, Schneeweiss A, Huober J, Braun M, Rey J, Blohmer JU, Furlanetto J, Zahm DM, Hanusch C, Thomalla J, Jackisch C, Staib P, Link T, Rhiem K, Solbach C, Fasching PA, Nekljudova V, Denkert C, Untch M. Neoadjuvant durvalumab improves survival in early triple-negative breast cancer independent of pathological complete response. Ann Oncol 2022; 33:1149-1158. [PMID: 35961599 DOI: 10.1016/j.annonc.2022.07.1940] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 06/22/2022] [Accepted: 07/27/2022] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Addition of immune checkpoint inhibitors (CPI) to neoadjuvant chemotherapy (NACT) is a promising strategy in early breast cancer, but the optimal duration of therapy is currently unknown. In the GeparNuevo (NCT02685059) trial, addition of durvalumab to NACT as previously reported led to a moderate increase in pCR rate by absolute 9% (p=0.287). PATIENTS AND METHODS Durvalumab or placebo 1.5g/placebo q4 weeks plus nab-paclitaxel 125mg/m2 weekly for 12 weeks, followed by 4 cycles durvalumab/placebo plus epirubicin/cyclophosphamide (EC) q2 weeks was given to cT1b-cT4a-d TNBC patients. Durvalumab was not continued after surgery. Primary objective was pathological complete response (pCR). Secondary endpoints included invasive disease-free survival (iDFS), distant disease-free survival (DDFS) and overall survival (OS). RESULTS 174 patients were randomised between June 2016 and October 2017. After a median follow-up of 43.7 months, 34 events had occurred. Despite a non-significant increase in the pCR rate, significant differences were observed for 3-year iDFS, DDFS and OS: iDFS was 85.6% with durvalumab vs 77.2% with placebo (HR 0.48, 95%CI 0.24-0.97, stratified log-rank p=0.036); DDFS 91.7% vs 78.4% (HR 0.31, 95%CI 0.13-0.74, p=0.005); OS 95.2% vs 83.5% (HR 0.24, 95%CI 0.08-0.72, p=0.006). pCR patients had 3-year iDFS of 95.5% with durvalumab and 86.1% without (HR 0.22, 95% CI 0.05-1.06). In non-pCR cohort 3-year iDFS was 76.3% vs 69.7% (HR 0.67, 95% CI 0.29-1.54). Multivariable analysis confirmed durvalumab effect independent of the pCR effect. No new safety signals occurred. CONCLUSION Durvalumab added to NACT in TNBC significantly improved survival despite a modest pCR increase and no adjuvant component of durvalumab. Additional studies are needed to clarify the optimal duration and sequence of CPIs in the treatment of early TNBC.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, Germany; Center for Hematology and Oncology Bethanien, Frankfurt, Germany.
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - J Huober
- Universitätsklinikum Ulm, Germany; Breast Center, Cantonal hospital St Gallen, Switzerland
| | - M Braun
- Department of Gynecology, Breast Center, Red Cross Hospital Munich, Germany
| | - J Rey
- German Breast Group, Neu-Isenburg, Germany
| | - J-U Blohmer
- Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Germany
| | | | - D-M Zahm
- SRH Waldklinikum Gera GmbH, Germany
| | - C Hanusch
- Department of Gynecology, Breast Center, Red Cross Hospital Munich, Germany
| | - J Thomalla
- Praxis für Hämatologie und Onkologie Koblenz, Germany
| | | | - P Staib
- Klinik für Hämatologie und Onkologie, St.-Antonius Hospital, Eschweiler, Germany
| | - T Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer and Center for Integrated Oncology (CIO), Medical Faculty, University Hospital Cologne, Germany
| | - C Solbach
- Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Frankfurt, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-Nuremberg, National Center for Tumour Diseases, Erlangen, Germany
| | | | - C Denkert
- Institut für Pathologie, Philipps-Universität Marburg und Universitätsklinikum Marburg (UKGM), Marburg, Germany
| | - M Untch
- HELIOS Klinikum Berlin Buch, Berlin, Germany
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Loibl S, Untch M, Burchardi N, Huober J, Sinn BV, Blohmer JU, Grischke EM, Furlanetto J, Tesch H, Hanusch C, Engels K, Rezai M, Jackisch C, Schmitt WD, von Minckwitz G, Thomalla J, Kümmel S, Rautenberg B, Fasching PA, Weber K, Rhiem K, Denkert C, Schneeweiss A. Corrigendum to "A randomised phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadjuvant therapy in early triple-negative breast cancer: clinical results and biomarker analysis of GeparNuevo study": [Annals of Oncology (2019), volume 30:1279-1288]. Ann Oncol 2022; 33:743-744. [PMID: 35595658 DOI: 10.1016/j.annonc.2022.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg; Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main.
| | - M Untch
- HELIOS Klinikum Berlin-Buch, Berlin
| | | | - J Huober
- Brustzentrum, Universitätsfrauenklinik Ulm, Ulm
| | - B V Sinn
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin; Berlin Institute of Health (BIH), Berlin
| | - J-U Blohmer
- Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Berlin
| | | | | | - H Tesch
- Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main
| | - C Hanusch
- Rotkreuzklinikum München Frauenklinik, München
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss
| | - M Rezai
- Medical Center, Luisenkrankenhaus Düsseldorf, Düsseldorf
| | - C Jackisch
- Brustzentrum, Sana-Klinikum Offenbach, Offenbach
| | - W D Schmitt
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | | | - J Thomalla
- Praxisklinik für Hämatologie und Onkologie Koblenz, Koblenz
| | - S Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen
| | - B Rautenberg
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg
| | - P A Fasching
- Brustzentrum, Universitätsklinikum Erlangen, Erlangen
| | - K Weber
- German Breast Group, Neu-Isenburg
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne
| | - C Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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Reinisch M, Blohmer JU, Link T, Just M, Untch M, Stötzer O, Fasching P, Schneeweiss A, Wimberger P, Seiler S, Huober J, Thill M, Jackisch C, Rhiem K, Solbach C, Hanusch C, Denkert C, Engels K, Nekljudova V, Loibl S. 94P Patient quality of life (QoL) from the GeparX trial on the addition of denosumab (Dmab) added to two different nab-paclitaxel (nP) regimens as neoadjuvant chemotherapy (NACT) in primary breast cancer (BC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Jackisch C, Banys-Paluchowski M, Korfel A, Stoffregen C, Otto T, Brown J, Sanderson I, Rider A, Lüftner D. 74P Management of early-stage hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2-) breast cancer in a real-word setting in Germany: A patient perspective. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.090] [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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Gennari A, Jackisch C, McCutcheon S, Flood E, Murali B, Guillaume X, Will O, Shimizu C, Mokiou S. 70P Factors influencing patient treatment decisions in early breast cancer (eBC): Discrete choice experiment (DCE) findings. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Kalfoutzos K, Argyriadis A, Joechel E, Kosse J, Jackisch C, Marek S. 285 Clinical management of placenta percreta non-previa with pelvic wall involvement: A case presentation. Eur J Obstet Gynecol Reprod Biol 2022. [DOI: 10.1016/j.ejogrb.2021.11.079] [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: 11/04/2022]
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Marmé F, Hanusch C, Furlanetto J, Denkert C, Link T, Untch M, Blohmer JU, Jackisch C, Reinisch M, Rhiem K, Schneeweiss A, Solbach C, Schöllhorn L, Fasching P, Rey J, Loibl S. 199TiP Phase III post-neoadjuvant study evaluating sacituzumab govitecan (SG), an antibody drug conjugate in primary HER2-negative breast cancer patients with high relapse risk after standard neoadjuvant treatment: SASCIA. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Harbeck N, Lüftner D, Breitenstein U, Jackisch C, Müller V, Schmidt M, Balic M, Rinnerthaler G, Schwitter M, Zaman K, Wrobel D, Guth D, Terhaag J, Zaiss M, Schinköthe T, Bartsch R. 200TiP ELEANOR: A multi-national, prospective, non-interventional study (NIS) in patients with human epidermal growth factor receptor (HER2) positive, early breast cancer (eBC) observing real-life extended adjuvant treatment with neratinib and concurrent use of the eHealth solution CANKADO. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.481] [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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Vladimirova V, Schneeweiss A, Jackisch C, Weber K, Denkert C, Schmatloch S, Karn T, Fasching P, Braun S, Szeto C, Sinn B, van Mackelenbergh M, Schem C, Stickeler E, Soon-Shiong P, Marmé F, Mueller V, Untch M, Nekljudova V, Loibl S. 21P BACH1 and HIF1α predict response to neoadjuvant nab-paclitaxel (nP) treatment in early breast cancer (BC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Labidi-Galy S, Schneeweiss A, Sinn H, Blohmer JU, Romanens L, Zahm DM, Huober J, Dohnal D, Link T, Hanusch C, Jackisch C, Fasching P, Solbach C, Rhiem K, Denkert C, Weber K, Lederer B, Untch M, Loibl S, Furlanetto J. 66P Baseline menopausal status, Ki-67 and stromal tumour-infiltrating lymphocytes (TILs) and association with outcome in triple-negative breast cancer (TNBC): Exploratory analysis in GeparSixto. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Bartsch R, Lüftner D, Balic M, Rinnerthaler G, Jackisch C, Müller V, Schmidt M, Harbeck N. Extended adjuvant treatment of patients with HER2+ early breast cancer with neratinib: a multi-centric, prospective, non-interventional study (NIS) in Germany and Austria (ELEANOR). Breast 2021. [DOI: 10.1016/s0960-9776(21)00091-6] [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: 11/26/2022] Open
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Denkert C, Untch M, Benz S, Schneeweiss A, Weber KE, Schmatloch S, Jackisch C, Sinn HP, Golovato J, Karn T, Marmé F, Link T, Budczies J, Nekljudova V, Schmitt WD, Stickeler E, Müller V, Jank P, Parulkar R, Heinmöller E, Sanborn JZ, Schem C, Sinn BV, Soon-Shiong P, van Mackelenbergh M, Fasching PA, Rabizadeh S, Loibl S. Reconstructing tumor history in breast cancer: signatures of mutational processes and response to neoadjuvant chemotherapy ⋆. Ann Oncol 2021; 32:500-511. [PMID: 33418062 DOI: 10.1016/j.annonc.2020.12.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 11/13/2020] [Accepted: 12/20/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Different endogenous and exogenous mutational processes act over the evolutionary history of a malignant tumor, driven by abnormal DNA editing, mutagens or age-related DNA alterations, among others, to generate the specific mutational landscape of each individual tumor. The signatures of these mutational processes can be identified in large genomic datasets. We investigated the hypothesis that genomic patterns of mutational signatures are associated with the clinical behavior of breast cancer, in particular chemotherapy response and survival, with a particular focus on therapy-resistant disease. PATIENTS AND METHODS Whole exome sequencing was carried out in 405 pretherapeutic samples from the prospective neoadjuvant multicenter GeparSepto study. We analyzed 11 mutational signatures including biological processes such as APOBEC-mutagenesis, homologous recombination deficiency (HRD), mismatch repair deficiency and also age-related or tobacco-induced alterations. RESULTS Different subgroups of breast carcinomas were defined mainly by differences in HRD-related and APOBEC-related mutational signatures and significant differences between hormone-receptor (HR)-negative and HR-positive tumors as well as correlations with age, Ki-67 and immunological parameters were observed. We could identify mutational processes that were linked to increased pathological complete response rates to neoadjuvant chemotherapy with high significance. In univariate analyses for HR-positive tumors signatures, S3 (HRD, P < 0.001) and S13 (APOBEC, P = 0.001) as well as exonic mutation rate (P = 0.002) were significantly correlated with increased pathological complete response rates. The signatures S3 (HRD, P = 0.006) and S4 (tobacco, P = 0.011) were prognostic for reduced disease-free survival of patients with chemotherapy-resistant tumors. CONCLUSION The results of this investigation suggest that the clinical behavior of a tumor, in particular, response to neoadjuvant chemotherapy and disease-free survival of therapy-resistant tumors, could be predicted by the composition of mutational signatures as an indicator of the individual genomic history of a tumor. After additional validations, mutational signatures might be used to identify tumors with an increased response rate to neoadjuvant chemotherapy and to define therapy-resistant subgroups for future therapeutic interventions.
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Affiliation(s)
- C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UK-GM), Marburg, Germany; Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany.
| | - M Untch
- Helios Klinikum Berlin-Buch, Department of Obstetrics and Gynaecology, Berlin, Germany
| | - S Benz
- NantOmics, LLC, Culver City, USA
| | - A Schneeweiss
- Nationales Centrum für Tumorerkrankungen, Universitätsklinikum und Deutsches Krebsforschungszentrum Heidelberg, Heidelberg, Germany
| | - K E Weber
- German Breast Group (GBG), Neu-Isenburg, Germany
| | - S Schmatloch
- Brustzentrum Kassel, Elisabeth Krankenhaus, Kassel, Germany
| | - C Jackisch
- Department of Obstetrics and Gynecology and Breast Cancer Center, Sana Klinikum Offenbach, Offenbach, Germany
| | - H P Sinn
- Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; German Cancer consortium (DKTK), Heidelberg, Germany
| | | | - T Karn
- Klinik für Frauenheilkunde und Geburtshilfe, Goethe Universität, Frankfurt, Germany
| | - F Marmé
- Universitätsfrauenklinik Mannheim, Mannheim, Germany
| | - T Link
- Department of Gynecology and Obstetrics, Technische Universität Dresden, Dresden, Germany
| | - J Budczies
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany; Institute of Pathology, University Hospital Heidelberg, Heidelberg, Germany; German Cancer consortium (DKTK), Heidelberg, Germany
| | - V Nekljudova
- German Breast Group (GBG), Neu-Isenburg, Germany
| | - W D Schmitt
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany
| | - E Stickeler
- Department of Gynecology, RWTH Aachen, Aachen, Germany
| | - V Müller
- Department of Gynecology, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany
| | - P Jank
- Institute of Pathology, Philipps-University Marburg and University Hospital Marburg (UK-GM), Marburg, Germany; Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany
| | | | | | | | - C Schem
- Mammazentrum Hamburg am Krankenhaus Jerusalem, Hamburg, Germany
| | - B V Sinn
- Charité - Universitätsmedizin Berlin, Institute of Pathology, Berlin, Germany
| | | | - M van Mackelenbergh
- Universitätsklinikum Schleswig-Holstein, Klinik für Gynäkologie und Geburtshilfe, Kiel, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany
| | | | - S Loibl
- German Breast Group (GBG), Neu-Isenburg, Germany; University of Frankfurt, Frankfurt am Main, Germany
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Fasching PA, Link T, Hauke J, Seither F, Jackisch C, Klare P, Schmatloch S, Hanusch C, Huober J, Stefek A, Seiler S, Schmitt WD, Uleer C, Doering G, Rhiem K, Schneeweiss A, Engels K, Denkert C, Schmutzler RK, Hahnen E, Untch M, Burchardi N, Blohmer JU, Loibl S. Neoadjuvant paclitaxel/olaparib in comparison to paclitaxel/carboplatinum in patients with HER2-negative breast cancer and homologous recombination deficiency (GeparOLA study). Ann Oncol 2020; 32:49-57. [PMID: 33098995 DOI: 10.1016/j.annonc.2020.10.471] [Citation(s) in RCA: 85] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/30/2020] [Accepted: 10/12/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The efficacy and toxicity of olaparib as combination therapy in early breast cancer (BC) patients with homologous recombinant deficiency (HRD) [score high and/or germline (g) or tumour (t) BRCA1/2 mutation] is not well described. GeparOLA (ClinicalTrials.gov, NCT02789332) investigated olaparib in combination with paclitaxel in HER2-negative early BC with HRD. PATIENTS AND METHODS Patients with untreated primary HER2-negative cT2-cT4a-d or cT1c with either cN+ or pNSLN+ or cT1c and triple-negative breast cancer (TNBC) or cT1c and Ki-67>20% BC with HRD were randomised either to paclitaxel (P) 80 mg/m2 weekly plus olaparib (O) 100 mg twice daily for 12 weeks or P plus carboplatinum (Cb) area under the curve 2 weekly for 12 weeks, both followed by epirubicin/cyclophosphamide (EC). Stratification factors were hormone receptor (HR) status (HR+ versus HR-) and age (<40 versus ≥40 years). The primary endpoint was pathological complete response (pCR; ypT0/is ypN0). A two-sided one-group χ2-test was planned to exclude a pCR rate of ≤55% in the PO-EC arm. Secondary end points were other pCR definitions, breast conservation rate, clinical/imaging response, tolerability and safety. RESULTS A total of 107 patients were randomised between September 2016 and July 2018; 106 (PO N = 69; PCb N = 37) started treatment. Median age was 47.0 years (range 25.0-71.0); 36.2% had cT1, 61.0% cT2, 2.9% cT3, and 31.8% cN-positive tumours; grade 3 tumours: 86.8%; Ki-67>20%: 89.6%; TNBC: 72.6%; confirmed gBRCA1/2 mutation: 56.2%. The pCR rate with PO was 55.1% [90% confidence interval (CI) 44.5% to 65.3%] versus PCb 48.6% (90% CI 34.3% to 63.2%). Analysis for the stratified subgroups showed higher pCR rates with PO in the cohorts of patients <40 years and HR+ patients. CONCLUSION GeparOLA could not exclude a pCR rate of ≤55% in the PO arm. PO was significantly better tolerated and the combination merits further evaluation.
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Affiliation(s)
- P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Comprehensive Cancer Center Erlangen-Nuremberg, National Center for Tumor Diseases, Erlangen, Germany
| | - T Link
- Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum Carl Gustav Carus Dresden, Germany
| | - J Hauke
- Center for Familial Breast and Ovarian Cancer, University of Cologne, Cologne, Germany
| | - F Seither
- German Breast Group, Neu-Isenburg, Germany
| | - C Jackisch
- Sana Klinikum Offenbach, Offenbach, Germany
| | - P Klare
- MediOnko-Institut GbR Berlin, Berlin, Germany
| | | | - C Hanusch
- Rotkreuzklinikum Munich, Munich, Germany
| | - J Huober
- University Hospital Ulm, Ulm, Germany
| | - A Stefek
- Johanniter-Krankenhaus Genthin-Stendal, Stendal, Germany
| | - S Seiler
- German Breast Group, Neu-Isenburg, Germany
| | - W D Schmitt
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - C Uleer
- Gemeinschaftspraxis Hildesheim, Hildesheim, Germany
| | - G Doering
- Hämato-Onkologie im Medicum Bremen, Bremen, Germany
| | - K Rhiem
- Center for Familial Breast and Ovarian Cancer, University of Cologne, Cologne, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - K Engels
- Center for Pathology, Cytology and Molecular Pathology Neuss, Neuss, Germany
| | - C Denkert
- Institute of Pathology, Philipps-Universität Marburg und University Hospital Marburg (UKGM), Marburg, Germany
| | - R K Schmutzler
- Center for Familial Breast and Ovarian Cancer, University of Cologne, Cologne, Germany
| | - E Hahnen
- Center for Familial Breast and Ovarian Cancer, University of Cologne, Cologne, Germany
| | - M Untch
- Helios-Klinikum Berlin-Buch, Berlin, Germany
| | | | - J-U Blohmer
- Brustzentrum Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany.
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Thill M, Anastasiadou L, Solbach C, Möbus V, Baier P, Ackermann S, Giesecke D, Schulmeyer E, Gabriel B, Mosch D, Buchen S, Krapfl E, Hurst U, Vescia M, Tesch H, Aulmann S, Jackisch C. The REMAR (Rhein-Main-Registry)-Study: Prospective evaluation of oncotype DX® Assay in Addition to Ki-67 for adjuvant treatment decisions in early breast cancer. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30782-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Stoenescu A, Iffland Y, Argyriadis A, Skoberne T, Ludolph A, Engler M, Jochim J, K-H H, Jackisch C. Case-Report: Postpartaler Visusverlust im Rahmen eines kombinierten posterioren reversiblen Enzephalopathiesyndroms (PRES) und reversiblen kranialen Vasokonstriktionssyndroms (RCVS). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1718346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
| | - Y Iffland
- Sana Klinikum Offenbach, Frauenklinik
| | | | - T Skoberne
- Sana Klinikum Offenbach, Neurologische Klinik
| | | | - M Engler
- Sana Klinikum Offenbach, Kinderklinik
| | - J Jochim
- Sana Klinikum Offenbach, Kinderklinik
| | - Henn K-H
- Sana Klinikum Offenbach, Neurologische Klinik
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Wimberger P, Sehouli J, Schmalfeldt B, Rau J, Thiel F, Hanker L, Marmé F, El-Balat A, De Gregorio N, Baumann K, Mahner S, Park-Simon TW, Meier W, Kommoss S, Bauerschlag D, Lück HJ, Kimmig R, Burges A, Schröder W, Jackisch C, Gropp-Meier M, Harter P, Pfisterer J. Carboplatin/PLD/Bevacizumab als neue Standardtherapieoption beim Ovarialkarzinomspätrezidiv – aktuelle Ergebnisse der AGO OVAR 2.21 Studie. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1717206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- P Wimberger
- Klinik und Poliklinik für Gynäkologie und Geburtshilfe der Technischen Universität Dresden
| | - J. Sehouli
- Charite Berlin, Klinik für Gynäkologie und Gynäkologische Onkologie – CVK
| | - B Schmalfeldt
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - J. Rau
- Philipps Universität Marburg, KKS
| | - F Thiel
- Universitätsklinikum Erlangen, Frauenklinik
| | - L Hanker
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Frauenklinik
| | - F Marmé
- Universitätsklinikum Mannheim, Frauenklinik
- Universitätsklinikum Heidelberg, NCT/Frauenklinik
| | - A El-Balat
- Universitätsklinikum Frankfurt, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | | | - K Baumann
- Klinikum der Stadt Ludwigshafen am Rhein gemeinnützige GmbH, Frauenklinik
| | - S Mahner
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
- LMU München Großhadern, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | - TW Park-Simon
- Medizinische Hochschule Hannover, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | - W Meier
- Universitätsklinikum Düsseldorf, Frauenklinik
- EVK Düsseldorf, Düsseldorf
| | - S Kommoss
- Universitätsklinikum Tübingen, Frauenklinik
| | - D Bauerschlag
- Universitätsklinikum Schleswig-Holstein, Campus Kiel, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | - HJ Lück
- Gynäkologisch Onkologische Praxis Hannover
| | - R Kimmig
- Universitätsklinikum Essen, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | - A Burges
- LMU München Großhadern, Klinik und Poliklinik für Gynäkologie und Geburtshilfe
| | | | | | | | - P Harter
- Kliniken Essen-Mitte, Klinik für Gynäkologie und Gynäkologische Onkologie
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Loibl S, Rastogi P, Seiler S, Jackisch C, Lucas P, Denkert C, Poklepovic A, Moreno F, Mamounas E, Nekljudova V, Lin Y, Wolmark N, Geyer C. 248TiP A randomized, double-blind, phase III trial of neoadjuvant chemotherapy (NACT) with atezolizumab/placebo in patients (pts) with triple-negative breast cancer (TNBC) followed by adjuvant continuation of atezolizumab/placebo (GeparDouze). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.369] [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: 10/23/2022] Open
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Link T, Blohmer JU, Just M, Untch M, Stötzer O, Fasching P, Schneeweiss A, Wimberger P, Seiler S, Huober J, Schmitt W, Jackisch C, Rhiem K, Hanusch C, Denkert C, Sinn B, Engels K, Nekljudova V, Loibl S. 168MO GeparX: Denosumab (Dmab) as add-on to different regimen of nab-paclitaxel (nP)-anthracycline based neoadjuvant chemotherapy (NACT) in early breast cancer (BC): Subgroup analyses by RANK expression and HR status. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.290] [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: 10/23/2022] Open
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Gerber B, Schneeweiss A, Möbus V, Golatta M, Tesch H, Krug D, Denkert C, Lübbe K, Heil J, Ataseven B, Klare P, Untch M, Kast K, Jackisch C, Seither F, Nekljudova V, Loibl S, Kühn T. Management of the axilla for high-risk early breast cancer (EBC) before and after neoadjuvant chemotherapy (NACT): an analysis of the multicentre GeparOcto trial. Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714551] [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: 03/22/2023] Open
Affiliation(s)
- B Gerber
- Department of Obstetrics and Gynaecology, University of Rostock
| | | | | | | | - H Tesch
- Bethanien Krankenhaus Frankfurt
| | - D Krug
- Universitätsklinikum Schleswig-Holstein Kiel, Klinik für Strahlentherapie
| | - C Denkert
- Universitätsklinikum Marburg, Institut für Pathologie UKGM
| | - K Lübbe
- Diakovere Henriettenstiftung Hannover
| | - J Heil
- Universitätsklinikum Heidelberg
| | | | - P Klare
- Praxisklinik Krebsheilkunde für Frauen
| | | | - K Kast
- Universitätsklinikum Carl Gustav Carus Dresden
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Harbeck N, Bartsch R, Jackisch C, Müller V, Schmidt M, Balic M, Rinnerthaler G, Lüftner D. Extended adjuvant treatment of patients with HER2+ early breast cancer with neratinib: a multi-centric, prospective, non-interventional study (NIS) in Germany and Austria (ELEANOR). Geburtshilfe Frauenheilkd 2020. [DOI: 10.1055/s-0040-1714557] [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: 03/22/2023] Open
Affiliation(s)
- N Harbeck
- Universitätsklinikum LMU-München, Klinik und Poliklinik für Frauenheilkunde und Geburtshilfe, Brustzentrum
| | - R Bartsch
- Medizinische Universität Wien, Klinische Abteilung für Onkologie
| | - C Jackisch
- Sana Klinikum Offenbach, Klinik für Gynäkologie und Geburtshilfe
| | - V Müller
- Universitätsklinikum Hamburg-Eppendorf, Klinik und Poliklinik für Gynäkologie
| | - M Schmidt
- Universitätsmedizin Mainz, Klinik und Poliklinik für Geburtshilfe und Frauengesundheit
| | - M Balic
- Universitätsklinik für Innere Medizin, Klinische Abteilung für Onkologie
| | | | - D Lüftner
- Charité - Universitätsmedizin Berlin, Medizinische Klinik mit Schwerpunkt Hämatologie, Onkologie und Tumorimmunologie
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Loibl S, Untch M, Burchardi N, Huober J, Sinn BV, Blohmer JU, Grischke EM, Furlanetto J, Tesch H, Hanusch C, Engels K, Rezai M, Jackisch C, Schmitt WD, von Minckwitz G, Thomalla J, Kümmel S, Rautenberg B, Fasching PA, Weber K, Rhiem K, Denkert C, Schneeweiss A. A randomised phase II study investigating durvalumab in addition to an anthracycline taxane-based neoadjuvant therapy in early triple-negative breast cancer: clinical results and biomarker analysis of GeparNuevo study. Ann Oncol 2020; 30:1279-1288. [PMID: 31095287 DOI: 10.1093/annonc/mdz158] [Citation(s) in RCA: 387] [Impact Index Per Article: 96.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Combining immune-checkpoint inhibitors with chemotherapy yielded an increased response rates in patients with metastatic triple-negative breast cancer (TNBC). Therefore, we evaluated the addition of durvalumab to standard neoadjuvant chemotherapy (NACT) in primary TNBC. PATIENTS AND METHODS GeparNuevo is a randomised phase II double-blind placebo-controlled study randomising patients with TNBC to durvalumab or placebo given every 4 weeks in addition to nab-paclitaxel followed by standard EC. In the window-phase durvalumab/placebo alone was given 2 weeks before start of nab-paclitaxel. Randomisation was stratified by stromal tumour-infiltrating lymphocyte (sTILs). Patients with primary cT1b-cT4a-d disease, centrally confirmed TNBC and sTILs were included. Primary objective was pathological complete response (pCR) (ypT0 ypN0). RESULTS A total of 174 patients were randomised, 117 participated in the window-phase. Median age was 49.5 years (range 23-76); 47 patients (27%) were younger than 40 years; 113 (65%) had stage ≥IIA disease, 25 (14%) high sTILs, 138 of 158 (87%) were PD-L1-positive. pCR rate with durvalumab was 53.4% (95% CI 42.5% to 61.4%) versus placebo 44.2% (95% CI 33.5% to 55.3%; unadjusted continuity corrected χ2P = 0.287), corresponding to OR = 1.45 (95% CI 0.80-2.63, unadjusted Wald P = 0.224). Durvalumab effect was seen only in the window cohort (pCR 61.0% versus 41.4%, OR = 2.22, 95% CI 1.06-4.64, P = 0.035; interaction P = 0.048). In both arms, significantly increased pCR (P < 0.01) were observed with higher sTILs. There was a trend for increased pCR rates in PD-L1-positive tumours, which was significant for PD-L1-tumour cell in durvalumab (P = 0.045) and for PD-L1-immune cell in placebo arm (P = 0.040). The most common immune-related adverse events were thyroid dysfunction any grade in 47%. CONCLUSIONS Our results suggest that the addition of durvalumab to anthracycline-/taxane-based NACT increases pCR rate particularly in patients treated with durvalumab alone before start of chemotherapy. TRIAL REGISTRATION ClinicalTrials.gov number: NCT02685059.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg; Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main.
| | - M Untch
- HELIOS Klinikum Berlin-Buch, Berlin
| | | | - J Huober
- Brustzentrum, Universitätsfrauenklinik Ulm, Ulm
| | - B V Sinn
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin; Berlin Institute of Health (BIH), Berlin
| | - J-U Blohmer
- Gynäkologie mit Brustzentrum, Charité-Universitätsmedizin Berlin, Berlin
| | | | | | - H Tesch
- Oncological Practice Bethanien, Cancer Center Frankfurt Northeast, Frankfurt am Main
| | - C Hanusch
- Rotkreuzklinikum München Frauenklinik, München
| | - K Engels
- Zentrum für Pathologie, Zytologie und Molekularpathologie Neuss, Neuss
| | - M Rezai
- Medical Center, Luisenkrankenhaus Düsseldorf, Düsseldorf
| | - C Jackisch
- Brustzentrum, Sana-Klinikum Offenbach, Offenbach
| | - W D Schmitt
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | | | - J Thomalla
- Praxisklinik für Hämatologie und Onkologie Koblenz, Koblenz
| | - S Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen
| | - B Rautenberg
- Klinik für Frauenheilkunde, Universitätsklinikum Freiburg, Freiburg
| | - P A Fasching
- Brustzentrum, Universitätsklinikum Erlangen, Erlangen
| | - K Weber
- German Breast Group, Neu-Isenburg
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne
| | - C Denkert
- Institute of Pathology, Charité-Universitätsmedizin Berlin, Berlin
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
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Reinisch M, Untch M, Reimer T, Mahlberg R, Aydogdu M, Hitschold T, Jackisch C, Marmé F, Lück HJ, Ladda E, Schmatloch S, Schmidt M, Klare P, Sinn B, Stickeler E, Seiler S, Rey J, Klutinus N, Möbus V, Loibl S. 86P Patients (pts) preference for different administration methods of trastuzumab (T) in pts with HER2+ early breast cancer (BC) treated within the GAIN-2 trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.026] [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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Karn T, Denkert C, Weber K, Holtrich U, Hanusch C, Sinn B, Higgs B, Jank P, Huober J, Blohmer JU, Schmitt W, Wu S, van Mackelenbergh M, Schem C, Stickeler E, Jackisch C, Untch M, Schneeweiss A, Loibl S. 127O Tumour mutational burden and immune infiltration as independent predictors of response to neoadjuvant immune checkpoint inhibition in early TNBC in GeparNuevo. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.230] [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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28
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Loibl S, Weber KE, Timms KM, Elkin EP, Hahnen E, Fasching PA, Lederer B, Denkert C, Schneeweiss A, Braun S, Salat CT, Rezai M, Blohmer JU, Zahm DM, Jackisch C, Gerber B, Klare P, Kümmel S, Schem C, Paepke S, Schmutzler R, Rhiem K, Penn S, Reid J, Nekljudova V, Hartman AR, von Minckwitz G, Untch M. Survival analysis of carboplatin added to an anthracycline/taxane-based neoadjuvant chemotherapy and HRD score as predictor of response-final results from GeparSixto. Ann Oncol 2019; 29:2341-2347. [PMID: 30335131 DOI: 10.1093/annonc/mdy460] [Citation(s) in RCA: 155] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background In the neoadjuvant GeparSixto study, adding carboplatin to taxane- and anthracycline-based chemotherapy improved pathological complete response (pCR) rates in patients with triple-negative breast cancer (TNBC). Here, we present survival data and the potential prognostic and predictive role of homologous recombination deficiency (HRD). Patients and methods Patients were randomized to paclitaxel plus nonpegylated liposomal doxorubicin (Myocet®) (PM) or PM plus carboplatin (PMCb). The secondary study end points disease-free survival (DFS) and overall survival (OS) were analyzed. Median follow-up was 47.3 months. HRD was among the exploratory analyses in GeparSixto and was successfully measured in formalin-fixed, paraffin-embedded tumor samples of 193/315 (61.3%) participants with TNBC. Homologous recombination (HR) deficiency was defined as HRD score ≥42 and/or presence of tumor BRCA mutations (tmBRCA). Results A significantly better DFS (hazard ratio 0.56, 95% CI 0.34-0.93; P = 0.022) was observed in patients with TNBC when treated with PMCb. The improvement of OS with PMCb was not statistically significant. Additional carboplatin did not improve DFS or OS in patients with HER2-positive tumors. HR deficiency was detected in 136 (70.5%) of 193 triple-negative tumors, of which 82 (60.3%) showed high HRD score without tmBRCA. HR deficiency independently predicted pCR (ypT0 ypN0) [odds ratio (OR) 2.60, 95% CI 1.26-5.37, P = 0.008]. Adding carboplatin to PM significantly increased the pCR rate from 33.9% to 63.5% in HR deficient tumors (P = 0.001), but only marginally in HR nondeficient tumors (from 20.0% to 29.6%, P = 0.540; test for interaction P = 0.327). pCR rates with carboplatin were also higher (63.2%) than without carboplatin (31.7%; OR 3.69, 1.46-9.37, P = 0.005) in patients with high HRD score but no tmBRCA. DFS rates were improved with addition of carboplatin, both in HR nondeficient (hazard ratio 0.44, 0.17-1.17, P = 0.086) and HR deficient tumors (hazard ratio 0.49, 0.23-1.04, P = 0.059). Conclusions The addition of carboplatin to neoadjuvant PM improved DFS significantly in TNBC. Long-term survival analyses support the neoadjuvant use of carboplatin in TNBC. HR deficiency in TNBC and HRD score in non-tmBRCA TNBC are predictors of response. HRD does not predict for carboplatin benefit.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, Germany.
| | - K E Weber
- German Breast Group, Neu-Isenburg, Germany
| | - K M Timms
- Myriad Genetics Inc, Salt Lake City, USA
| | - E P Elkin
- The Permanente Medical Group Inc, Oakland, USA
| | - E Hahnen
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - P A Fasching
- Department of Gynecology and Obstetrics, University Hospital Erlangen, Erlangen, Germany
| | - B Lederer
- German Breast Group, Neu-Isenburg, Germany
| | - C Denkert
- Institute of Pathology, Charité University Hospital and German Cancer Consortium (DKTK), Berlin, Germany
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - S Braun
- Brustzentrum, Sana Kliniken Offenbach, Offenbach, Germany
| | - C T Salat
- Hämatoonkologische Schwerpunktpraxis, Munich, Germany
| | - M Rezai
- Luisenkrankenhaus, Düsseldorf, Germany
| | - J U Blohmer
- Klinik für Gynäkologie mit Brustzentrum Charité, Berlin, Germany
| | - D M Zahm
- Brustzentrum SRH Waldklinikum, Gera, Germany
| | - C Jackisch
- Brustzentrum, Sana Kliniken Offenbach, Offenbach, Germany
| | - B Gerber
- Frauenklinik, Universität Rostock, Rostock, Germany
| | - P Klare
- Praxisklinik, Berlin, Germany
| | - S Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany
| | - C Schem
- Mammazentrum am Krankenhaus Jerusalem, Hamburg, Germany
| | - S Paepke
- Klinikum rechts der Isar der Technischen Universität München, Frauenklinik, München, Germany
| | - R Schmutzler
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - K Rhiem
- Center for Hereditary Breast and Ovarian Cancer, University Hospital Cologne, Cologne, Germany
| | - S Penn
- Myriad Genetics Inc, Salt Lake City, USA
| | - J Reid
- Myriad Genetics Inc, Salt Lake City, USA
| | | | | | | | - M Untch
- Helios-Klinikum Berlin-Buch, Berlin, Germany
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Cardoso F, Bardia A, André F, Cescon D, McArthur H, Telli M, Loi S, Cortes J, Schmid P, Harbeck N, Denkert C, Jackisch C, Jia L, Hirshfield K, Karantza V. KEYNOTE-756: A randomized, double-blind, phase III study of pembrolizumab or placebo with neoadjuvant chemotherapy and adjuvant endocrine therapy for high-risk, early-stage, ER+/HER2−breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz416.023] [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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Werutsky G, Untch M, Hanusch C, Fasching P, Blohmer JU, Seiler S, Denkert C, Tesch H, Jackisch C, Gerber B, Schneeweiss A, Link T, Huober J, Rhiem K, Vladimirova V, Nekljudova V, Loibl S. Risk factors for locoregional recurrence (LRR) after neoadjuvant chemotherapy: Pooled analysis of prospective neoadjuvant breast cancer (BC) trials. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.014] [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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Marmé F, Solbach C, Michel L, Fasching P, Schneeweiss A, Blohmer JU, Rezai M, Huober J, Jackisch C, Nekljudova V, Link T, Rhiem K, Denkert C, Hanusch C, Tesch H, Lederer B, Loibl S, Untch M. Utility of the CPS+EG scoring system in triple-negative breast cancer treated with neoadjuvant chemotherapy. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.008] [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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Tesch H, Loibl S, Kast K, Jackisch C, Möbus V, Buchen S, Untch M, Hanusch C, Seiler S, Weigel M, Fasching P, Rhiem K, Huober J, Blohmer JU, Solbach C, Denkert C, Nekljudova V, Link T, Schneeweiss A. Chemotherapy (CT)-induced anaemia in patients (pts) treated with dose-dense regimen: Results of the prospectively randomised anaemia substudy from the neoadjuvant GeparOcto study. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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de Gregorio N, Park-Simon TW, Meier W, Kommoss S, Hilpert F, Lück HJ, Baumann K, Harter P, Sehouli J, Canzler U, Schmalfeldt B, Hein A, Hanker L, Marmé F, El-Balat A, Mahner S, Kimmig R, Burges A, Schröder W, Jackisch C, Gropp-Meier M, Fehm T, Hasenburg A, Denschlag D, Belau A, Pfisterer J. Carboplatin/Caelyx/Bevacizumab vs. Carboplatin/Gemcitabine/Bevacizumab beim platinsensiblen Ovarialkarzinomrezidiv: Ergebnisse der prospektiv-randomisierten Phase III AGO-OVAR 2.21 Studie. Geburtshilfe Frauenheilkd 2019. [DOI: 10.1055/s-0039-1693899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
| | | | - W Meier
- Evangelisches Krankenhaus Düsseldorf
| | | | - F Hilpert
- Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - HJ Lück
- Gynäkologisch-Onkologische Praxis Hannover
| | | | | | | | - U Canzler
- Universitätsklinikum an der TU Dresden
| | | | - A Hein
- Universitäts-Frauenklinik Erlangen
| | | | - F Marmé
- Universitätsklinikum Heidelberg
| | | | | | | | | | | | | | | | - T Fehm
- Universitätsklinikum Düsseldorf
| | - A Hasenburg
- Klinik und Poliklinik für Geburtshilfe und Frauengesundheit, Mainz
| | | | - A Belau
- Universitätsmedizin Greifswald
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Loibl S, Jackisch C, Rastogi P, Seiler S, Lucas P, Denkert C, Costantino J, Nekljudova V, Wolmark N, Geyer C. GeparDouze/NSABP B-59: A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy with atezolizumab or placebo in patients with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz097.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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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Huober J, Schneeweiss A, Blohmer JU, Denkert C, Hanusch C, Jackisch C, Nekljudova V, Seither F, Loibl S, Untch M. Factors predicting relapse in early breast cancer patients with a pathological complete response after neoadjuvant therapy: Pooled analysis based on the GBG database. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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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Möbus V, Jackisch C, Lück HJ, du Bois A, Thomssen C, Kuhn W, Nitz U, Schneeweiss A, Huober J, Harbeck N, von Minckwitz G, Runnebaum IB, Hinke A, Konecny GE, Untch M, Kurbacher C. Ten-year results of intense dose-dense chemotherapy show superior survival compared with a conventional schedule in high-risk primary breast cancer: final results of AGO phase III iddEPC trial. Ann Oncol 2019; 29:178-185. [PMID: 29069370 DOI: 10.1093/annonc/mdx690] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Primary breast cancer (BC) patients with extensive axillary lymph-node involvement have a limited prognosis. The Arbeitsgemeinschaft fuer Gynaekologische Onkologie (AGO) trial compared intense dose-dense (idd) adjuvant chemotherapy with conventionally scheduled chemotherapy in high-risk BC patients. Here we report the final, 10-year follow-up analysis. Patients and methods Enrolment took place between December 1998 and April 2003. A total of 1284 patients with 4 or more involved axillary lymph nodes were randomly assigned to receive 3 courses each of idd sequential epirubicin, paclitaxel and cyclophosphamide (iddEPC) q2w or standard epirubicin/cyclophosphamide followed by paclitaxel (EC → P) q3w. Event-free survival (EFS) was the primary end point. Results A total of 658 patients were assigned to receive iddEPC and 626 patients were assigned to receive EC → P. The median duration of follow-up was 122 months. EFS was 47% (95% CI 43% to 52%) in the standard group and 56% (95% CI 52% to 60%) in the iddEPC group [hazard ratio (HR) 0.74, 95% CI 0.63-0.87; log-rank P = 0.00014, one-sided]. This benefit was independent of menopausal, hormone receptor or HER2 status. Ten-year overall survival (OS) was 59% (95% CI 55% to 63%) for patients in the standard group and 69% (95% CI 65% to 73%) for patients in the iddEPC group (HR = 0.72, 95% CI 0.60-0.87; log-rank P = 0.0007, two-sided). Nine versus two cases of secondary myeloid leukemia/myelodysplastic syndrome were observed in the iddEPC and the EC → P arm, respectively. Conclusion The previously reported OS benefit of iddEPC in comparison to conventionally dosed EC → P has been further increased and achieved an absolute difference of 10% after 10 years of follow-up.
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Affiliation(s)
- V Möbus
- Department of Gynecology and Obstetrics, Klinikum Frankfurt Höchst, Frankfurt, Germany
| | - C Jackisch
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - H J Lück
- Gynecologic Oncology Practice, Hannover, Germany
| | - A du Bois
- Department of Gynecology & Gynecologic Oncology, Klinikum Essen-Mitte, Essen, Germany
| | - C Thomssen
- Department of Gynecology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - W Kuhn
- Department of Gynecology and Obstetrics, University of Bonn, Bonn, Germany
| | - U Nitz
- Breast Center Niederrhein, Evangelic Hospital Bethesda, Mönchengladbach, Germany
| | - A Schneeweiss
- National Centre of Tumor Diseases, University of Heidelberg, Heidelberg, Germany
| | - J Huober
- Department of Gynecology and Obstetrics, University of Ulm, Ulm, Germany
| | - N Harbeck
- Department of Gynecology and Obstetrics, University of Munich, Munich, Germany
| | | | - I B Runnebaum
- Department of Gynecology, University of Jena, Jena, Germany
| | - A Hinke
- WiSP Research Institute, Langenfeld, Germany
| | - G E Konecny
- David Geffen School of Medicine, University of California Los Angeles, Los Angeles, USA
| | - M Untch
- Department of Gynecology and Obstetrics, Helios Klinikum Berlin-Buch, Berlin, Germany
| | - C Kurbacher
- Medical Center, Bonn-Friedensplatz, Bonn, Germany
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Geyer CE, Loibl S, Rastogi P, Seiler S, Costantino JP, Nekljudova VN, Cortazar P, Lucas PC, Denkert C, Mamounas EP, Jackisch C, Wolmark N. Abstract OT3-05-01: A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy (NAC) with atezolizumab or placebo in patients (pts) with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo: NSABP B-59/GBG 96-GeparDouze. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-05-01] [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:
TNBC is associated with higher percentages of pathological complete response (pCR) to neoadjuvant chemotherapy (NAC), and women with a pCR have a favorable prognosis. However, Liedtke (2008) and Loibl (2017) found that women with residual disease have a substantially higher risk of recurrence than women with other subtypes of breast cancer. Additionally, Adams (2017) and Schmid (2017) found that therapeutic blockade of PD-L1 binding by atezolizumab has resulted in relevant anti-tumor efficacy.
Methods:
Design
This is a phase III, double blind, placebo-control trial evaluating neoadjuvant atezolizumab with NAC followed by adjuvant atezolizumab in TNBC. Pts are stratified by region (North America; Europe), tumor size (1.1-3.0cm; >3.0cm), AC/EC schedule (q2w; q3w), and nodal status (positive; negative), then randomized 1:1 to receive atezolizumab/placebo 1200 mg IV every 3 wks concurrently with both sequential regimens of weekly paclitaxel 80 mg/m2 IV for 12 doses with every 3-wk carboplatin AUC of 5 IV for 4 doses followed by AC/EC every 2-3 wks (per investigator discretion) for 4 cycles. Following surgery, pts resume atezolizumab/placebo 1200 mg IV every 3 wks as adjuvant therapy for 6 months. Radiotherapy based on local standards is co-administered with atezolizumab/placebo.
Eligibility criteria
Centrally-confirmed ER-neg, PR-neg, HER2-neg invasive breast cancer by ASCO/CAP guidelines. Primary tumor must be stage T2 or T3 if cN0 or cN1 with negative biopsy or T1c, T2, or T3 if cN1 with positive biopsy or cN2 or cN3. LVEF >55% and no significant cardiac history.
Statistical methods
Co-primary endpoints are event-free survival (EFS) and pCR breast/nodes. Secondary endpoints include pCR breast, overall survival, distant disease-free survival, safety and toxicity. Trial is an academic collaboration between NSABP and GBG with support from Genentech/Roche.
NCT03281954
Support: Genentech/Roche
Citation Format: Geyer, Jr. CE, Loibl S, Rastogi P, Seiler S, Costantino JP, Nekljudova VN, Cortazar P, Lucas PC, Denkert C, Mamounas EP, Jackisch C, Wolmark N. A randomized double-blind phase III clinical trial of neoadjuvant chemotherapy (NAC) with atezolizumab or placebo in patients (pts) with triple negative breast cancer (TNBC) followed by adjuvant atezolizumab or placebo: NSABP B-59/GBG 96-GeparDouze [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 OT3-05-01.
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Affiliation(s)
- CE Geyer
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - S Loibl
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - P Rastogi
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - S Seiler
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - JP Costantino
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - VN Nekljudova
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - P Cortazar
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - PC Lucas
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - C Denkert
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - EP Mamounas
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - C Jackisch
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
| | - N Wolmark
- NSABP/NRG Oncology, Pittsburgh; Virginia Commonwealth University Massey Cancer Ctr., Richmond; German Breast Group (GBG), Neu-Isenburg, Germany; McGee-Women's Hospital of UPMC, Pittsburgh; University of Pitsburgh, Pittsburgh; Genentech, Inc., San Francisco; University of Pittsburgh School of Medicine, Pittsburgh; Institute of Pathology, Charité - Universitätsmedizin Berlin, Berlin, Germany; Orlando Health UF Cancer Center, Orlando; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Allegheny Health Network Cancer Institute, Pittsburgh
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Gnant M, Martin M, Holmes FA, Jackisch C, Chia SK, Iwata H, Moy B, Martinez N, Mansi J, Morales S, Ruiz-Borrego M, von Minckwitz G, Buyse M, Delaloge S, Bhandari M, Murias Rosales A, Galeano T, Fujita T, Luczak A, Barrios CH, Saura C, Rugo HS, Chien J, Johnston SR, Spencer M, Xu F, Barnett B, Chan A, Ejlertsen B. Abstract P2-13-01: Efficacy of neratinib in hormone receptor-positive patients who initiated treatment within 1 year of completing trastuzumab-based adjuvant therapy in HER2+ early-stage breast cancer: Subgroup analyses from the phase III ExteNET trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-13-01] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The international, randomized, placebo-controlled phase III ExteNET trial showed that 1 year (yr) of neratinib 240 mg/day after trastuzumab-based adjuvant therapy significantly improved invasive disease-free survival (iDFS) in 2840 patients with early-stage HER2+ breast cancer at 2 yr (hazard ratio 0.67; 95% CI 0.50–0.91; p=0.009) [Chan 2016] and 5 yr (hazard ratio 0.73; 95% CI 0.57-0.92; p=0.008) [Martin 2017]. A prespecified subgroup analysis by hormone receptor (HR) status suggested enhanced efficacy with neratinib in patients with HR+ (2-yr hazard ratio 0.51; 95% CI 0.33–0.77) vs. HR– tumors (2-yr hazard ratio 0.93; 95% CI 0.60–1.43). The efficacy of neratinib was also greater in patients who initiated treatment within 1 yr of prior trastuzumab compared with those who started neratinib later. The European Medicines Agency's Committee for Medicinal Products for Human Use recently recommended neratinib for use in patients with HR+ tumors who initiate treatment within 1 yr of completing trastuzumab-based adjuvant therapy. Subgroup analyses from ExteNET examining iDFS benefits in this patient population are presented here.
Methods: Patients with early-stage HER2+ breast cancer who completed trastuzumab-based (neo)adjuvant therapy were assigned to oral neratinib 240 mg/day or placebo for 1 yr. Randomization was stratified by HR status (determined locally before trial entry), nodal status, and trastuzumab regimen. Endocrine therapy was allowed in patients with HR+ disease. The primary endpoint, iDFS, was tested by 2-sided log-rank test and hazard ratios (95% CI) were estimated using Cox proportional hazards models. Kaplan-Meier methods were used to estimate iDFS rates. Secondary endpoints were DFS-DCIS, time to distant recurrence, distant DFS, and CNS recurrences. The primary analysis was conducted at 2 yr, and a sensitivity analysis conducted at 5 yr. Clinicaltrials.gov:NCT00878709.
Results: Of the 2840 patients (neratinib, n=1420; placebo, n=1420), 1631 (57%) had HR+ disease (neratinib, n=816; placebo, n=815). Most (93%) HR+ patients were receiving endocrine therapy at baseline. 1334 of 1631 (82%) patients with HR+ tumors were randomized to start neratinib within 1 yr of last trastuzumab dose (neratinib, n=670; placebo, n=664). iDFS benefits from neratinib in this population are shown in the table. Secondary endpoints were also improved with neratinib vs. placebo in this population. Safety data in this subset will be presented at the meeting.
Table. iDFS in patients with an interval between last trastuzumab dose and randomization of ≤1 yr
HR+ population (N=1334)ITT population (N=2297) Hazard ratiob Hazard ratiob Δ, %a(95% CI)P-valueΔ, %a(95% CI)P-value2-yr analysisc+4.50.490.002+2.90.630.006 (0.30–0.78) (0.45–0.88) 5-yr analysisd+5.10.580.002+3.20.700.006 (0.41–0.82) (0.54–0.90) aDifference in iDFS rates between neratinib vs. placebo; bNeratinib vs. placebo; cData cut-off: July 2014; dData cut-off: March 2017
Conclusions: Neratinib may have enhanced and sustained efficacy in patients with HR+ disease who initiate treatment within 1 yr of trastuzumab-based adjuvant therapy.
Citation Format: Gnant M, Martin M, Holmes F-A, Jackisch C, Chia SK, Iwata H, Moy B, Martinez N, Mansi J, Morales S, Ruiz-Borrego M, von Minckwitz G, Buyse M, Delaloge S, Bhandari M, Murias Rosales A, Galeano T, Fujita T, Luczak A, Barrios CH, Saura C, Rugo HS, Chien J, Johnston SR, Spencer M, Xu F, Barnett B, Chan A, Ejlertsen B. Efficacy of neratinib in hormone receptor-positive patients who initiated treatment within 1 year of completing trastuzumab-based adjuvant therapy in HER2+ early-stage breast cancer: Subgroup analyses from the phase III ExteNET trial [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 P2-13-01.
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Affiliation(s)
- M Gnant
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Martin
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - F-A Holmes
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - C Jackisch
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - SK Chia
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - H Iwata
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - B Moy
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - N Martinez
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - J Mansi
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - S Morales
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Ruiz-Borrego
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - G von Minckwitz
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Buyse
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - S Delaloge
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Bhandari
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - A Murias Rosales
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - T Galeano
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - T Fujita
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - A Luczak
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - CH Barrios
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - C Saura
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - HS Rugo
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - J Chien
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - SR Johnston
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - M Spencer
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - F Xu
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - B Barnett
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - A Chan
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
| | - B Ejlertsen
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria; Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain; Texas Oncology, Houston, TX; Sana Klinikum Offenbach, Offenbach, Germany; British Columbia Cancer Agency, Vancouver, Canada; Aichi Cancer Center Hospital, Chikusa-ku Nagoya, Japan; Massachusetts General Hospital Cancer Center, Boston, MA; Hospital Universitario Ramón y Cajal, Madrid, Spain; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London, London, United Kingdom; Hospital Universitari Arnau de Vilanova de Lleida, Lleida, Spain; Hospital Universitario Virgen del Rocio, Seville, Spain; German Breast Group, Neu-Isenburg, Germany; International Drug Development Institute, San Francisco, CA; Institut Gustave Roussy, Villejuif, France; Christ Hospital of Cincinnati, Cincinnati, OH; Compejo Hospitalario Materno Insular de Las Palmas, Las Palmas, Spain; Magna Graecia University, Catan
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Sinn BV, Loibl S, Karn T, Untch M, Kunze CA, Weber KE, Treue D, Wagner K, Hanusch CA, Klauschen F, Fasching PA, Huober J, Zahm DM, Jackisch C, Thomalla J, Blohmer JU, van Mackelenbergh M, Rhiem K, Felder B, von Minckwitz G, Burchardi N, Schneeweiss A, Denkert C. Abstract PD5-05: Pre-therapeutic PD-L1 expression and dynamics of Ki-67 and gene expression during neoadjuvant immune-checkpoint blockade and chemotherapy to predict response within the GeparNuevo trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd5-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
In the GeparNuevo trial, the PD-L1 inhibitor durvalumab increased the rate of pathologic complete response (pCR; ypT0 ypN0) in triple-negative breast cancer if treatment started in a two-week window before neoadjuvant taxane/anthracycline chemotherapy (61 % pCR vs. 41%; p = 0.048; Loibl et al. ASCO 2018). Overall, pCR rates increased only numerically from 53 % to 44 % (p = 0.281). Herein, we aimed to evaluate the predictive value of PD-L1 immunohistochemistry in pre-therapeutic core biopsies. In addition, we identified dynamics in gene expression using repeated biopsies.
Patients and Methods
174 patients were randomized to receive durvalumab or placebo with neoadjuvant chemotherapy. In the window part, 117 patients received a single dose of durvalumab (or placebo) before chemotherapy. Core biopsies were taken at three times: pre-treatment (“A”; N=174), after the window part (“B”; N=88) and after 12 weeks of nab-Paclitaxel (“C”; N=33). PD-L1 immunohistochemistry in A-biopsies (Ventana SP263 Assay) was recorded as percentage of cells with membranous staining in tumor cells and lymphocytes (TILs). We defined a tumor as PD-L1 high if ≥ 25 % of either compartment was stained. Ki-67 was stained on all available A, B and C biopsies (MIB-1, Dako, 1:100) and recorded as the percentage of tumor cells with nuclear staining. We profiled all available biopsies with targeted RNASeq using the HTG EdgeSeq platform (Oncology Biomarker panel, 2560 genes). Sequencing (IonTorrent S5) was successful in 162 A-, 79 B- and 31 C-biopsies.
Results
PD-L1 expression was high in 24 % of A-biopsies and was predictive for pCR in the complete cohort (OR 2.561; 1.183-5.554; p = 0.017). PD-L1 status of the TILs, but not of the tumor cells, was predictive (OR 1.313; 1.040-1.656; P= 0.022). The effect was not specific for durvalumab treatment. Higher levels of Ki-67 were predictive for pCR in B- biopsies in all patients (OR 1.399; 1.053-1.858; P =0.021) and in the placebo arm, but not in the durvalumab arm. Ki-67 levels in C-biopsies were not predictive; neither was the change in Ki-67 between pre-treatment and later time points (B vs. A or C vs. A).
In a differential mRNA expression analysis (A vs. B), we found seven differentially expressed genes after one dose of durvalumab. We observed strong effects on gene expression after taxane treatment (A vs. C), but no significant difference according to treatment. These genes were associated with biological processes involved in therapy response. The pre-treatment levels of 12 of 69 markedly differentially expressed genes were associated with worse response to chemotherapy.
Conclusion
In A-biopsies, PD-L1 in TILs was predictive for response, and in B-biopsies, Ki-67 was predictive, but neither marker could specifically predict response to durvalumab. We observed limited effects of a single half-dose of durvalumab on global gene expression, but could identify substantial differential expression after taxane treatment. The evaluation of gene expression dynamic offers a promising approach for the identification of resistance-associated markers.
The study was financially supported by AstraZeneca and Celgene
Citation Format: Sinn BV, Loibl S, Karn T, Untch M, Kunze CA, Weber KE, Treue D, Wagner K, Hanusch CA, Klauschen F, Fasching PA, Huober J, Zahm D-M, Jackisch C, Thomalla J, Blohmer J-U, van Mackelenbergh M, Rhiem K, Felder B, von Minckwitz G, Burchardi N, Schneeweiss A, Denkert C. Pre-therapeutic PD-L1 expression and dynamics of Ki-67 and gene expression during neoadjuvant immune-checkpoint blockade and chemotherapy to predict response within the GeparNuevo trial [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 PD5-05.
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Affiliation(s)
- BV Sinn
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - S Loibl
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - T Karn
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - M Untch
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - CA Kunze
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - KE Weber
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - D Treue
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - K Wagner
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - CA Hanusch
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - F Klauschen
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - PA Fasching
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - J Huober
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - D-M Zahm
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - C Jackisch
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - J Thomalla
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - J-U Blohmer
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - M van Mackelenbergh
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - K Rhiem
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - B Felder
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - G von Minckwitz
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - N Burchardi
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - A Schneeweiss
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
| | - C Denkert
- Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; German Breast Group, Neu-Isenburg, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Pathologie am Rotkreuzklinikum, München, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Gynäkologie und Geburtshilfe, Universitätsklinikum, Kiel, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany
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Lüftner D, Schuetz F, Schneeweiss A, Grischke EM, Bloch W, Decker T, Uleer C, Salat C, Förster F, Schmidt M, Mundhenke C, Tesch H, Jackisch C, Fischer T, Guderian G, Hanson S, Fasching P. Abstract P6-18-08: Everolimus + exemestane for HR+ advanced breast cancer in routine clinical practice- Final results from the non-interventional trial, BRAWO. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-18-08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In the pivotal BOLERO-2 trial, everolimus (EVE) + exemestane (EXE) more than doubled the median progression-free survival (PFS) vs EXE alone in hormone receptor positive (HR+), human epidermal growth factor-receptor 2-negative (HER2-) advanced breast cancer (ABC) recurring/progressing on/after prior non-steroidal aromatase inhibitors (NSAIs). BRAWO is a German non-interventional study conducted in patients (pts) with HR+, HER2–ABC receiving EVE + EXE, according to Summary of Product Characteristics (SmPC), in routine clinical practice. Here we report the final PFS and safety results.
Methods: This multicenter study documented 2100 pts between October 2012 and December 2017 across 341 sites in Germany. Postmenopausal women with HR+, HER2– ABC with recurrence or progression after a NSAI were included. Primary observation parameters included the evaluation of the effectiveness of EVE + EXE used in routine care for the entire pt group.
Results: In the final analysis, out of the 2100 documented pts, 2074 were included in the full analysis set. The median time since the primary diagnosis was 7.1 years and the median time from first sign of relapse (local recurrence or distant metastases) was 2.1 years. At baseline, 54.1% of pts presented with visceral metastases and 50.1% had an ECOG performance status of 0. Approximately, 63% of pts started with EVE 10 mg (median duration of exposure: 5.1 months; 95% CI, 4.6-5.4), while 34.1% started with EVE 5 mg (median duration of exposure: 4.6 months; 95% CI, 4.1-5.2).
The distribution of treatment lines was as follows: first line, 28.7% (n=595); second line, 31.9% (n=662); third line, 18.1% (n=376); fourth line, 10.7% (n=221) and, fifth line and later, 10.6% (n=220). Treatment was discontinued by 55.7% of pts (n=1170) due to progressive disease and 26% of pts (n=546) due to adverse events. The Kaplan-Meier estimate of the median PFS was 6.6 months (95% CI, 6.2-7.0). The best overall responses, based on clinical routine, were complete response, 0.8% (n=17), partial response, 7.4% (n=150), and stable disease, 41.3% (n=842). The general safety profile was consistent with the previously reported safety findings. The most common adverse events were stomatitis (any grade: 42.6%, grade 3: 3.8%, grade 4: <0.1%) and fatigue (any grade: 19.8%, grade 3: 1.5%).
Conclusions: Data from BRAWO support EVE + EXE as a suitable treatment option with a reasonable safety profile for HR+, HER2− ABC recurring or progressing on/after prior NSAIs.
Citation Format: Lüftner D, Schuetz F, Schneeweiss A, Grischke E-M, Bloch W, Decker T, Uleer C, Salat C, Förster F, Schmidt M, Mundhenke C, Tesch H, Jackisch C, Fischer T, Guderian G, Hanson S, Fasching P. Everolimus + exemestane for HR+ advanced breast cancer in routine clinical practice- Final results from the non-interventional trial, BRAWO [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 P6-18-08.
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Affiliation(s)
- D Lüftner
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - F Schuetz
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - A Schneeweiss
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - E-M Grischke
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - W Bloch
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - T Decker
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C Uleer
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C Salat
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - F Förster
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - M Schmidt
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C Mundhenke
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - H Tesch
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - C Jackisch
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - T Fischer
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - G Guderian
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - S Hanson
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
| | - P Fasching
- Charité University Medicine, Campus Benjamin Franklin, Berlin, Germany; University Hospital Heidelberg, Heidelberg, Germany; Universitäts-Frauenklinik Tubingen, Eberhard Karls University, Tubingen, Germany; German Sport University Cologne, Cologne, Germany; Studienzentrum Onkologie Ravensburg, Ravensburg, Germany; Gyn.-onkologische Gemeinschaftspraxis Hildesheim, Hildesheim, Germany; Hematology -Oncology Clinic, Munich, Germany; Poliklinik GmbH Chemnitz, Chemnitz, Germany; Johannes Gutenberg University, Mainz, Germany; University of Kiel, Kiel, Germany; Oncological Practice Bethanien, Frankfurt, Germany; Sana Klinikum Offenbach GmbH, Offenbach, Germany; Winicker Norimed GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Nuernberg, Germany; Novartis Pharma GmbH, Goettingen, Germany; University Hospital Erlangen, Comprehensive Cancer Center Erlangen-EMN, Friedrich-Alexander University Erlangen-Nuremberg, Erlangen, Germany
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Huober J, Schneeweiss A, Blohmer JU, Denkert C, Tesch H, Hanusch CA, Salat C, Rhiem K, Rezai M, Solbach C, Fasching PA, Jackisch C, Mehta K, Nekljudova V, Seither F, von Minckwitz G, Loibl S, Untch M. Abstract P2-08-01: Factors predicting relapse in early breast cancer patients with a pathological complete response after neoadjuvant therapy – Results of a pooled analysis based on the GBG meta-database. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p2-08-01] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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
Even though patients with a pCR following neoadjuvant chemotherapy have an excellent prognosis still some of these patients will eventually relapse. A better identification of pts with an increased risk of relapse despite a pCR would be helpful to select these patients for additional post-neoadjuvant treatment strategies. Thus, the rationale of this retrospective analysis was to identify factors predicting relapse despite a pCR.
Methods
This pooled retrospective analysis based on the GBG meta-database includes the neoadjuvant trials GeparTrio, GeparQuattro, GeparQuinto, GeparSixto and GeparSepto. In these trials 2188 (27%) of 7933 pts had a pCR according to ypT0/ypTis ypN0 Definition and were included. The primary endpoint was disease-free survival (DFS), secondary endpoints were distant DFS (DDFS) and overall survival (OS). A multivariate Cox proportional hazards model was used to report hazard ratios with 95% confidence interval (CI). The two-sided significance level was set to α=0.05. Endpoints were analysed for all pts and in subgroups defined by intrinsic subtypes. The potential risk factors intrinsic subtype (HER2 negative/hormone receptor (HR) positive, triple negative, HER2 positive/HR positive, HER2 positive/HR negative), histological tumor type (lobular vs other), grade (G1/G2 vs G3), KI67 (≤20% vs higher), initial cT and cN stadium (cT1 vs cT2 vs cT3/4; cN0 vs cN+), age (≤40 vs 41-59 vs ≥60), BMI (< 25 vs 25-29 vs ≥ 30), planned number of cycles of chemotherapy (≤6 vs > 6), menopausal status (pre- vs postmenopausal) and clinical response after 2-4 cycles (SD vs PR vs CR vs PD) were included as covariates in multivariate Cox regression models as well as study identification.
Results
From 2188 evaluable patients DFS, DDFS and OS events were observed in 290/197/130 pts respectively; the median follow-up over all studies was 59 months. In multivariate analysis including study and all potential risk factors DFS was significantly different with regard to the initial cN status (cN+ vs cN0, hazard ratio (HR) 1.70; 95% CI [1.2, 2.4], p=0.002). Of borderline significance was histological type (non-lobular vs lobular, HR 0.52 95% CI [0.3, 1.1]; p=0.076) and initial tumor stage (cT3/4 vs cT1, HR 1.61 95% CI [1.0, 2.7]; p=0.064). In terms of DDFS significant differences were seen for the initial cN status (cN+ vs cN0, HR 2.34; 95% CI [1.5, 3.6], p<0.001) and initial tumor stage (cT3/4 vs cT1, HR 1.83 95% CI [1.0, 3.3]; p=0.044); histological type was again close to significance (non-lobular vs lobular, HR 0.46 95% CI [0.2, 1.1]; p=0.067). Multivariate analysis showed significantly worse OS with initial cT3/4 tumors (cT3/4 vs cT1, HR 2.48 95%CI [1.1, 5.7]; p=0.030), and the lobular type (non-lobular vs lobular, HR 0.35 95% CI [0.1, 0.9]; p=0.026) and a trend for worse OS in pts with cN+ (cN+ vs cN0, HR 1.67 95% CI [1.0, 2.9]; p=0.067).
Conclusions
Initial tumor load before start of neoadjuvant chemotherapy (tumor stage and nodal status) and lobular subtype were predictors of long term outcome after a pCR following neoadjuvant chemotherapy. Intrinsic subtype, KI67, grade and planned number of cycles were not predictive for a relapse.
Citation Format: Huober J, Schneeweiss A, Blohmer J-U, Denkert C, Tesch H, Hanusch CA, Salat C, Rhiem K, Rezai M, Solbach C, Fasching PA, Jackisch C, Mehta K, Nekljudova V, Seither F, von Minckwitz G, Loibl S, Untch M. Factors predicting relapse in early breast cancer patients with a pathological complete response after neoadjuvant therapy – Results of a pooled analysis based on the GBG meta-database [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 P2-08-01.
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Affiliation(s)
- J Huober
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - A Schneeweiss
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - J-U Blohmer
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Denkert
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - H Tesch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - CA Hanusch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Salat
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - K Rhiem
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - M Rezai
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Solbach
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - PA Fasching
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - C Jackisch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - K Mehta
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - V Nekljudova
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - F Seither
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - G von Minckwitz
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - S Loibl
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
| | - M Untch
- Universitätsfrauenklink, Brustzentrum, Ulm, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Centrum für Hämatologie und Onkologie Bethanien, Frankfurt, Germany; Klinikum zum Roten Kreuz, München, Germany; Zentrum für Hämatologie und Onkologie, München, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany; Medical Center, Luisenkrankenhaus, Düsseldorf, Germany; Universitätsklinikum, Frankfurt, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Sana Klinikum, Offenbach, Germany; German Breast Group, Neu-Isenburg, Germany; HELIOS Klinikum, Berlin-Buch, Germany
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Loibl S, Sinn BV, Karn T, Untch M, Treue D, Sinn HP, Weber KE, Hanusch CA, Fasching PA, Huober J, Zahm DM, Jackisch C, Thomalla J, Blohmer JU, Marmé F, Klauschen F, Rhiem K, Felder B, von Minckwitz G, Burchardi N, Schneeweiss A, Denkert C. Abstract PD2-07: mRNA signatures predict response to durvalumab therapy in triple negative breast cancer (TNBC)– Results of the translational biomarker programme of the neoadjuvant double-blind placebo controlled GeparNuevo trial. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-pd2-07] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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 GeparNuevo trial showed a numerical increase in the pCR rate to 53% vs 44%; p=0.281 compared to placebo in TNBC with the addition of the anti-PD-L1 antibody durvalumab to a neoadjuvant anthracycline-taxane containing chemotherapy (Loibl S et al. ASCO 2018). In a predefined subgroup analysis, a significant increase of the pCR rate was observed for patients that received durvalumab for 2 weeks alone prior to the start of chemotherapy in a window phase (61% vs 41%, p interaction=0.048), while the pCR rate was not increased for the subset of patients that did start durvalumab together with chemotherapy.
Here we report the main results of the translational programme for GeparNuevo with a focus on mRNA signatures predictive for pCR in pretherapeutic core biopsies.
Methods: A total of 162 baseline FFPE core biopsies were evaluable for expression of 2560 genes using the HTG EdgeSeq® system that combines a modified nuclease protection assay with next generation sequencing. Data was processed as recommended by the HTG and median transformed for further analyses. For differential gene expression analyses, the data was scale-normalized (TMM normalization; EdgeR package) and linear models were fit (limma package). Prior to these analyses, genes were filtered based on minimal expression (> 4) and variability (IQR > 1). As a first step, predefined immune-genes signature (TILs signature) (Denkert et al. JCO 2016) as well as IFN-gamma signatures were evaluated for correlation with pCR in logistic regression models. Subsequently, we performed a differential gene expression analysis according to therapy response for the durvalumab-arm and the placebo arm using the pre-filtered candidate genes. Gene names are not included in this abstract to allow filing of IP, but full gene names will be presented at the SABCS meeting.
Results: The predefined TIL- and IFN-gamma signatures were associated with increased pCR rates in the complete cohort (TIL-signature: OR 1.44, 95% CI 1.15-1.82, p=0.002; IFN-Gamma-signature: OR 1.63, 95% CI 1.22-2.24, p=0.002) as well as in the durvalumab arm (p=0.012 and 0.042) and the placebo arm (p=0.050 and 0.011). These signatures were general pCR predictors without specificity for durvalumab response.
Additional 44 genes were significantly (p<0.05) correlated with pCR in the durvalumab arm. Of those, 21 genes were upregulated and 23 genes were downregulated in pCR patients. 14 of the 21 upregulated genes are related to tumorbiologically relevant immune cell functions. A total of 6 of the 44 genes had a positive test for interaction (interaction p<0.05) with the therapy arm (durvalumab + NACT vs. placebo + NACT), suggesting that these genes might specifically predict response to durvalumab. Additional analyses investigating the role of molecular tumor subtypes, additional immune gene signatures and other subgroup analyses will be presented at the meeting.
Conclusion: Our results show that specific immune-related gene expression signatures predict response to durvalumab in primary triple negative breast cancer.
The trial was financially supported by Astra Zeneca and Celgene
Citation Format: Loibl S, Sinn BV, Karn T, Untch M, Treue D, Sinn H-P, Weber KE, Hanusch CA, Fasching PA, Huober J, Zahm D-M, Jackisch C, Thomalla J, Blohmer J-U, Marmé F, Klauschen F, Rhiem K, Felder B, von Minckwitz G, Burchardi N, Schneeweiss A, Denkert C. mRNA signatures predict response to durvalumab therapy in triple negative breast cancer (TNBC)– Results of the translational biomarker programme of the neoadjuvant double-blind placebo controlled GeparNuevo trial [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 PD2-07.
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Affiliation(s)
- S Loibl
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - BV Sinn
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - T Karn
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - M Untch
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - D Treue
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - H-P Sinn
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - KE Weber
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - CA Hanusch
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - PA Fasching
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - J Huober
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - D-M Zahm
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - C Jackisch
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - J Thomalla
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - J-U Blohmer
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - F Marmé
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - F Klauschen
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - K Rhiem
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - B Felder
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - G von Minckwitz
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - N Burchardi
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - A Schneeweiss
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
| | - C Denkert
- German Breast Group, Neu-Isenburg, Germany; Institut für Pathologie, Charité-Universitätsmedizin, Berlin, Germany; Klinik für Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Frankfurt, Germany; HELIOS Klinikum, Berlin-Buch, Germany; Allgemeine Pathologie, Universitätsklinikum, Heidelberg, Germany; Klinikum zum Roten Kreuz, München, Germany; Brustzentrum, Universitätsklinikum, Erlangen, Germany; Universitätsfrauenklink, Brustzentrum, Ulm, Germany; SRH Wald-Klinikum, Gera, Germany; Sana Klinikum, Offenbach, Germany; Praxisklinik für Haematologie und Onkologie, Koblenz, Germany; Brustzentrum, Charité-Universitätsmedizin, Berlin, Germany; Nationales Centrum für Tumorerkrankungen, Heidelberg, Germany; Zentrum Familiärer Brust- und Eierstockkrebs, Universitätsklinikum, Köln, Germany
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Cardoso F, Bardia A, Andre F, Cescon DW, McArthur H, Telli M, Loi S, Cortés J, Schmid P, Harbeck N, Denkert C, Jackisch C, Jia L, Tryfonidis K, Karantza V. Abstract OT3-04-03: KEYNOTE-756: A randomized, double-blind, phase III study of pembrolizumab versus placebo in combination with neoadjuvant chemotherapy and adjuvant endocrine therapy for high-risk early-stage ER+/HER2– breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-04-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background:Although ER+/HER2– breast cancer has a better overall prognosis than other breast cancer subtypes, there is a high-risk subpopulation characterized by high-grade tumors and decreased sensitivity to endocrine therapy, higher responsiveness to chemotherapy and worse prognosis. A large meta-analysis of prospective studies focusing on neoadjuvant chemotherapy (NAC) for treatment of stage I-III breast cancer demonstrated that increased pathologic complete response (pCR) rates at surgery were associated with improved survival. This correlation was observed across triple-negative breast cancer (TNBC), HER2+ breast cancer, and high-grade HR+/HER2- breast cancer. Specifically, patients with a pCR after NAC had a 5-year event-free survival (EFS) rate of 90%, whereas patients who did not achieve a pCR had a 5-year EFS rate of 60%.Therefore, increasing pCR rates after NAC may have a substantial impact for patients with high-risk early-stage HR+/HER2– breast cancer. KEYNOTE-756 is a global, randomized, double-blind, phase III study of pembrolizumab (vs placebo) + chemotherapy as neoadjuvant treatment, followed by pembrolizumab (vs placebo) plus endocrine therapy as adjuvant treatment for patients with high-risk, early-stage ER+/HER2– breast cancer.
Methods: Patients with T1c-2 cN1-2 or T3-4 cN0-2 grade 3 or grade 2 with Ki-67 ≥30%, invasive, ductal ER+/HER2– breast cancerwill be stratified by lymph node involvement (positive vs negative), tumor PD-L1 status (positive vs negative), ER positivity (≥10% vs <10%), and anthracycline dosing schedule (Q3W vs Q2W), and then randomized 1:1 to receive neoadjuvant treatment with pembrolizumab 200 mg Q3W or placebo in combination with paclitaxel (80 mg/m2 QW) for 4 cycles followed by (doxorubicin [60 mg/m2] or epirubicin [100 mg/m2]) plus cyclophosphamide (600 mg/m2) Q2/3W for another 4 cycles. After definitive surgery (± radiation therapy, as indicated), patients will receive adjuvant treatment with pembrolizumab (200 mg Q3W) or placebo for 9 additional administrations, in combination with endocrine therapy, which can be given for up to 10 years. Co-primary end points are pCR rate and EFS. Secondary end points are safety and overall survival. The global study will open in North America and Latin America, Europe, and Asia Pacific in the second half of 2018.
Citation Format: Cardoso F, Bardia A, Andre F, Cescon DW, McArthur H, Telli M, Loi S, Cortés J, Schmid P, Harbeck N, Denkert C, Jackisch C, Jia L, Tryfonidis K, Karantza V. KEYNOTE-756: A randomized, double-blind, phase III study of pembrolizumab versus placebo in combination with neoadjuvant chemotherapy and adjuvant endocrine therapy for high-risk early-stage ER+/HER2– breast cancer [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 OT3-04-03.
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Affiliation(s)
- F Cardoso
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - A Bardia
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - F Andre
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - DW Cescon
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - H McArthur
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - M Telli
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - S Loi
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - J Cortés
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - P Schmid
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - N Harbeck
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - C Denkert
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - C Jackisch
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - L Jia
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - K Tryfonidis
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
| | - V Karantza
- Champalimaud Clinical Centre/Champalimaud Foundation, Lisbon, Portugal; Massachusetts General Hospital, Harvard Medical School, Boston, MA; Faculté de Medicine Paris-Sud XI, Gustave Roussy, Paris, France; Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada; Cedars-Sinai Medical Center, Los Angeles, CA; Stanford University School of Medicine, Stanford, CA; Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia; Breast Cancer Program, Ramon y Cajal University Hospital, Madrid, Spain; Centre for Experimental Medicine, Barts Cancer Institute, London, United Kingdom; Breast Center, Ludwig-Maximilian University of Munich, Munich, Germany; Institute of Pathology, Charité–Universitätsmedizin Berlin, Berlin, Germany; Sana Klinikum, Offenbach, Germany; Merck & Co., Inc., Kenilworth, NJ
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Pohl E, Schneeweiss A, Hauke J, Moebus V, Furlanetto J, Denkert C, Fasching P, Hanusch C, Tesch H, Weber-Lassalle N, Müller V, Rhiem K, Untch M, Luebbe K, Lederer B, Jackisch C, Nekljudova V, Schmutzler R, Hahnen E, Loibl S. Germline mutation status and therapy response in patients with triple-negative breast cancer (TNBC): Results of the GeparOcto study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Untch M, Jackisch C, Schneeweiss A, Schmatloch S, Aktas B, Denkert C, Schem C, Wiebringhaus H, Kümmel S, Rhiem K, Warm M, Fasching P, Just M, Hanusch C, Hackmann J, Blohmer JU, Furlanetto J, Nekljudova V, von Minckwitz G, Loibl S. Impact of nab-paclitaxel dose reduction on survival of the randomized phase III GeparSepto trial comparing neoadjuvant chemotherapy of weekly nab-paclitaxel (nP) with solvent-based paclitaxel (P) followed by anthracycline/cyclophosphamide for patients with early breast cancer (BC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.185] [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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Sonnenblick A, Bailey A, Uziely B, Untch M, Smith I, Gianni L, Baselga J, Jackisch C, Cameron D, Bell R, Zardavas D, Al-Sakaff N, Gelber R, Dowsett M, Leyland-jones B, Piccart M, de Azambuja E. Autoimmunity and benefit from trastuzumab treatment in breast cancer: Results from the HERA phase III trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.213] [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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Fasching P, Decker T, Guderian G, Heim J, Jackisch C, Lueck HJ, Lüftner D, Marmé F, Reimer T, Woeckel A. Real-world effectiveness of ribociclib + aromatase inhibitor, or endocrine monotherapy, or chemotherapy as first-line treatment in postmenopausal women with HR-positive, HER2-negative locally advanced or metastatic breast cancer: The RIBANNA study. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy271.275] [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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Reinisch M, Seiler S, Hauzenberger T, Schmatloch S, Strittmatter HJ, Zahm DM, Thode C, Jackisch C, Strik D, Moebus V, Reimer T, Sinn B, Stickeler E, Marme F, Janni W, Kamischke A, Rudlowski C, Nekljudova V, von Minckwitz G, Loibl S. Final analysis of the Male-GBG54 study: A prospective, randomised multi-centre phase II study evaluating endocrine treatment with either tamoxifen +/- gonadotropin releasing hormone analogue (GnRHa) or an aromatase inhibitor + GnRHa in male breast cancer patients. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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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Möbus V, von Minckwitz G, Jackisch C, Lück HJ, Schneeweiss A, Tesch H, Elling D, Harbeck N, Conrad B, Fehm T, Huober J, Müller V, Bauerfeind I, du Bois A, Loibl S, Nekljudova V, Untch M, Thomssen C. German Adjuvant Intergroup Node-positive Study (GAIN): a phase III trial comparing two dose-dense regimens (iddEPC versus ddEC-PwX) in high-risk early breast cancer patients. Ann Oncol 2018; 28:1803-1810. [PMID: 28459941 DOI: 10.1093/annonc/mdx203] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Dose-dense (dd) regimens are one of the preferred options for the adjuvant treatment of breast cancer patients with intermediate to high risk. The German Adjuvant Intergroup Node-positive trial aimed at optimizing intense dd (idd) strategies by evaluating drug combinations and the addition of capecitabine. Patients and methods Women (aged 18 years and biologically <65 years) with histologically involved axillary lymph nodes were randomly assigned to receive three courses each of epirubicin (E) 150 mg/m2, paclitaxel (P) 225 mg/m2 and cyclophosphamide (C) 2500 mg/m2 (reduced to 2000 mg/m2 after recruitment of 1200 patients) q2w intravenously (i.v.) (iddEPC-regimen) or ddEC (E 112.5 mg/m2 + C 600 mg/m2, i.v. q2w for 4 cycles) followed by paclitaxel weekly (Pw 67.5 mg/m2 i.v. q8d for 10 weeks) plus capecitabine (X 2000 mg/m2 p.o. days 1-14, q22 for 4 cycles) (ddEC-PwX-regimen). Further randomization assigned patients to ibandronate for 2 years versus observation and to pegfilgrastim day 2 versus 4. Results From June 2004 to August 2008, 2994 patients were randomized to either iddEPC (N = 1498), or ddEC-PwX (N = 1496) and started treatment. Median age was 50 years; pN1 (37.8%), pN2 (35.3%); pN3 (26.9%); 46.4% were G3 tumors; 76.9% hormone receptor-positive and 22% HER2-positive. After a median follow-up of 74 months, 645 events and 383 deaths were recorded. Hematological adverse events grades 3-4 were more common with iddEPC (P < 0.001), nonhematological with ddEC-PwX (P = 0.04), even if the toxicity profile of the two regimens was different. At 5 years, estimated disease-free survival rates for ddEC-PwX and iddEPC were 81.7% [95% confidence interval (CI) 79.5-83.6] versus 80.2% (95% CI 78.0-82.2). Hazard ratio (HR)=0.95 (95% CI 0.81-1.11, log-rank P = 0.49). Five-year overall survival rates were 89.4% for ddEC-PwX (95% CI 87.7-91.0) and 89.0% for iddEPC (95% CI 87.2-90.6), HR = 0.85 (95% CI 0.69-1.04, log-rank P = 0.10). Conclusion Adding capecitabine to ddEC-Pw did not improve outcome in comparison to iddEPC but increased toxicity and should not be recommended for further use.
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Affiliation(s)
- V Möbus
- Department of Gynecology and Obstetrics, Klinikum Frankfurt Höchst, Academic Hospital of the Goethe University Frankfurt, Frankfurt
| | | | - C Jackisch
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach GmbH, Offenbach
| | - H-J Lück
- Gynecology and Oncology Practice Hannover, Hannover
| | - A Schneeweiss
- National Centre of Tumor Diseases, University of Heidelberg, Heidelberg
| | - H Tesch
- Department of Hematology & Oncology at Bethanien-Hospital, Frankfurt
| | - D Elling
- Department of Gynecology and Obstetrics, Sana Klinikum Berlin, Berlin
| | - N Harbeck
- Department of Gynecology and Obstetrics, University of Munich, Munich
| | - B Conrad
- Elisabeth Krankenhaus Kassel, Breast Center, Kassel
| | - T Fehm
- Department of Gynecology and Obstetrics, University of Duesseldorf, Duesseldorf
| | - J Huober
- Department of Gynecology and Obstetrics, University of Ulm, Ulm
| | - V Müller
- Department of Gynecology, University Hospital of Hamburg-Eppendorf, Hamburg
| | - I Bauerfeind
- Department of Gynecology and Obstetrics, Klinikum Landshut, Landshut
| | - A du Bois
- Department of Gynecology & Gynecologic Oncology, Klinikum Essen-Mitte, Essen
| | - S Loibl
- German Breast Group, Neu-Isenburg
| | | | - M Untch
- Department of Gynecology and Obstetrics, Helios Klinikum Berlin-Buch, Berlin
| | - C Thomssen
- Department of Gynecology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
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Anastasiadou L, Aulmann S, Falk S, Baier P, Giesecke D, Buchen S, Hurst U, Krapfl E, Moebus V, Mosch D, Schulmeyer E, Solbach C, Ackermann S, Gabriel B, Jackisch C, Thill M. Abstract OT1-06-02: Oncotype DX®-REMAR(Rhein-Main-Registry)-study: Use of the oncotype DX® assay in early breast cancer in certified breast cancer centers in Rhine-Main Region, Germany. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot1-06-02] [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: 11/16/2022]
Abstract
Abstract
A brief background discussion:
The OncotypeDX® multigene assay is recommended by several international guidelines as a predictive and prognostic factor for HR+/HER2- early breast cancer (EBC). Several trials have shown the necessity of OncotypeDX® Recurrence Score (RS) as a decision tool for HR+/HER2- EBC with 0-3 lymph nodes (LN) involved. At present, though, only limited data from the routine setting are available on the impact of treatment decision making process based on the usage of classical proliferation marker Ki67 with or without knowing the individual RS prior and after a treatment decision from a multidisciplinary tumor board (MTB) for the decision making of the adjuvant therapy of EBC. The Oncotype DX® assay is still not reimbursed by every insurance, therefore we expect that this registry will have an impact on reimbursement in Germany.
Trial design:
The OncotypeDX®-REMAR(Rhein-Main-Registry) study is a prospective, non-interventional, multicenter and non-randomized, study. 13 certified breast cancer (BC) centers in the Rhine-Main region in Germany participate. The sponsor of this trial is the AGAPLESION, Markus Hospital Frankfurt, Genomic Health provides the financial support.
After registration, the patient´s case will be discussed in the respective institution's MTB, before and after the RS result. The adjuvant treatment will be recommended based on available clinical and histopathological data according to the guidelines and the RS result. After each meeting, the physician and patient will fill in a questionnaire. In addition to the local determination of Ki67 and nuclear grading, a central pathology assessment of these two markers will be provided in a blinded fashion. Only the sponsor has access to these results. Consequently, this independent test has no influence both on the local histopathology result and on the recommended treatment.
Eligibility criteria:
Inclusion criteria:
Female patients, ≥18 years, with a hormone-receptor positive, HER2-negative EBC and 0-3 positive LN, T1-3, nuclear grading 1-3, Ki67:10-40%, cM0.
Specific aims:
Primary endpoint is the decision impact of the RS result in patients with mid-range Ki67 on adjuvant chemotherapy in EBC.
Secondary endpoints include the correlation of Ki67 with tumor grade and RS result. Moreover, an economic subanalysis will be done.
Statistical methods:
The change in physicians' treatment recommendations will be measured pre-assay vs. post-assay. The proportion of patients for whom the treatment recommendation changed and the 95% confidence interval will be reported overall and by select groups. McNemar's test will be used to compare the proportion of patients' recommended chemo-hormonal therapy pre-assay vs. post-assay.
Present accrual and target accrual:
Thirteen participating centers recruited 97 patients by the end of April 2017. 600 patients are planned in total.
Contact information for people with a specific interest in the trial:
In case of interest you can contact Ms. Louiza Anastasiadou, Tel: +4969-9533-66395, Fax: +4969-9533-2385, email: louiza.anastasiadou@fdk.info
Citation Format: Anastasiadou L, Aulmann S, Falk S, Baier P, Giesecke D, Buchen S, Hurst U, Krapfl E, Moebus V, Mosch D, Schulmeyer E, Solbach C, Ackermann S, Gabriel B, Jackisch C, Thill M. Oncotype DX®-REMAR(Rhein-Main-Registry)-study: Use of the oncotype DX® assay in early breast cancer in certified breast cancer centers in Rhine-Main Region, Germany [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT1-06-02.
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Affiliation(s)
- L Anastasiadou
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - S Aulmann
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - S Falk
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - P Baier
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - D Giesecke
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - S Buchen
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - U Hurst
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - E Krapfl
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - V Moebus
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - D Mosch
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - E Schulmeyer
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - C Solbach
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - S Ackermann
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - B Gabriel
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - C Jackisch
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
| | - M Thill
- AGAPLESION, Markus Hospital, Frankfurt Main, Hessen, Germany; OptiPath, MVZ für Pathologie, Frankfurt Main, Hessen, Germany; Ketteler Hospital Offenbach; Hochtaunus-Hospital, Bad Homburg; Asklepios Paulinen Klinik, Wiesbaden; KKH Bergstrasse, Heppenheim; Asklepios Klinikum Langen; Klinikum Frankfurt Hoechst; Bad Soden Klinik; Main-Kinzig-Kliniken, Gelnhausen; University Hospital Frankfurt; Klinikum Darmstadt; St. Josefs Hospital, Wiesbaden; Sana Klinikum Offenbach; Frankfurt Diakonia Clinics
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