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Dang C, Ewer MS, Delaloge S, Ferrero JM, Verrill M, Colomer R, Vieira C, de la Cruz Merino L, Lucas J, Werner TL, Douthwaite H, Bradley D, Waldron-Lynch M, Eng-Wong J, Swain SM. Abstract P5-20-04: Safety of adjuvant treatment with pertuzumab plus trastuzumab after neoadjuvant anthracycline-based chemotherapy in patients with HER2-positive localized breast cancer: Updated results from the BERENICE study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-20-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background Anti-HER2 therapies are associated with a risk of cardiac toxicity, particularly as part of anthracycline-based regimens. BERENICE (NCT02132949), a nonrandomized, Phase 2 cardiac safety study showed neoadjuvant treatment with pertuzumab (P) + trastuzumab (H) and 2 common anthracycline–taxane-based regimens had a safety profile consistent with prior studies of P+H, and was associated with high pathologic complete response rates. Here we report safety data from the P+H adjuvant treatment period (AP).
Methods Patients (pts) with centrally confirmed, localized HER2-positive breast cancer and normal cardiac function received 4 q2w dose-dense doxorubicin and cyclophosphamide cycles (60/600mg/m2) then 12 qw paclitaxel injections (80mg/m2; Cohort A), or 4 q3w fluorouracil/epirubicin/cyclophosphamide cycles (500/100/600 mg/m2) then 4 q3w docetaxel cycles (75mg/m2, up to 100mg/m2;Cohort B). In both cohorts, 4 q3w cycles of P (loading:840mg; maintenance:420mg) + H (loading:8mg/kg; maintenance:6mg/kg) were started with taxane therapy and continued in the adjuvant setting (for up to 13 cycles to complete 1 year of treatment). Surgery was scheduled after 8 cycles of preoperative therapy. Primary endpoints were incidence of New York Heart Association (NYHA) Class III/IV heart failure and incidence of left ventricular ejection fraction (LVEF) declines (≥10%-points from baseline to <50%; asymptomatic and symptomatic events) assessed by ECHO/MUGA. Confirmed LVEF declines were defined as significant LVEF declines at 2 consecutive visits.
Results In total, 397 pts received ≥1 dose of study medication and were included in the overall treatment period (OTP) safety analysis. Of these, 371 (Cohort A:181; Cohort B:190) pts entered the AP and were included in the AP safety analysis. Mean (SD) number of AP treatment cycles of P and H were 12.3 (2.0) in Cohort A and 12.3 (2.2) in Cohort B. In the AP, incidence of heart failure was minimal (0.5%) and confirmed LVEF decline incidence was low (Table 1).
Table 1: Cardiac AE Cohort ACohort B OTP n=199AP n=181OTP n=198OTP n=190NYHA Class III/IV heart failure Events, n4011Pts with event, n (%)3(1.5)01(0.5)1(0.5)LVEF decline Events, n36223429Pts with LVEF decline, n (%)21(10.6)14(7.7)22(11.1)20(10.5)Pts with confirmed LVEF decline, n (%)7(3.5)5(2.8)7(3.5)6(3.2)
General adverse events (AEs) are shown in Table 2; 26 (14.4%) pts in Cohort A and 45 (23.7%) in Cohort B had diarrhea AEs (mostly grade 1).
Table 2: General AE Cohort ACohort BPts, n (%)OTP n=199AP n=181OTP n=198AP n=190Any AE198(99.5)171(94.5)198(100.0)171(90.0)Grade ≥3 AE109(54.8)23(12.7)126(63.6)40(21.1)Serious AE54(27.1)15(8.3)61(30.8)17(8.9)AE leading to P or H discontinuation19(9.5)9(5.0)14(7.1)11(5.8)
Conclusion P+H in the adjuvant setting, following P+H with anthracycline-based regimens in the neoadjuvant setting, are associated with low incidence of cardiac AEs. Cardiac safety results for P+H in the AP and OTP of BERENICE were consistent with results from prior studies evaluating adjuvant treatment with single-agent H, suggesting the addition of P to H in the adjuvant setting does not increase cardiac toxicity.
Citation Format: Dang C, Ewer MS, Delaloge S, Ferrero J-M, Verrill M, Colomer R, Vieira C, de la Cruz Merino L, Lucas J, Werner TL, Douthwaite H, Bradley D, Waldron-Lynch M, Eng-Wong J, Swain SM. Safety of adjuvant treatment with pertuzumab plus trastuzumab after neoadjuvant anthracycline-based chemotherapy in patients with HER2-positive localized breast cancer: Updated results from the BERENICE study [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 P5-20-04.
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Affiliation(s)
- C Dang
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - MS Ewer
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - S Delaloge
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - J-M Ferrero
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - M Verrill
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - R Colomer
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - C Vieira
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - L de la Cruz Merino
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - J Lucas
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - TL Werner
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - H Douthwaite
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - D Bradley
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - M Waldron-Lynch
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - J Eng-Wong
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
| | - SM Swain
- Memorial Sloan-Kettering Cancer Center, New York, NY; The University of Texas MD Anderson Cancer Center, Houston, TX; Institut Gustave Roussy, Paris, France; Centre Antoine Lacassagne, Nice, France; Northern Centre for Cancer Care, Newcastle upon Tyne, United Kingdom; Hospital Universitario La Princesa, Madrid, Spain; Instituto Português de Oncologia Francisco Gentil (IPOFG), Porto, Portugal; Hospital Universitario Virgen Macarena, Seville, Spain; Marin Cancer Care, Greenbrae, CA; Huntsman Cancer Institute, University of Utah, Salt Lake City, UT; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech Inc, South San Francisco, CA; Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, DC
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Schneeweiss A, Chia S, Hickish T, Harvey V, Eniu A, Waldron-Lynch M, Eng-Wong J, Kirk S, Cortés J. Abstract P4-21-02: Pertuzumab and trastuzumab plus standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: Efficacy analysis of a phase II cardiac safety study (TRYPHAENA). Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p4-21-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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 multicenter, open-label Phase II TRYPHAENA study (NCT00976989) showed that neoadjuvant pertuzumab (P) + trastuzumab (H) + chemotherapy (anthracycline-containing or anthracycline-free) was generally well tolerated with low rates of symptomatic left ventricular systolic dysfunction (LVSD, the primary endpoint), in patients (pts) with HER2-positive, operable, locally advanced or inflammatory breast cancer. All three arms were highly clinically active: total pathologic complete response in the breast and axilla (tpCR; ypT0/is, ypN0) rates were 55–64%. We now report long-term disease-free survival (DFS), progression-free survival (PFS), overall survival (OS), and cardiac safety.
Methods:
Pts were randomized 1:1:1 to six 3-weekly neoadjuvant treatment cycles. Arm A: H + P (cycles 1–6) + fluorouracil, epirubicin, cyclophosphamide (FEC, cycles 1–3) + docetaxel (T) (cycles 4–6), Arm B: FEC (cycles 1–3) followed by T + H + P (cycles 4–6), Arm C: T + H + P + carboplatin (cycles 1–6). Adjuvant H was then given to complete 1 year of treatment. Doses: P 840mg loading and 420mg maintenance; H 8mg/kg loading and 6mg/kg maintenance; T 75mg/m2, up to 100mg/m2 if tolerated (Arms A and B); fluorouracil 500mg/m2; epirubicin 100mg/m2; cyclophosphamide 600mg/m2; carboplatin area under the plasma concentration–time curve 6. A preplanned descriptive analysis of DFS (time from surgery until disease progression or death), PFS (time from randomization until disease progression or death, equivalent to the common definition of event-free survival), and OS (time from randomization until death from any cause) was conducted 5 years after randomization of the last pt.
Results:
Median follow-up was balanced across arms (61.1 months in Arm A; 61.8 months in Arm B; 60.9 months in Arm C); 3-year Kaplan–Meier (KM) survival estimates and 95% CIs are shown in the table.
Arm A n=73Arm B n=75Arm C n=773-year KM survival estimate, %DFS87 (79–95)88 (80–96)90 (82–97) PFS89 (81–96)89 (81–96)87 (80–95) OS94 (89–100)94 (89–100)93 (87–99)
For all three arms combined, the hazard ratio for DFS in pts who achieved tpCR versus those who did not achieve tpCR was 0.27 (95% CI 0.11–0.64). During post-treatment follow-up, 2/72 (2.8%) pts in Arm A, 3/75 (4.0%) in Arm B, and 4/76 (5.3%) in Arm C had LVSD (any grade). Of the pts with LVSD, only 1 pt experienced an event indicative of symptomatic LVSD (assessed as NYHA class II and grade ≥3). Also during this period, 8 pts in Arm A (11.1%), 12 (16.0%) in Arm B, and 9 (11.8%) in Arm C experienced LVEF declines to <50% and ≥10% from baseline.
Conclusions:
The 3-year DFS and PFS rates were similar between treatment arms and were comparable to rates previously observed in the neoadjuvant NeoSphere study. Pts who achieved tpCR had improved DFS compared with those who did not achieve tpCR, supporting previous findings of an association between pCR and long-term outcomes (Cortazar et al, Lancet 2014). The combination of P, H, and standard anthracycline-containing or anthracycline-free chemotherapy regimens was generally well tolerated and no new safety signals were identified with 5 years follow-up.
Citation Format: Schneeweiss A, Chia S, Hickish T, Harvey V, Eniu A, Waldron-Lynch M, Eng-Wong J, Kirk S, Cortés J. Pertuzumab and trastuzumab plus standard neoadjuvant anthracycline-containing and anthracycline-free chemotherapy regimens in patients with HER2-positive early breast cancer: Efficacy analysis of a phase II cardiac safety study (TRYPHAENA) [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-21-02.
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Affiliation(s)
- A Schneeweiss
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; British Columbia Cancer Agency – Vancouver Centre, University of British Columbia, Vancouver, Canada; Royal Bournemouth Hospital, Bournemouth University, Bournemouth, United Kingdom; Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand; Cancer Institute "I Chiricuta", Cluj-Napoca, Romania; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech, Inc, South San Francisco, CA; Ramón y Cajal University Hospital, Madrid & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - S Chia
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; British Columbia Cancer Agency – Vancouver Centre, University of British Columbia, Vancouver, Canada; Royal Bournemouth Hospital, Bournemouth University, Bournemouth, United Kingdom; Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand; Cancer Institute "I Chiricuta", Cluj-Napoca, Romania; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech, Inc, South San Francisco, CA; Ramón y Cajal University Hospital, Madrid & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - T Hickish
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; British Columbia Cancer Agency – Vancouver Centre, University of British Columbia, Vancouver, Canada; Royal Bournemouth Hospital, Bournemouth University, Bournemouth, United Kingdom; Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand; Cancer Institute "I Chiricuta", Cluj-Napoca, Romania; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech, Inc, South San Francisco, CA; Ramón y Cajal University Hospital, Madrid & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - V Harvey
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; British Columbia Cancer Agency – Vancouver Centre, University of British Columbia, Vancouver, Canada; Royal Bournemouth Hospital, Bournemouth University, Bournemouth, United Kingdom; Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand; Cancer Institute "I Chiricuta", Cluj-Napoca, Romania; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech, Inc, South San Francisco, CA; Ramón y Cajal University Hospital, Madrid & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - A Eniu
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; British Columbia Cancer Agency – Vancouver Centre, University of British Columbia, Vancouver, Canada; Royal Bournemouth Hospital, Bournemouth University, Bournemouth, United Kingdom; Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand; Cancer Institute "I Chiricuta", Cluj-Napoca, Romania; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech, Inc, South San Francisco, CA; Ramón y Cajal University Hospital, Madrid & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - M Waldron-Lynch
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; British Columbia Cancer Agency – Vancouver Centre, University of British Columbia, Vancouver, Canada; Royal Bournemouth Hospital, Bournemouth University, Bournemouth, United Kingdom; Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand; Cancer Institute "I Chiricuta", Cluj-Napoca, Romania; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech, Inc, South San Francisco, CA; Ramón y Cajal University Hospital, Madrid & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Eng-Wong
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; British Columbia Cancer Agency – Vancouver Centre, University of British Columbia, Vancouver, Canada; Royal Bournemouth Hospital, Bournemouth University, Bournemouth, United Kingdom; Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand; Cancer Institute "I Chiricuta", Cluj-Napoca, Romania; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech, Inc, South San Francisco, CA; Ramón y Cajal University Hospital, Madrid & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - S Kirk
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; British Columbia Cancer Agency – Vancouver Centre, University of British Columbia, Vancouver, Canada; Royal Bournemouth Hospital, Bournemouth University, Bournemouth, United Kingdom; Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand; Cancer Institute "I Chiricuta", Cluj-Napoca, Romania; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech, Inc, South San Francisco, CA; Ramón y Cajal University Hospital, Madrid & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - J Cortés
- National Center for Tumor Diseases, University Hospital, Heidelberg, Germany; British Columbia Cancer Agency – Vancouver Centre, University of British Columbia, Vancouver, Canada; Royal Bournemouth Hospital, Bournemouth University, Bournemouth, United Kingdom; Regional Cancer and Blood Centre, Auckland City Hospital, Auckland, New Zealand; Cancer Institute "I Chiricuta", Cluj-Napoca, Romania; Roche Products Ltd, Welwyn Garden City, United Kingdom; Genentech, Inc, South San Francisco, CA; Ramón y Cajal University Hospital, Madrid & Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
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