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Agostinetto E, Buisseret L, Salgado R, Kok M, Ignatiadis M. Residual disease post neoadjuvant chemo-immunotherapy in early triple-negative breast cancer: does it help tailor adjuvant treatment? Ann Oncol 2024; 35:409-411. [PMID: 38484973 DOI: 10.1016/j.annonc.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 03/05/2024] [Indexed: 04/15/2024] Open
Affiliation(s)
- E Agostinetto
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - L Buisseret
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - R Salgado
- Department of Pathology, ZAS Hospitals, Antwerp, Belgium; Division of Research, Peter Mac Callum cancer Centre, Melbourne, Belgium
| | - M Kok
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - M Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium.
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Nader-Marta G, Monteforte M, Agostinetto E, Cinquini M, Martins-Branco D, Langouo M, Llombart-Cusac A, Cortés J, Ignatiadis M, Torri V, Apolone G, Cappelletti V, Pruneri G, de Azambuja E, Di Cosimo S. Circulating tumor DNA for predicting recurrence in patients with operable breast cancer: a systematic review and meta-analysis. ESMO Open 2024; 9:102390. [PMID: 38460249 PMCID: PMC10940943 DOI: 10.1016/j.esmoop.2024.102390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 01/25/2024] [Accepted: 01/26/2024] [Indexed: 03/11/2024] Open
Abstract
BACKGROUND The incorporation of circulating tumor DNA (ctDNA) into the management of operable breast cancer (BC) has been hampered by the heterogeneous results from different studies. We aimed to assess the prognostic value of ctDNA in patients with operable (non metastatic) BC. MATERIALS AND METHODS A systematic search of databases (PubMed/Medline, Embase, and CENTRAL) and conference proceedings was conducted to identify studies reporting the association of ctDNA detection with disease-free survival (DFS) and overall survival (OS) in patients with stage I-III BC. Log-hazard ratios (HRs) were pooled at each timepoint of ctDNA assessment (baseline, after neoadjuvant therapy, and follow-up). ctDNA assays were classified as primary tumor-informed and non tumor-informed. RESULTS Of the 3174 records identified, 57 studies including 5779 patients were eligible. In univariate analyses, ctDNA detection was associated with worse DFS at baseline [HR 2.98, 95% confidence interval (CI) 1.92-4.63], after neoadjuvant therapy (HR 7.69, 95% CI 4.83-12.24), and during follow-up (HR 14.04, 95% CI 7.55-26.11). Similarly, ctDNA detection at all timepoints was associated with worse OS (at baseline: HR 2.76, 95% CI 1.60-4.77; after neoadjuvant therapy: HR 2.72, 95% CI 1.44-5.14; and during follow-up: HR 9.19, 95% CI 3.26-25.90). Similar DFS and OS results were observed in multivariate analyses. Pooled HRs were numerically higher when ctDNA was detected at the end of neoadjuvant therapy or during follow-up and for primary tumor-informed assays. ctDNA detection sensitivity and specificity for BC recurrence ranged from 0.31 to 1.0 and 0.7 to 1.0, respectively. The mean lead time from ctDNA detection to overt recurrence was 10.81 months (range 0-58.9 months). CONCLUSIONS ctDNA detection was associated with worse DFS and OS in patients with operable BC, particularly when detected after treatment and using primary tumor-informed assays. ctDNA detection has a high specificity for anticipating BC relapse.
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Affiliation(s)
- G Nader-Marta
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium.
| | - M Monteforte
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - E Agostinetto
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium. https://twitter.com/ElisaAgostinett
| | - M Cinquini
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | - D Martins-Branco
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium. https://twitter.com/DMBranco
| | - M Langouo
- Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - A Llombart-Cusac
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain; Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA; Arnau de Vilanova Hospital; Universidad Católica de Valencia, Valencia, Spain
| | - J Cortés
- Medica Scientia Innovation Research (MEDSIR), Barcelona, Spain; Medica Scientia Innovation Research (MEDSIR), Ridgewood, New Jersey, USA; International Breast Cancer Center (IBCC), Pangaea Oncology, Quiron Group, Barcelona, Spain; Department of Medicine, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Madrid, Spain. https://twitter.com/JavierCortesMD
| | - M Ignatiadis
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium; Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium. https://twitter.com/MIgnatiadis
| | - V Torri
- Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy. https://twitter.com/ValterTorri
| | - G Apolone
- Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - V Cappelletti
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - G Pruneri
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; University of Milan, School of Medicine, Milan, Italy. https://twitter.com/PruneriG
| | - E de Azambuja
- Academic Trials Promoting Team (ATPT), Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium; Medical Oncology Department, Institut Jules Bordet, Hôpital Universitaire de Bruxelles (HUB), Université Libre de Bruxelles (U.L.B), Brussels, Belgium. https://twitter.com/E_de_Azambuja
| | - S Di Cosimo
- Department of Advanced Diagnostics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. https://twitter.com/serenadicosimo
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Agostinetto E, Ignatiadis M. ctDNA as a predictive biomarker in advanced breast cancer: Lessons from the MONALEESA studies. Ann Oncol 2023; 34:955-959. [PMID: 37996168 DOI: 10.1016/j.annonc.2023.09.3111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Accepted: 09/22/2023] [Indexed: 11/25/2023] Open
Affiliation(s)
- E Agostinetto
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
| | - M Ignatiadis
- Institut Jules Bordet, Université Libre de Bruxelles (U.L.B.), Hôpital Universitaire de Bruxelles (HUB), Brussels, Belgium
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Gombos A, Goncalves A, Curigliano G, Bartsch R, Kyte JA, Ignatiadis M, Awada A. How I treat endocrine-dependent metastatic breast cancer. ESMO Open 2023; 8:100882. [PMID: 36806375 PMCID: PMC9969253 DOI: 10.1016/j.esmoop.2023.100882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 01/12/2023] [Accepted: 01/12/2023] [Indexed: 02/19/2023] Open
Abstract
Estrogen receptor-positive (ER+)/HER2-negative (HER2-), the so-called luminal-type breast cancer, is the most frequent subset, accounting for around 70% of all breast cancer cases. Endocrine therapy (ET) combined with cyclin-dependent kinases (CDK) 4/6 inhibitors is the standard first option in the management of advanced luminal breast cancer independently of disease extension. Classically, patients undergo multiple lines of ET ± targeted treatments until endocrine resistance occurs and palliative chemotherapy is proposed. Understanding endocrine resistance mechanisms and development of novel ET options is one of the main challenges in current clinical research. Another area of utmost interest is the improvement of post-endocrine therapeutic approaches. Among others, the development of antibody-drug conjugates (ADCs) is very promising, and some of these drugs will probably soon become a part of the therapeutic arsenal against this incurable disease. This review paper provides an overview of currently available treatment options in ER+/HER2- metastatic breast cancer and extensively discusses new approaches in late clinical development.
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Affiliation(s)
- A Gombos
- Department of Medical Oncology Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - A Goncalves
- Institut Paoli Calmettes, Centre de Recherche en Cancérologie de Marseille (CRCM), Inserm U1068, CNRS U7258, Aix Marseille University, Marseille, France
| | - G Curigliano
- European Institute of Oncology, University of Milano, Milano, Italy
| | - R Bartsch
- Department of Medicine I, Medical University of Vienna, Vienna, Austria
| | - J A Kyte
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - M Ignatiadis
- Department of Medical Oncology Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - A Awada
- Department of Medical Oncology Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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Amato O, Aftimos P, Ignatiadis M. Liquid biopsy accelerates precision medicine. Ann Oncol 2023; 34:333-335. [PMID: 36804455 DOI: 10.1016/j.annonc.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 02/07/2023] [Indexed: 02/17/2023] Open
Affiliation(s)
- O Amato
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium; Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy
| | - P Aftimos
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium
| | - M Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet and Université Libre de Bruxelles, Brussels, Belgium.
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De Caluwe A, Romano E, Poortmans P, Gombos A, Laragione A, Agostinetto E, Nader Marta G, Picchia S, Vandekerkhove C, Ameye L, Craciun L, Veys I, Van Gestel D, Larsimont D, Sotiriou C, Piccart M, Ignatiadis M, Buisseret L. 98P Neo-CheckRay, radiation therapy and adenosine pathway blockade to potentiate benefit of immuno-chemotherapy in early stage luminal B breast cancer: Results of the safety run-in phase. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.114] [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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Martinez Chanza N, Carnot A, Barthelemy P, Casert V, Sautois B, Van den Brande J, Vanhaudenarde V, Staudacher L, Seront E, Culine S, Gizzi M, Gil T, Paesmans M, Kotecki N, Ignatiadis M, Albisinni S, Fantoni J, Tricard T, Roumeguere T, Awada A. 659MO Avelumab (A) as the basis of neoadjuvant chemotherapy (NAC) regimen in platinum eligible and ineligible patients (pts) with non-metastatic muscle invasive bladder cancer (NM-MIBC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.055] [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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Agostinetto E, Paesmans M, Ameye L, Veys I, Buisseret L, Neven P, Taylor D, Fontaine C, Duhoux F, Canon JL, Denys H, Coussy F, Chakiba C, Pistilli B, Piccart M, Ignatiadis M, Aftimos P. 72TiP ROSALINE: A phase II, single-arm, neoadjuvant study of targeting ROS1 in combination with endocrine therapy (ET) in invAsive Lobular carcINoma of the brEast. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.086] [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: 10/21/2022] Open
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De Caluwe A, Buisseret L, Poortmans P, Sotiriou C, Larsimont D, Van Gestel D, Laragione A, Desmet A, Van Den Begin R, Philippson C, Eiger D, Piccart M, Romano E, Ignatiadis M. 84TiP Neo-CheckRay: Radiation therapy and adenosine pathway blockade to increase benefit of immuno-chemotherapy in early stage luminal B breast cancer: A randomized phase II trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.571] [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: 10/22/2022] Open
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Eiger D, Maurer C, Brandao M, Aftimos P, Punie K, Taylor D, Van den Mooter T, Poncin R, Canon JL, Duhoux F, Casert V, Clatot F, Velghe C, Craciun L, Paesmans M, de Azambuja E, Ignatiadis M, Larsimont D, Piccart M, Buisseret L. 348P First findings from SYNERGY, a phase I/II trial testing the addition of the anti-CD73 oleclumab (O) to the anti-PD-L1 durvalumab (D) and chemotherapy (ChT) as first line therapy for patients (pts) with metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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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Affiliation(s)
- M Brandão
- Medical Oncology Department, Academic Trials Promoting Team - Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Ignatiadis
- Medical Oncology Department, Academic Trials Promoting Team - Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.
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Brandão M, Coens C, Ignatiadis M. Patient-reported outcomes and genomic signatures: tools to tailor adjuvant endocrine treatment? Ann Oncol 2019; 30:1677-1681. [PMID: 31613310 DOI: 10.1093/annonc/mdz404] [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: 11/14/2022] Open
Affiliation(s)
- M Brandão
- Medical Oncology Department, Academic Trials Promoting Team, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - C Coens
- Department of Biostatistics, European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - M Ignatiadis
- Medical Oncology Department, Academic Trials Promoting Team, Institut Jules Bordet and Université Libre de Bruxelles (ULB), Brussels, Belgium.
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Ignatiadis M, McArthur H, Bailey A, Martinez J, de Azambuja E, Metzger O, Lai C, Franzoi M, Goulioti T, Daly F, Bouhlel A, Balta V, Maetens M, Viale G, André B, DuFRane C, Nguyen D, Gelber R, Piccart M, Winer E. ALEXANDRA/IMpassion030: A phase III study of standard adjuvant chemotherapy with or without atezolizumab in early stage triple negative breast cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.112] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [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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Maurer C, Eiger D, Velghe C, Aftimos P, Maetens M, Gaye J, Paesmans M, Ignatiadis M, Piccart M, Buisseret L. SYNERGY: Phase I and randomized phase II trial to investigate the addition of the anti-CD73 antibody oleclumab to durvalumab, paclitaxel and carboplatin for previously untreated, locally recurrent inoperable or metastatic triple-negative breast cancer (TNBC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz100.046] [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: 11/14/2022] Open
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Lambertini M, Goldrat O, Ferreira AR, Dechene J, Azim HA, Desir J, Delbaere A, t'Kint de Roodenbeke MD, de Azambuja E, Ignatiadis M, Demeestere I. Reproductive potential and performance of fertility preservation strategies in BRCA-mutated breast cancer patients. Ann Oncol 2019; 29:237-243. [PMID: 29045555 DOI: 10.1093/annonc/mdx639] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [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: 12/17/2022] Open
Abstract
Background Preclinical evidence suggests a possible negative impact of deleterious BRCA mutations on female fertility. However, limited and rather conflicting clinical data are available. This study assessed the reproductive potential and performance of fertility preservation strategies in BRCA-mutated breast cancer patients. Patients and methods This was a retrospective analysis of two prospective studies investigating oocyte cryopreservation and ovarian tissue cryopreservation in newly diagnosed early breast cancer patients. In the current analysis, baseline anti-Mullerian hormone (AMH) and performance of cryopreservation strategies were compared between patients with or without germline deleterious BRCA mutations. Results Out of 156 patients included, 101 had known BRCA status of whom 29 (18.6%) were BRCA-mutated and 72 (46.1%) had no mutation. Median age in the entire cohort was 31 years [interquartile range (IQR) 28-33). Median AMH levels were 1.8 μg/l (IQR 1.0-2.7) and 2.6 µg/l (IQR 1.5-4.1) in the BRCA-positive and BRCA-negative cohorts, respectively (P = 0.109). Among patients who underwent oocyte cryopreservation (N = 29), women in the BRCA-positive cohort tended to retrieve (6.5 versus 9; P = 0.145) and to cryopreserve (3.5 versus 6; P = 0.121) less oocytes than those in the BRCA-negative cohort. Poor response rate (i.e. retrieval of ≤4 oocytes) was 40.0% and 11.1% in the BRCA-positive and BRCA-negative cohorts, respectively (P = 0.147). Among patients who underwent ovarian tissue cryopreservation (N = 72), women in the BRCA-positive cohort tended to have a numerically lower number of oocytes per fragment (0.08 versus 0.14; P = 0.193) and per square millimeter (0.33 versus 0.78; P = 0.153) than those in the BRCA-negative cohort. Two BRCA-mutated patients were transplanted after chemotherapy and one delivered at term a healthy baby. No difference between BRCA1- and BRCA2-mutated patients was observed in any of the above-mentioned outcomes. Conclusion A consistent trend for reduced reproductive potential and performance of cryopreservation strategies was observed in BRCA-mutated breast cancer patients. Independent validation of these results is needed.
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Affiliation(s)
- M Lambertini
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium.,Breast Cancer Translational Research Laboratory, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - O Goldrat
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A R Ferreira
- Hospital de Santa Maria and Instituto de Medicina Molecular, Faculdade de Medicina, Universiade de Lisboa, Lisbon, Portugal
| | - J Dechene
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - H A Azim
- Department of Internal Medicine, American University of Beirut (AUB), Beirut, Lebanon
| | - J Desir
- Medical Genetics Department, CUB-Hôpital Erasme, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A Delbaere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M-D t'Kint de Roodenbeke
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - E de Azambuja
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - M Ignatiadis
- Department of Medicine, Institut Jules Bordet and Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - I Demeestere
- Fertility Clinic, CUB-Hôpital Erasme and Research Laboratory on Human Reproduction, Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
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Ignatiadis M, McArthur H, Bailey A, Martinez JL, De Azambuja E, Metzger O, Lai C, Ponde N, Goulioti T, Daly F, Bouhlel A, Balta V, Van Dooren V, Viale G, Maetens M, Dufrane C, Nguyen Duc A, Winer E, Gelber R, Piccart M. Abstract OT3-05-02: ALEXANDRA/IMpassion030: A phase III study of standard adjuvant chemotherapy with or without atezolizumab in early triple negative breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot3-05-02] [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
Background: Triple negative breast cancer (TNBC) is a subtype with a high risk of relapse in the early disease setting. Because TNBC does not currently have specific targeted agents approved for use in the early setting it is treated primarily with chemotherapy. A growing body of evidence indicates that TNBC is more immunogenic than other subtypes of breast cancer and promising clinical activity has been reported with atezolizumab (an anti–PD-L1 antibody) in Phase 1/1b metastatic TNBC trials. Furthermore, the anti-tumor activity of PD-1/PD-L1 targeting drugs is hypothesized to be enhanced when co-administered with chemotherapy. ALEXANDRA/IMpassion030 will evaluate the efficacy and safety of atezolizumab in combination with standard adjuvant chemotherapy in early TNBC.
Methods: ALEXANDRA/IMpassion030 is a global, prospective, randomised, open-label Phase 3 trial investigating the efficacy, safety and pharmacokinetic (PK) profile of adjuvant atezolizumab plus standard chemotherapy versus chemotherapy alone in early TNBC. In total, 2300 patients diagnosed with non-metastatic operable stage II or III TNBC confirmed by central pathology review will be randomised. TumorPD-L1evaluationwill be performed centrally. Patients will be stratified by type of surgery, nodal status, and PD-L1 status. The adjuvant treatment will consist of weekly paclitaxel 80 mg/m2 for 12 weeks followed by dose dense anthracycline (epirubicin 90 mg/m2 or doxorubicin 60 mg/m2) and cyclophosphamide 600 mg/m2 for 4 doses every 2 weeks or the same chemotherapy regimen (T-EC/AC) given concomitantly with atezolizumab 840 mg every 2 weeks followed by maintenance atezolizumab 1200 mg every 3 weeks until completion of 1 year of atezolizumab. Primary end-point is invasive disease-free survival (iDFS) and secondary end-points include iDFS by PD-L1 and lymph node status, overall survival, safety, patient functioning and health related quality of life (HRQoL). Tumour tissue and blood samples will be collected for biomarker research. The first site was activated in May 4th, and approximately 430 sites are expected to be open globally in 30 countries. This trial is sponsored by Roche and conducted in partnership with the Breast International Group, Frontier Science and Technology Research Foundation, Institute Jules Bordet and Alliance Foundation Trials. Clinicaltrials.gov NCT03498716.
Citation Format: Ignatiadis M, McArthur H, Bailey A, Martinez J-L, De Azambuja E, Metzger O, Lai C, Ponde N, Goulioti T, Daly F, Bouhlel A, Balta V, Van Dooren V, Viale G, Maetens M, Dufrane C, Nguyen Duc A, Winer E, Gelber R, Piccart M. ALEXANDRA/IMpassion030: A phase III study of standard adjuvant chemotherapy with or without atezolizumab in early triple negative 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 OT3-05-02.
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Affiliation(s)
- M Ignatiadis
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - H McArthur
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - A Bailey
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - J-L Martinez
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - E De Azambuja
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - O Metzger
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - C Lai
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - N Ponde
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - T Goulioti
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - F Daly
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - A Bouhlel
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - V Balta
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - V Van Dooren
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - G Viale
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - M Maetens
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - C Dufrane
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - A Nguyen Duc
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - E Winer
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - R Gelber
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
| | - M Piccart
- Institut Jules Bordet, Brussels, Belgium; Breast International Group, Brussels, Belgium; Frontier Science Ltd, Kincraig, United Kingdom; Dana-Farber Cancer Institute, Boston; Roche, Basel, Switzerland; Alliance Foundation Trials, Boston; Istituto Europeo di Oncologia, Milan, Italy; Genentech, San Francisco; Cedars-Sinai Medical Center, Los Angeles
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Ignatiadis M, Brandao M, Maetens M, Ponde N, Martel S, Drisis S, Veys I, Mazy S, Bollue E, Neven P, Duhoux F, Chapiro J, Awada A, Besse-Hammer T, Paesmans M, Piccart M, Vuylsteke P, Sotiriou C. Neoadjuvant biomarker research study of palbociclib combined with endocrine therapy in estrogen receptor positive/HER2 negative breast cancer: The phase II NeoRHEA trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy269.181] [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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Ignatiadis M, Litière S, Rothe F, Riethdorf S, Proudhon C, Fehm T, Aalders K, Forstbauer H, Fasching P, Brain E, Vuylsteke P, Guardiola E, Lorenz R, Pantel K, Tryfonidis K, Janni W, Piccart M, Sotiriou C, Rack B, Pierga JY. Trastuzumab versus observation for HER2 nonamplified early breast cancer with circulating tumor cells (EORTC 90091-10093, BIG 1-12, Treat CTC): a randomized phase II trial. Ann Oncol 2018; 29:1777-1783. [DOI: 10.1093/annonc/mdy211] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [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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Drisis S, Flamen P, Ignatiadis M, Metens T, Chao SL, Chintinne M, Lemort M. Total choline quantification measured by 1H MR spectroscopy as early predictor of response after neoadjuvant treatment for locally advanced breast cancer: The impact of immunohistochemical status. J Magn Reson Imaging 2018; 48:982-993. [PMID: 29659077 DOI: 10.1002/jmri.26042] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 03/21/2018] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Validation of new biomarkers is essential for the early evaluation of neoadjuvant treatments. PURPOSE To determine whether measurements of total choline (tCho) by 1H spectroscopy could predict morphological or pathological complete response (pCR) of neoadjuvant treatment and whether breast cancer subgroups are related to prediction accuracy. STUDY TYPE Prospective, nonrandomized, monocentric, diagnostic study. POPULATION Sixty patients were initially included with 39 women participating in the final cohort. FIELD STRENGTH/SEQUENCE A 1.5T scanner was used for acquisition and MRS was performed using the syngo GRACE sequence. ASSESSMENT MRS and MRI examinations were performed at baseline (TP1), 24-72 hours after first chemotherapy (TP2), after the end of anthracycline treatment (TP3), and MRI only after the end of taxane treatment (TP4). Early (EMR) and late (LMR) morphological response were defined as %ΔDmax13 or %ΔDmax14, respectively. Responders were patients with %ΔDmax >30. Pathological complete response (pCR) patients achieved a residual cancer burden score of 0. STATISTICAL TESTS T-test, receiver operating characteristic (ROC) curves, multiple regression, logistic regression, one-way analysis of variance (ANOVA) analysis were used for the analysis. RESULTS At TP1 there was a significant difference between response groups for tCho1 concerning EMR prediction (P = 0.05) and pCR (P < 0.05) and for Kep 1 (P = 0.03) concerning LMR prediction. At TP2, no modification of tCho and other parameters could predict response. At TP3, ΔtCho, ΔDmax, and ΔVol could predict LMR (P < 0.05 for all parameters), pCR (P < 0.05 for all parameters), and ΔKtrans could predict only pCR (P = 0.04). Logistic regression at baseline showed the highest area under the curve (AUC) of 0.9 for prediction of pCR. The triple negative (TN) subgroup showed significantly higher tCho at baseline (P = 0.02) and higher ΔtCho levels at TP3 (P < 0.05). DATA CONCLUSION Baseline measurements of tCho in combination with clinicopathological criteria could predict non-pCR with a high AUC. Furthermore, tCho quantification for prediction of pCR was more sensitive for TN tumors. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;48:982-993.
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Affiliation(s)
| | - Patrick Flamen
- Nuclear Department, Institute Jules Bordet, Brussels, Belgium
| | | | - Thierry Metens
- Radiology Department, Erasme University Hospital, Brussels, Belgium
| | - Shih-Li Chao
- Radiology Department, Institute Jules Bordet, Brussels, Belgium
| | - Marie Chintinne
- Pathology Department, Institute Jules Bordet, Brussels, Belgium
| | - Marc Lemort
- Radiology Department, Institute Jules Bordet, Brussels, Belgium
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20
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Bareche Y, Venet D, Ignatiadis M, Aftimos P, Piccart M, Rothe F, Sotiriou C. Unravelling triple-negative breast cancer molecular heterogeneity using an integrative multiomic analysis. Ann Oncol 2018; 29:895-902. [PMID: 29365031 PMCID: PMC5913636 DOI: 10.1093/annonc/mdy024] [Citation(s) in RCA: 215] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Background Recent efforts of genome-wide gene expression profiling analyses have improved our understanding of the biological complexity and diversity of triple-negative breast cancers (TNBCs) reporting, at least six different molecular subtypes of TNBC namely Basal-like 1 (BL1), basal-like 2 (BL2), immunomodulatory (IM), mesenchymal (M), mesenchymal stem-like (MSL) and luminal androgen receptor (LAR). However, little is known regarding the potential driving molecular events within each subtype, their difference in survival and response to therapy. Further insight into the underlying genomic alterations is therefore needed. Patients and methods This study was carried out using copy-number aberrations, somatic mutations and gene expression data derived from the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) and The Cancer Genome Atlas. TNBC samples (n = 550) were classified according to Lehmann's molecular subtypes using the TNBCtype online subtyping tool (http://cbc.mc.vanderbilt.edu/tnbc/). Results Each subtype showed significant clinic-pathological characteristic differences. Using a multivariate model, IM subtype showed to be associated with a better prognosis (HR = 0.68; CI = 0.46-0.99; P = 0.043) whereas LAR subtype was associated with a worst prognosis (HR = 1.47; CI = 1.0-2.14; P = 0.046). BL1 subtype was found to be most genomically instable subtype with high TP53 mutation (92%) and copy-number deletion in genes involved in DNA repair mechanism (BRCA2, MDM2, PTEN, RB1 and TP53). LAR tumours were associated with higher mutational burden with significantly enriched mutations in PI3KCA (55%), AKT1 (13%) and CDH1 (13%) genes. M and MSL subtypes were associated with higher signature score for angiogenesis. Finally, IM showed high expression levels of immune signatures and check-point inhibitor genes such as PD1, PDL1 and CTLA4. Conclusion Our findings highlight for the first time the substantial genomic heterogeneity that characterize TNBC molecular subtypes, allowing for a better understanding of the disease biology as well as the identification of several candidate targets paving novel approaches for the development of anticancer therapeutics for TNBC.
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Affiliation(s)
- Y Bareche
- J.-C. Heuson Breast Cancer Translational Research Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - D Venet
- J.-C. Heuson Breast Cancer Translational Research Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - M Ignatiadis
- Department of Medical Oncolog, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Aftimos
- Department of Medical Oncolog, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Piccart
- Department of Medical Oncolog, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F Rothe
- J.-C. Heuson Breast Cancer Translational Research Laboratory, Université Libre de Bruxelles, Brussels, Belgium
| | - C Sotiriou
- J.-C. Heuson Breast Cancer Translational Research Laboratory, Université Libre de Bruxelles, Brussels, Belgium; Department of Medical Oncolog, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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21
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Ignatiadis M, Litiere S, Rothe F, Riethdorf S, Proudhon C, Fehm T, Aalders K, Forstbauer H, Fasching P, Brain E, Vuylsteke P, Guardiola E, Lorenz R, Pantel K, Tryfonidis K, Janni W, Piccart M, Sotiriou C, Rack B, Pierga JY. Abstract P1-13-09: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-09] [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
This abstract was withdrawn by the authors.
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Affiliation(s)
- M Ignatiadis
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - S Litiere
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - F Rothe
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - S Riethdorf
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - C Proudhon
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - T Fehm
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - K Aalders
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - H Forstbauer
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - P Fasching
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - E Brain
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - P Vuylsteke
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - E Guardiola
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - R Lorenz
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - K Pantel
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - K Tryfonidis
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - W Janni
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - M Piccart
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - C Sotiriou
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - B Rack
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
| | - J-Y Pierga
- Institut Jules Bordet, Brussels, Belgium; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University Medical Center Hamburg-Eppendorf, Center of Experimental Medicine; Circulating Biomarker Lab, SIRIC, Institut Curie; Forschungslabore der Frauenklinik des Universitätsklinikums; Haemotologic-Oncologic Practice Dres; Universitetsklinikum Erlangen; Institut Curie - Hôpital René Huguenin; CHU UCL Namur - Site Sainte-Elisabeth; Centre Hospitalier de la Dracénie; Gemeinschaftspraxis Lorenz / Hecker / Wesche; Universitaetsklinikum Ulm; Ludwig-Maximilians-Universitaet; Institut Curie
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Venet D, Rothé F, Dupont F, Maetens M, Fumagalli D, Salgado R, Bradbury I, Pusztai L, Harbeck N, Izquierdo M, de la Pena L, Ignatiadis M, de Azambuja E, Huober J, Nuciforo P, Baselga J, Piccart M, Loi S, Sotiriou C. Abstract P2-05-04: Deregulation of A-to-I RNA editing is associated with poor prognosis in HER2+ breast cancers in the neoALTTO trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-05-04] [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
A-to-I RNA editing, a post-transcriptional modification of the RNA catalyzed by the ADAR family of enzymes, is emerging as a widespread phenomenon in breast cancer (BC). A-to-I RNA editing is more frequent in the highly repetitive Alu regions but can affect both coding and non-coding regions. It has been shown to greatly impact cell functionality. In a recent report, we have shown that A-to-I RNA editing is regulated both by ADAR copy number and type I interferon response (Fumagalli et al. Cell Rep 2015). The main aim of the current study was to investigate the extent and profile of A-to-I RNA editing in HER2+ BC patients (pts) treated in the NeoALTTO trial, and to explore its impact on pathologic complete response (pCR) and survival.
Methods
Aligned RNAseq reads of sufficient quality and quantity were obtained for 252 of the 455 pts enrolled in the study, as described previously (Fumagalli et al. JAMA Oncol 2016). Editing sites from the rediPortal database were assessed. The editing level at a given site was computed by counting the number of Gs and As. Sites with coverage more than 10 were considered for further analyses. Editing in normal tissues was obtained from the GTEx project of the rediPortal database. Tumor infiltrating lymphocytes (TILs) and copy number aberrations were previously reported. Correlations between different parameters were assessed using Spearman correlations (ρ). The Mann-Whitney test was used to relate binary and numerical features. Event-free survival (EFS) analysis was performed using the Cox proportional hazard model.
Results
There was a median of 71470 edited sites per sample. As expected, mean editing per sample correlated with ADAR expression (ρ=59%, p<10-16) and ADAR copy number (ρ=54%, p<10-16). It was also correlated with the IFN-gamma driven signature (ρ=22%, p=0.0005), as well as with ESR1 gene expression (ρ=24%, p=0.0002). Neither ADAR expression nor mean editing was correlated with TILs (ρ=-0.5% and ρ=3%). No relationship between mean editing and pCR or EFS was found. The correlations between editing in NeoALTTO tumor samples and GTEx normal tissues were computed, and the median editing per sample was taken. These median correlations, ranging from 32% to 56%, were not associated with ADAR expression (ρ=-25%, p=6x10-5) nor mean editing (ρ=8%, p=0.19). Of interest, patients whose tumors showed low correlation with editing in normal tissues were associated with poor EFS (p=0.028, HR=0.56 to 0.96) suggesting that deregulation of RNA editing may impact disease progression and outcome. Similar results were obtained when the correlations were assessed between tumor samples instead of between tumor and normal samples (ρ between the two median editing: 76%; p-value survival: 0.013). The median correlations were not predictive for pCR (p=0.44). There was no interaction between editing and treatment arm.
Conclusions
Our study shows for the first time that deregulated RNA editing, as compared to editing in normal tissues, is a widespread phenomenon in HER2+ BC patients treated in the NeoALTTO trial and is associated with poor outcome. These results may provide new perspectives for the treatment of HER2+ disease by developing therapies targeting RNA editing.
Citation Format: Venet D, Rothé F, Dupont F, Maetens M, Fumagalli D, Salgado R, Bradbury I, Pusztai L, Harbeck N, Izquierdo M, de la Pena L, Ignatiadis M, de Azambuja E, Huober J, Nuciforo P, Baselga J, Piccart M, Loi S, Sotiriou C. Deregulation of A-to-I RNA editing is associated with poor prognosis in HER2+ breast cancers in the neoALTTO trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-05-04.
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Affiliation(s)
- D Venet
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - F Rothé
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - F Dupont
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - M Maetens
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - D Fumagalli
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - R Salgado
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - I Bradbury
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - L Pusztai
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - N Harbeck
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - M Izquierdo
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - L de la Pena
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - M Ignatiadis
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - E de Azambuja
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - J Huober
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - P Nuciforo
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - J Baselga
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - M Piccart
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - S Loi
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
| | - C Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast International Group - BIG aisbl, Belgium; Frontier Science Scotland, United Kingdom; Breast Medical Oncology Section, Yale Cancer Center, Yale School of Medicine, New Haven; University of Munich, Germany; Novartis Pharmaceuticals Corporation; SOLTI-Breast Cancer Research Group, Barcelona, Spain; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Breast European Adjuvant Study Team, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; University of Ulm, Germany; Molecular Oncology Laboratory, Vall d'Hebron Institute of Oncology, Barcelona, Spain; Memorial Sloan Kettering Cancer Center, New York; Peter MacCallum Cancer Center, Melbourne, Australia
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Lambertini M, Goldrat O, Ferreira A, Dechene J, Desir J, Delbaere A, de Roodenbeke MDT, De Azambuja E, Ignatiadis M, Demeestere I. Reproductive potential and performance of fertility-preserving procedures in BRCA mutation-positive (BRCA+) breast cancer (BC) patients (pts). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.073] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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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Solinas C, Ceppi M, Lambertini M, Scartozzi M, Buisseret L, Garaud S, Fumagalli D, de Azambuja E, Salgado R, Sotiriou C, Willard-Gallo K, Ignatiadis M. Tumor-infiltrating lymphocytes in patients with HER2-positive breast cancer treated with neoadjuvant chemotherapy plus trastuzumab, lapatinib or their combination: A meta-analysis of randomized controlled trials. Cancer Treat Rev 2017; 57:8-15. [DOI: 10.1016/j.ctrv.2017.04.005] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/21/2017] [Accepted: 04/23/2017] [Indexed: 01/13/2023]
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Raspé E, Coulonval K, Pita J, Paternot S, Rothé F, Twijffels L, Van Laere S, Ignatiadis M, Sotiriou C, Roger P. CDK4 phosphorylation status and corresponding gene expression profile predict sensitivity to Palbociclib. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx138.011] [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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Solinas C, Ceppi M, Lambertini M, Scartozzi M, Garaud S, Fumagalli D, De Azambuja E, Salgado R, Willard-Gallo K, Ignatiadis M. Tumor infiltrating lymphocytes in HER2-positive breast cancer patients treated with neoadjuvant chemotherapy plus trastuzumab, lapatinib or their combination: A meta-analysis of published randomized clinical trials. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx138.004] [Citation(s) in RCA: 2] [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: 11/12/2022] Open
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Ignatiadis M, Rothé F, Peeters D, Rouas G, Smeets D, Haan J, Lambrechts D, Campbell P, Piccart M, Voet T, Dirix L, Venet D, Sotiriou C. Abstract P1-01-10: Exome sequencing of circulating tumor cells in metastatic breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p1-01-10] [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
Aim: We interrogated whether Circulating Tumor Cells (CTCs) can complement metastatic biopsies for genomic analyses.
Patients and Methods: We compared single nucleotide variants (SNVs) and copy number aberrations (CNAs) identified using whole exome sequencing (WES) of DNA from frozen tumor tissue (primary/metastasis), amplified DNA from CTCs and normal DNA from 3 metastatic breast cancer (BC) patients (pts). All samples of the same patient were collected at the same timepoint. CTC isolation was performed using CellSearch and DEPArray systems followed by whole genome amplification (Ampli1 kit). WES was performed using the Illumina HiSeq2000 with 200X targeted coverage. Reads were aligned using bwa. SNVs had to be called by both Haplotype Caller (vs. reference genome) and Strelka (vs. paired normal). CNAs were determined by counting reads in 1MB windows and by comparing tumor/CTC samples with normal DNA. Pairwise concordance of CNAs profiles of different samples from the same patient was assessed using Spearman correlation (ρ). Significance of ρ differences between pts was obtained by Kruskal-Wallis test. Orthogonal validation for selected SNVs was performed.
Results: We studied 3 patients from the 3 major BC subtypes, patient (pt)1 with ER-/HER2+ BC (samples collected at diagnosis, initially metastatic disease), pt2 with triple-negative BC (samples collected 2 years from diagnosis) and pt3 with ER+/HER2- BC (samples collected 8 years from diagnosis).
We first compared tumor tissue and CTCs for SNVs. For pt1, of the 77 SNVs identified in the tumor, 51 were found on at least one of 12 CTCs samples. For pt2, of the 62 SNVs identified in the tumor, 19 were found on at least 1 of 11 CTCs samples. For pt3, of the 225 SNVs identified in the tumor, 48 were found on at least 1 of 3 CTCs samples. Interestingly, by increasing the number of CTCs analyzed, we increased the % of identified SNVs from synchronous tumor tissue. SNVs with high variant allele fraction (VAF) in tumor tissue were detected significantly more often in CTCs: 22% of the SNVs with VAFs <20% were found at least once, compared to 53% and 74% of SNVs with VAFs >20% and >40%, respectively (p=10-12, Fisher exact test).
Then, we compared tumor tissue and CTCs for CNAs. As time from diagnosis of metastatic disease to samples collection increased, we observed significantly higher heterogeneity within CTCs from the same patient (median ρ between CTCs was 86% for pt1, 84% for pt2 and 28% for pt3, p<0.01) and between CTCs and tumor tissue from the same patient (median ρ was 78% for pt1, 67% for pt2 and 21% for pt3, p<10-4). Interestingly, in pt3 one CTC was more similar to the metastasis than the other 2 (ρ of 53%, 21% and 21%). When a phylogenetic tree was constructed for pt3 by combining SNVs and CNAs data, three clones were identified: one clone with an AKT1 (E17K) and a TP53 (R248W) mutation and a 8p deletion, a second clone with the above profile plus an 8q amplification and a third clone with an AKT1 and an ESR1 (Y537N) mutation and 1p deletion. The metastasis was similar with the first clone.
Conclusions: These data suggest that tumor tissue and single CTC exome sequencing analyses provide complementary information to map tumor heterogeneity. Further validation for potential clinical applications is needed.
Citation Format: Ignatiadis M, Rothé F, Peeters D, Rouas G, Smeets D, Haan J, Lambrechts D, Campbell P, Piccart M, Voet T, Dirix L, Venet D, Sotiriou C. Exome sequencing of circulating tumor cells in metastatic breast cancer [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 P1-01-10.
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Affiliation(s)
- M Ignatiadis
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - F Rothé
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - D Peeters
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - G Rouas
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - D Smeets
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - J Haan
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - D Lambrechts
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - P Campbell
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - M Piccart
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - T Voet
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - L Dirix
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - D Venet
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
| | - C Sotiriou
- Jules Bordet Institut, Brussels, Belgium; Antwerp University Hospital, Anwerp, Belgium; KU Leuven, Leuven, Belgium; Sanger Institute, United Kingdom
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Raspe ES, Coulonval K, Pita J, Paternot S, Rothé F, Larsimont D, Van Laere S, Piccart M, Ignatiadis M, Sotiriou C, Roger PP. Abstract P6-07-02: CDK4 phosphorylation status and corresponding gene expression profile predict sensitivity to Palbociclib. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p6-07-02] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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
Although the specific CDK4/6 inhibitor PD0332991 (Palbociclib) was recently approved by the FDA to treat advanced ER+ breast tumors, there is yet no reliable sensitivity prediction tool. Cyclin D-CDK4/6 are the first CDK complexes to be activated in G1 phase in response to oncogenic pathways. They phosphorylate and inactivate the central cell cycle/tumor suppressor pRb. CDK4 activity requires its binding to a cyclin D (CCND1-3 genes) with which INK4 CDK4 inhibitors such as p16 (CDKN2A-D genes) compete. Although the assembly of the CDK4-cyclin D complexes was considered to be the main level of CDK4 activity control, we have shown that the activating T172-phosphorylation of CDK4 is actually the central rate-limiting event that initiates the cell cycle decision and signals the presence of active CDK4.
Here, using 2D-gel electrophoresis to separate the modified forms of CDK4, we found in breast cancer cell lines that only the CDK4 T172-phosphorylation correlates with the sensitivity to PD0332991. The only exception was in the rare case of combined CCNE1 amplification and CDKN2A loss wherein combination of PD0332991 with a CDK2 inhibitor is required to block entry in the cell cycle. Additionally, three types of CDK4 modification profile were identified by 2D-gel electrophoresis in 56 breast tumors. In the first profile, the phosphorylated CDK4 was undetectable as in normal breast samples despite a high KI67 index. In the second and third profiles, the CDK4 phosphorylation was detectable and its intensity was either above or below 90% of the intensity of a second yet unidentified form of CDK4, respectively. The proportions of these profiles differ among breast tumors according to their clinic-pathological characteristics, molecular subtypes and risk. Finally, we identified a 11-gene expression signature that faithfully predicted the CDK4 modification profiles of breast tumors and cell lines (concordance rates of 84% and 100% in the 56 analyzed breast tumor samples or cell lines respectively). All three CDK4 modification profiles were evaluated in a merged independent dataset of 4034 published gene expression profiles. In these 4034 patients, 70% of triple-negative tumors, 18% of HER2-positive tumors and 5% of ER-positive tumors were predicted to have the first CDK4 profile wherein CDK4 phosphorylation is undetectable and to be completely unresponsive to CDK4 inhibitors. The phosphorylated CDK4 was predicted to be the major modified form in 26% of triple-negative tumors, 48% of HER2- positive tumors and 56% of ER-positive tumors. These patients should benefit the most from treatment with CDK4 inhibitors. Therefore, prediction of the CDK4 modification profile may allow extending treatment with Palbociclib to presently ineligible patients. As tumors with the third CDK4 modification profile generally present low grade and low OncotypeDX risks, the added value of including CDK4 inhibitors in their treatment compared to surgery and hormone therapy alone is questionable.
In conclusion, we identified CDK4 phosphorylation as the most direct biomarker of CDK4 inhibitor sensitivity in breast cancer and developed a promising 11-gene based surrogate marker to guide their use in the clinic.Although the specific CDK4/6 inhibitor PD0332991 (Palbociclib) was recently approved by the FDA to treat advanced ER+ breast tumors, there is yet no reliable sensitivity prediction tool. Cyclin D-CDK4/6 are the first CDK complexes to be activated in G1 phase in response to oncogenic pathways. They phosphorylate and inactivate the central cell cycle/tumor suppressor pRb. CDK4 activity requires its binding to a cyclin D (CCND1-3 genes) with which INK4 CDK4 inhibitors such as p16 (CDKN2A-D genes) compete. Although the assembly of the CDK4-cyclin D complexes was considered to be the main level of CDK4 activity control, we have shown that the activating T172-phosphorylation of CDK4 is actually the central rate-limiting event that initiates the cell cycle decision and signals the presence of active CDK4.
Here, using 2D-gel electrophoresis to separate the modified forms of CDK4, we found in breast cancer cell lines that only the CDK4 T172-phosphorylation correlates with the sensitivity to PD0332991. The only exception was in the rare case of combined CCNE1 amplification and CDKN2A loss wherein combination of PD0332991 with a CDK2 inhibitor is required to block entry in the cell cycle. Additionally, three types of CDK4 modification profile were identified by 2D-gel electrophoresis in 56 breast tumors. In the first profile, the phosphorylated CDK4 was undetectable as in normal breast samples despite a high KI67 index. In the second and third profiles, the CDK4 phosphorylation was detectable and its intensity was either above or below 90% of the intensity of a second yet unidentified form of CDK4, respectively. The proportions of these profiles differ among breast tumors according to their clinic-pathological characteristics, molecular subtypes and risk. Finally, we identified a 11-gene expression signature that faithfully predicted the CDK4 modification profiles of breast tumors and cell lines (concordance rates of 84% and 100% in the 56 analyzed breast tumor samples or cell lines respectively). All three CDK4 modification profiles were evaluated in a merged independent dataset of 4034 published gene expression profiles. In these 4034 patients, 70% of triple-negative tumors, 18% of HER2-positive tumors and 5% of ER-positive tumors were predicted to have the first CDK4 profile wherein CDK4 phosphorylation is undetectable and to be completely unresponsive to CDK4 inhibitors. The phosphorylated CDK4 was predicted to be the major modified form in 26% of triple-negative tumors, 48% of HER2- positive tumors and 56% of ER-positive tumors. These patients should benefit the most from treatment with CDK4 inhibitors. Therefore, prediction of the CDK4 modification profile may allow extending treatment with Palbociclib to presently ineligible patients. As tumors with the third CDK4 modification profile generally present low grade and low OncotypeDX risks, the added value of including CDK4 inhibitors in their treatment compared to surgery and hormone therapy alone is questionable.
In conclusion, we identified CDK4 phosphorylation as the most direct biomarker of CDK4 inhibitor sensitivity in breast cancer and developed a promising 11-gene based surrogate marker to guide their use in the clinic.
Citation Format: Raspe ES, Coulonval K, Pita J, Paternot S, Rothé F, Larsimont D, Van Laere S, Piccart M, Ignatiadis M, Sotiriou C, Roger PP. CDK4 phosphorylation status and corresponding gene expression profile predict sensitivity to Palbociclib [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 P6-07-02.
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Affiliation(s)
- ES Raspe
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - K Coulonval
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - J Pita
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - S Paternot
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - F Rothé
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - D Larsimont
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - S Van Laere
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - M Piccart
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - M Ignatiadis
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - C Sotiriou
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
| | - PP Roger
- Université Libre de Bruxelles (ULB), Bruxelles, Belgium; Institut Jules Bordet, Bruxelles, Belgium; University of Antwerp, Antwerp, Belgium
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Sonnenblick A, Brohée S, Fumagalli D, Rothé F, Vincent D, Ignatiadis M, Desmedt C, Salgado R, Sirtaine N, Loi S, Neven P, Loibl S, Denkert C, Joensuu H, Piccart M, Sotiriou C. Integrative proteomic and gene expression analysis identify potential biomarkers for adjuvant trastuzumab resistance: analysis from the Fin-her phase III randomized trial. Oncotarget 2016; 6:30306-16. [PMID: 26358523 PMCID: PMC4745800 DOI: 10.18632/oncotarget.5080] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/21/2015] [Indexed: 01/03/2023] Open
Abstract
Trastuzumab is a remarkably effective therapy for patients with human epidermal growth factor receptor 2 (HER2) - positive breast cancer (BC). However, not all women with high levels of HER2 benefit from trastuzumab. By integrating mRNA and protein expression data from Reverse-Phase Protein Array Analysis (RPPA) in HER2-positive BC, we developed gene expression metagenes that reflect pathway activation levels. Next we assessed the ability of these metagenes to predict resistance to adjuvant trastuzumab using gene expression data from two independent datasets. 10 metagenes passed external validation (false discovery rate [fdr] < 0.05) and showed biological relevance with their pathway of origin. These metagenes were further screened for their association with trastuzumab resistance. An association with trastuzumab resistance was observed and validated only for the AnnexinA1 metagene (ANXA1). In the randomised phase III Fin-her study, tumours with low levels of the ANXA1 metagene showed a benefit from trastuzumab (multivariate: hazard ratio [HR] for distant recurrence = 0.16[95%CI 0.05–0.5]; p = 0.002; fdr = 0.03), while high expression levels of the ANXA1 metagene were associated with a lack of benefit to trastuzmab (HR = 1.29[95%CI 0.55–3.02]; p = 0.56). The association of ANXA1 with trastuzumab resistance was successfully validated in an independent series of subjects who had received trastuzumab with chemotherapy (Log Rank; p = 0.01). In conclusion, in HER2-positive BC, some proteins are associated with distinct gene expression profiles. Our findings identify the ANXA1metagene as a novel biomarker for trastuzumab resistance.
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Affiliation(s)
- Amir Sonnenblick
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sylvain Brohée
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Debora Fumagalli
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Françoise Rothé
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Delphine Vincent
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Michael Ignatiadis
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christine Desmedt
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Nicolas Sirtaine
- Pathology Dept, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sherene Loi
- Division of Cancer Medicine and Research, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia
| | - Patrick Neven
- Multidisciplinary Breast Center, KULeuven, University Hospitals, Leuven, Belgium
| | - Sibylle Loibl
- German Breast Group, Neu-Isenburg and Sana-Klinikum, Offenbach, Germany
| | - Carsten Denkert
- Institute of Pathology, Charité Hospital, Campus Mitte, German Cancer Consortium (DKTK), Berlin, Germany
| | - Heikki Joensuu
- Department of Oncology, Helsinki University Central Hospital and Helsinki University, Helsinki, Finland
| | - Martine Piccart
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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30
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Gingras I, Sonnenblick A, de Azambuja E, Paesmans M, Delaloge S, Aftimos P, Piccart MJ, Sotiriou C, Ignatiadis M, Azim HA. The current use and attitudes towards tumor genome sequencing in breast cancer. Sci Rep 2016; 6:22517. [PMID: 26931736 PMCID: PMC4773754 DOI: 10.1038/srep22517] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Accepted: 02/09/2016] [Indexed: 12/24/2022] Open
Abstract
There is increasing availability of technologies that can interrogate the genomic landscape of an individual tumor; however, their impact on daily practice remains uncertain. We conducted a 28-item survey to investigate the current attitudes towards the integration of tumor genome sequencing in breast cancer management. A link to the survey was communicated via newsletters of several oncological societies, and dedicated mailing by academic research groups. Multivariable logistic regression modeling was carried out to determine the relationship between predictors and outcomes. 215 physicians participated to the survey. The majority were medical oncologists (88%), practicing in Europe (70%) and working in academic institutions (66%). Tumor genome sequencing was requested by 82 participants (38%), of whom 21% reported low confidence in their genomic knowledge, and 56% considered tumor genome sequencing to be poorly accessible. In multivariable analysis, having time allocated to research (OR 3.37, 95% CI 1.84–6.15, p < 0.0001), working in Asia (OR 5.76, 95% CI 1.57 – 21.15, p = 0.01) and having institutional guidelines for molecular sequencing (OR 2.09, 95% 0.99–4.42, p = 0.05) were associated with a higher probability of use. In conclusion, our survey indicates that tumor genome sequencing is sometimes used, albeit not widely, in guiding management of breast cancer patients.
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Affiliation(s)
- I Gingras
- Department of Hematology and Oncology, Hôpital du Sacré-Coeur de Montréal, Montreal, Quebec, Canada
| | - A Sonnenblick
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Breast Cancer Translational Research Laboratory J. C. Heuson, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - E de Azambuja
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - M Paesmans
- Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - S Delaloge
- Department of Medical Oncology, Institut Gustave-Roussy, Villejuif, France
| | - Philippe Aftimos
- Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - M J Piccart
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - C Sotiriou
- Breast Cancer Translational Research Laboratory J. C. Heuson, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - M Ignatiadis
- Breast Cancer Translational Research Laboratory J. C. Heuson, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Medical Oncology Clinic, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
| | - H A Azim
- Department of Medicine, BrEAST Data Centre, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium.,Breast Cancer Translational Research Laboratory J. C. Heuson, Institut Jules Bordet/Université libre de Bruxelles, Brussels, Belgium
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31
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Bidard FC, Peeters D, Fehm T, Nole F, Gisbert-Criado R, Mavroudis D, Grisanti S, Generali D, Garcia-Saenz JA, Stebbing J, Caldas C, Gazzaniga P, Manso L, Zamarchi R, Fernandez de Lascoiti A, de Mattos-Arruda L, Ignatiadis M, van Laere SJ, Meier-Stiegen F, Sandri MT, Vidal-Martinez J, Politaki E, Consoli F, Bottini A, Diaz-Rubio E, Krell J, Dawson SJ, Raimondi C, Rutten A, Janni W, Munzone E, Carañana V, Agelaki S, Almici C, Dirix L, Solomayer E, Zorzino L, Reis-Filho JS, Squifflet P, Pantel K, Beije N, Sleijfers S, Pierga JY, Michiels S. Abstract P2-08-08: Circulating tumor cells count-based nomograms to predict survival of metastatic breast cancer patients: Results from the European pooled analysis. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-08-08] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The European Pooled Analysis of CTC (EPAC) in metastatic breast cancer, based on 1,944 individual data from patients with various tumor types and clinical settings (Bidard et al, Lancet Oncol 2014), has established CTC count (CellSearch) at baseline and during therapy as a level of evidence 1 independent prognostic biomarker and demonstrated its superiority over serum blood markers. As part of the study pre-planned objectives, we sought to establish nomograms allowing accurate individual survival predictions.
Methods: Using individual data from 17 centers, we built simplified multivariate prognostic models taking into account the independent prognostic clinico-pathological (CP) characteristics including CTC count, dichotomized using the 5CTC/7.5ml threshold, at baseline and at 3-5 weeks after the start of a new treatment regimen, and derived nomograms for progression-free survival (PFS) and overall survival (OS) prediction at baseline and after 3-5 weeks of treatment. We report here the internal validation of these nomograms. Discrimination of the models was assessed using the c-index estimated by a jackknife procedure and the calibration was visually assessed through 10-fold crossvalidated calibration plots at 1,2,3 years for OS and 1,2 years for PFS.
Results: Multivariate models at baseline for PFS and OS were fitted on 1501 and 568 individual patient data with CTC count at baseline and CTC count at baseline and after 3-5 weeks, respectively. Models include tumor subtype, the number of previous chemotherapy lines (0/1/≥2), PS, age (<=50/>50-65/>65 years), metastasis-free intervals (0/>0-3/>3 years), metastatic sites (liver and CNS) and CTC count at baseline and eventually at 3-5 weeks of treatment. The C-index increased from 0.722 to 0.755 (increase in C-index:0.033, 95% CI [0.019;0.045]) when adding baseline CTC to the CP only model for OS (n=1501). For those patients with CTC values at 3-5 weeks (n=568), there was an additional increase in the C-index when adding CTC at 3-5 weeks to a model with already CP and baseline CTC from 0.731 to 0.743 (increase in C-index 0.013, 95% CI [-0.004;0.025]). The model with CP and baseline CTC counts showed a good calibration for OS at 1,2,3 years and the model with CP, baseline CTC and CTC count at 3-5 weeks a moderately good calibration. Similar results were obtained for PFS.
Conclusion: From the largest database with individual CTC data, we were able to build PFS and OS survival nomograms, with satisfactory discrimination and calibration. Our planned next step is to validate the nomogram in an additional cohort.
Citation Format: Bidard F-C, Peeters D, Fehm T, Nole F, Gisbert-Criado R, Mavroudis D, Grisanti S, Generali D, Garcia-Saenz JA, Stebbing J, Caldas C, Gazzaniga P, Manso L, Zamarchi R, Fernandez de Lascoiti A, de Mattos-Arruda L, Ignatiadis M, van Laere SJ, Meier-Stiegen F, Sandri M-T, Vidal-Martinez J, Politaki E, Consoli F, Bottini A, Diaz-Rubio E, Krell J, Dawson S-J, Raimondi C, Rutten A, Janni W, Munzone E, Carañana V, Agelaki S, Almici C, Dirix L, Solomayer E, Zorzino L, Reis-Filho JS, Squifflet P, Pantel K, Beije N, Sleijfers S, Pierga J-Y, Michiels S. Circulating tumor cells count-based nomograms to predict survival of metastatic breast cancer patients: Results from the European pooled analysis. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-08-08.
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Affiliation(s)
- F-C Bidard
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - D Peeters
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - T Fehm
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - F Nole
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - R Gisbert-Criado
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - D Mavroudis
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Grisanti
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - D Generali
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - JA Garcia-Saenz
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J Stebbing
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - C Caldas
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - P Gazzaniga
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L Manso
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - R Zamarchi
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - A Fernandez de Lascoiti
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L de Mattos-Arruda
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - M Ignatiadis
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - SJ van Laere
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - F Meier-Stiegen
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - M-T Sandri
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J Vidal-Martinez
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Politaki
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - F Consoli
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - A Bottini
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Diaz-Rubio
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J Krell
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S-J Dawson
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - C Raimondi
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - A Rutten
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - W Janni
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Munzone
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - V Carañana
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Agelaki
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - C Almici
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L Dirix
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - E Solomayer
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - L Zorzino
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - JS Reis-Filho
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - P Squifflet
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - K Pantel
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - N Beije
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Sleijfers
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - J-Y Pierga
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
| | - S Michiels
- Institut Curie, Paris, France; University of Antwerp, Antwerp, Belgium; Heinrich Heine University Düsseldorf, Düseeldorf, Germany; European Institute of Oncology, Milano, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Azienda Spedali Civili, Brescia, Italy; AZ Istituti Ospitalieri di Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College of Medicine, London, United Kingdom; Cancer Research UK Cambridge Institute, Cambridge, United Kingdom; Sapienza University, Roma, Italy; Hospital 12 de Octubre, Madrid, Spain; IOV-IRCCS, Padova, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University of Ulm, Ulm, Germany; Saarland University, Homburg, Germany; Memorial Sloan Kettering Cancer Center, New-York; University Medical Center Hamburg-Eppendorf, Hamburg, Germany; International Drug Development Institute - IDDI, Louvain La Neuve, Belgi
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Drisis S, Metens T, Ignatiadis M, Stathopoulos K, Chao SL, Lemort M. Quantitative DCE-MRI for prediction of pathological complete response following neoadjuvant treatment for locally advanced breast cancer: the impact of breast cancer subtypes on the diagnostic accuracy. Eur Radiol 2015; 26:1474-84. [DOI: 10.1007/s00330-015-3948-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 06/27/2015] [Accepted: 07/27/2015] [Indexed: 10/23/2022]
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Trapp EK, Rack B, Messina C, Müller V, Fehm T, Janni W, Sotiriou C, Pierga JY, Piccart M, Ignatiadis M. Die Studie TREAT CTC: Ein therapeutischer Ansatz zur Elimination von zirkulierenden Tumorzellen (CTCS) beim primären Mammakarzinom. Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555087] [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] Open
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34
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Ignatiadis M, Buyse M, Sotiriou C. St Gallen International Expert Consensus on the primary therapy of early breast cancer: an invaluable tool for physicians and scientists. Ann Oncol 2015; 26:1519-20. [PMID: 26063634 DOI: 10.1093/annonc/mdv259] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- M Ignatiadis
- Department of Medical Oncology and Breast Cancer Translational Research Laboratory, J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - M Buyse
- International Drug Development Institute, Louvain-la-Neuve, Belgium
| | - C Sotiriou
- Department of Medical Oncology and Breast Cancer Translational Research Laboratory, J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
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Salgado R, Denkert C, Demaria S, Sirtaine N, Klauschen F, Pruneri G, Wienert S, Van den Eynden G, Baehner FL, Penault-Llorca F, Perez EA, Thompson EA, Symmans WF, Richardson AL, Brock J, Criscitiello C, Bailey H, Ignatiadis M, Floris G, Sparano J, Kos Z, Nielsen T, Rimm DL, Allison KH, Reis-Filho JS, Loibl S, Sotiriou C, Viale G, Badve S, Adams S, Willard-Gallo K, Loi S. The evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer: recommendations by an International TILs Working Group 2014. Ann Oncol 2015; 26:259-271. [PMID: 25214542 PMCID: PMC6267863 DOI: 10.1093/annonc/mdu450 10.1097/pai.0000000000000594] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2014] [Accepted: 08/28/2014] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The morphological evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer (BC) is gaining momentum as evidence strengthens for the clinical relevance of this immunological biomarker. Accumulating evidence suggests that the extent of lymphocytic infiltration in tumor tissue can be assessed as a major parameter by evaluation of hematoxylin and eosin (H&E)-stained tumor sections. TILs have been shown to provide prognostic and potentially predictive value, particularly in triple-negative and human epidermal growth factor receptor 2-overexpressing BC. DESIGN A standardized methodology for evaluating TILs is now needed as a prerequisite for integrating this parameter in standard histopathological practice, in a research setting as well as in clinical trials. This article reviews current data on the clinical validity and utility of TILs in BC in an effort to foster better knowledge and insight in this rapidly evolving field, and to develop a standardized methodology for visual assessment on H&E sections, acknowledging the future potential of molecular/multiplexed approaches. CONCLUSIONS The methodology provided is sufficiently detailed to offer a uniformly applied, pragmatic starting point and improve consistency and reproducibility in the measurement of TILs for future studies.
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Affiliation(s)
- R Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - C Denkert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - S Demaria
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - N Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F Klauschen
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Pruneri
- European Institute of Oncology (IEO) and University of Milan, Milan, Italy
| | - S Wienert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Van den Eynden
- Department of Pathology GZA, TCRU Hospitals and CORE Antwerp University, Antwerp, Belgium
| | - F L Baehner
- Genomic Health, Inc., Redwood City, USA University of California San Francisco, San Francisco, USA
| | - F Penault-Llorca
- Clermont-Ferrand Biopathology, University of Auvergne, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| | - E A Perez
- Division of Haematology/Medical Oncology and
| | - E A Thompson
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville
| | - W F Symmans
- Department of Pathology, The UT M.D. Anderson Cancer Center, Boston
| | - A L Richardson
- Department of Pathology, Brigham and Women's Hospital, Boston Department of Cancer Biology, Dana Farber Cancer Institute, Boston
| | - J Brock
- Department of Cancer Biology, Dana Farber Cancer Institute, Boston Department of Cancer Biology, Harvard Medical School, Boston, USA
| | | | - H Bailey
- Genomic Health, Inc., Redwood City, USA
| | - M Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - J Sparano
- Department of Medicine, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein Medical Center, Bronx, USA
| | - Z Kos
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - T Nielsen
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - D L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven
| | - K H Allison
- Department of Pathology, Stanford University Medical Centre, Stanford
| | - J S Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - C Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - S Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - S Adams
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - K Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Loi
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia
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Abstract
Next-generation sequencing studies have provided further evidence to support the notion that cancer is a disease characterized by Darwinian evolution. Today, we often fail to capture this evolution and treatment decisions, even in the metastatic setting, are often based on analysis of primary tumor diagnosed years ago. Currently, this is considered a major reason for treatment failures in cancer care. Recent technological advances in the detection and characterization of circulating tumor cells and circulating tumor DNA might address this and allow for treatment tailoring based on real-time monitoring of tumor evolution. In this review, we summarize the most important recent findings in the field, focusing on challenges and opportunities in moving these tools forward in clinical practice.
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Affiliation(s)
- M Ignatiadis
- Department of Medical Oncology and Breast Cancer Translational Research Laboratory, J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
| | - S-J Dawson
- Division of Cancer Medicine; Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Salgado R, Denkert C, Demaria S, Sirtaine N, Klauschen F, Pruneri G, Wienert S, Van den Eynden G, Baehner FL, Penault-Llorca F, Perez EA, Thompson EA, Symmans WF, Richardson AL, Brock J, Criscitiello C, Bailey H, Ignatiadis M, Floris G, Sparano J, Kos Z, Nielsen T, Rimm DL, Allison KH, Reis-Filho JS, Loibl S, Sotiriou C, Viale G, Badve S, Adams S, Willard-Gallo K, Loi S. The evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer: recommendations by an International TILs Working Group 2014. Ann Oncol 2014; 26:259-71. [PMID: 25214542 DOI: 10.1093/annonc/mdu450] [Citation(s) in RCA: 1879] [Impact Index Per Article: 187.9] [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: 12/11/2022] Open
Abstract
BACKGROUND The morphological evaluation of tumor-infiltrating lymphocytes (TILs) in breast cancer (BC) is gaining momentum as evidence strengthens for the clinical relevance of this immunological biomarker. Accumulating evidence suggests that the extent of lymphocytic infiltration in tumor tissue can be assessed as a major parameter by evaluation of hematoxylin and eosin (H&E)-stained tumor sections. TILs have been shown to provide prognostic and potentially predictive value, particularly in triple-negative and human epidermal growth factor receptor 2-overexpressing BC. DESIGN A standardized methodology for evaluating TILs is now needed as a prerequisite for integrating this parameter in standard histopathological practice, in a research setting as well as in clinical trials. This article reviews current data on the clinical validity and utility of TILs in BC in an effort to foster better knowledge and insight in this rapidly evolving field, and to develop a standardized methodology for visual assessment on H&E sections, acknowledging the future potential of molecular/multiplexed approaches. CONCLUSIONS The methodology provided is sufficiently detailed to offer a uniformly applied, pragmatic starting point and improve consistency and reproducibility in the measurement of TILs for future studies.
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Affiliation(s)
- R Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - C Denkert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - S Demaria
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - N Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F Klauschen
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Pruneri
- European Institute of Oncology (IEO) and University of Milan, Milan, Italy
| | - S Wienert
- Institute of Pathology, Charité -University Hospital, Berlin, Germany
| | - G Van den Eynden
- Department of Pathology GZA, TCRU Hospitals and CORE Antwerp University, Antwerp, Belgium
| | - F L Baehner
- Genomic Health, Inc., Redwood City, USA University of California San Francisco, San Francisco, USA
| | - F Penault-Llorca
- Clermont-Ferrand Biopathology, University of Auvergne, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
| | - E A Perez
- Division of Haematology/Medical Oncology and
| | - E A Thompson
- Department of Cancer Biology, Mayo Clinic Comprehensive Cancer Center, Mayo Clinic, Jacksonville
| | - W F Symmans
- Department of Pathology, The UT M.D. Anderson Cancer Center, Boston
| | - A L Richardson
- Department of Pathology, Brigham and Women's Hospital, Boston Department of Cancer Biology, Dana Farber Cancer Institute, Boston
| | - J Brock
- Department of Cancer Biology, Dana Farber Cancer Institute, Boston Department of Cancer Biology, Harvard Medical School, Boston, USA
| | | | - H Bailey
- Genomic Health, Inc., Redwood City, USA
| | - M Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - J Sparano
- Department of Medicine, Department of Obstetrics and Gynecology and Women's Health, Albert Einstein Medical Center, Bronx, USA
| | - Z Kos
- Laboratory Medicine Program, University Health Network, University of Toronto, Toronto
| | - T Nielsen
- Department of Pathology and Laboratory Medicine, Genetic Pathology Evaluation Centre, University of British Columbia, Vancouver, Canada
| | - D L Rimm
- Department of Pathology, Yale University School of Medicine, New Haven
| | - K H Allison
- Department of Pathology, Stanford University Medical Centre, Stanford
| | - J S Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - C Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels
| | - G Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - S Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - S Adams
- Perlmutter Cancer Center, New York University Medical School, New York, USA
| | - K Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Loi
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre, University of Melbourne, Victoria, Australia
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Ignatiadis M. Circulating Tumour Cells: Isolation, Enrichment and Clinical Value in Breast Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu312.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Rothé F, Laes JF, Lambrechts D, Smeets D, Vincent D, Maetens M, Fumagalli D, Michiels S, Drisis S, Moerman C, Detiffe JP, Larsimont D, Awada A, Piccart M, Sotiriou C, Ignatiadis M. Plasma circulating tumor DNA as an alternative to metastatic biopsies for mutational analysis in breast cancer. Ann Oncol 2014; 25:1959-1965. [PMID: 25185240 DOI: 10.1093/annonc/mdu288] [Citation(s) in RCA: 178] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Molecular screening programs use next-generation sequencing (NGS) of cancer gene panels to analyze metastatic biopsies. We interrogated whether plasma could be used as an alternative to metastatic biopsies. PATIENTS AND METHODS The Ion AmpliSeq™ Cancer Hotspot Panel v2 (Ion Torrent), covering 2800 COSMIC mutations from 50 cancer genes was used to analyze 69 tumor (primary/metastases) and 31 plasma samples from 17 metastatic breast cancer patients. The targeted coverage for tumor DNA was ×1000 and for plasma cell-free DNA ×25 000. Whole blood normal DNA was used to exclude germline variants. The Illumina technology was used to confirm observed mutations. RESULTS Evaluable NGS results were obtained for 60 tumor and 31 plasma samples from 17 patients. When tumor samples were analyzed, 12 of 17 (71%, 95% confidence interval (CI) 44% to 90%) patients had ≥1 mutation (median 1 mutation per patient, range 0-2 mutations) in either p53, PIK3CA, PTEN, AKT1 or IDH2 gene. When plasma samples were analyzed, 12 of 17 (71%, 95% CI: 44-90%) patients had ≥1 mutation (median 1 mutation per patient, range 0-2 mutations) in either p53, PIK3CA, PTEN, AKT1, IDH2 and SMAD4. All mutations were confirmed. When we focused on tumor and plasma samples collected at the same time-point, we observed that, in four patients, no mutation was identified in either tumor or plasma; in nine patients, the same mutations was identified in tumor and plasma; in two patients, a mutation was identified in tumor but not in plasma; in two patients, a mutation was identified in plasma but not in tumor. Thus, in 13 of 17 (76%, 95% CI 50% to 93%) patients, tumor and plasma provided concordant results whereas in 4 of 17 (24%, 95% CI 7% to 50%) patients, the results were discordant, providing complementary information. CONCLUSION Plasma can be prospectively tested as an alternative to metastatic biopsies in molecular screening programs.
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Affiliation(s)
- F Rothé
- Breast Cancer Translational Research Laboratory J.C. Heuson, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
| | - J-F Laes
- OncoDNA, Gosselies, KU Leuven, Leuven
| | - D Lambrechts
- Laboratory of Translational Genetics, KU Leuven, Leuven; Vesalius Research Center, VIB, Leuven, Belgium
| | - D Smeets
- Laboratory of Translational Genetics, KU Leuven, Leuven; Vesalius Research Center, VIB, Leuven, Belgium
| | - D Vincent
- Breast Cancer Translational Research Laboratory J.C. Heuson, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
| | - M Maetens
- Breast Cancer Translational Research Laboratory J.C. Heuson, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
| | - D Fumagalli
- Breast Cancer Translational Research Laboratory J.C. Heuson, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
| | - S Michiels
- Department of Biostatistic and Epidemiology, Gustave Roussy, Univ. Paris-Sud, Villejuif, France
| | - S Drisis
- Department of Radiology, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
| | - C Moerman
- Department of Radiology, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
| | | | - D Larsimont
- Department of Pathology, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
| | - A Awada
- Department of Medical Oncology, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
| | - M Piccart
- Department of Medical Oncology, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
| | - C Sotiriou
- Breast Cancer Translational Research Laboratory J.C. Heuson, Université Libre de Bruxelles, Institut Jules Bordet, Brussels; Department of Medical Oncology, Université Libre de Bruxelles, Institut Jules Bordet, Brussels.
| | - M Ignatiadis
- Breast Cancer Translational Research Laboratory J.C. Heuson, Université Libre de Bruxelles, Institut Jules Bordet, Brussels; Department of Medical Oncology, Université Libre de Bruxelles, Institut Jules Bordet, Brussels
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Rack B, Messina C, Litiere S, Dittrich C, Mavroudis D, Kong A, Sotiriou C, Pierga JY, Piccart M, Ignatiadis M. Abstract OT1-3-02: The treat CTC trial – A new approach targeting circulating tumor cells (CTC) in early breast cancer (EBC). Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-ot1-3-02] [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
Background:
The presence of CTC in metastatic BC is associated with an impaired prognosis. Recent data show a reduced disease-free survival and increased risk of death in the presence of CTC in EBC. Therefore, patients with persisting CTC after (neo)adjuvant chemotherapy might benefit from additional systemic treatment.
Recent data have reinforced the hypothesis that trastuzumab can eliminate tumor cells by antibody dependent cell cytotoxicity (ADCC) or other immune mechanisms. Preclinical data have provided evidence that the benefit of trastuzumab may be associated with targeting cancer stem cells in a HER2 independent model (Ithimakin et al Cancer Res 2013). Trastuzumab eliminated CTC, irrespective of the HER2 status of the primary tumor and of CTC and this was associated with reduced relapses(Georgoulias et al Ann Oncol 2012).
Trial Design:
Treat CTC trial is a multicenter European randomized phase II trial, sponsored by the EORTC and run under the BIG umbrella. It will assess the efficacy of trastuzumab in eliminating persisting CTC after the completion of (neo)adjuvant chemotherapy and surgery in patients with HER-2-negative EBC. Eligible patients will be randomized in a 1:1 ratio to either 6 cycles of trastuzumab or observation. Patients’ peripheral blood will be tested again for CTC after 18 weeks.
Main Eligibility criteria:
- Adequately excised HER2-negative EBC
- Evidence of CTC detection using the CellSearch technology after completion of (neo)adjuvant chemotherapy
- Completion of adjuvant chemotherapy for node-positive disease or neoadjuvant chemotherapy with residual invasive disease in breast or lymph nodes (no complete pathological response)
- Histological Grade > 1 and primary tumor size > 1 cm
Specific aims:
The primaryobjective of the trial is to evaluate whether trastuzumab decreases the detection rate of CTC in patients with HER2-negative EBC by comparing the trastuzumab treated arm to the observation arm. Furthermore, clinical outcomes as measured by Recurrence Free Interval (RFI), Invasive Disease Free Survival (IDFS), Disease Free Survival (DFS) and Overall Survival (OS)) between the trastuzumab and observation arms will be compared.
Present accrual and target accrual:
Treat CTC started patient screening in April 2013 in Belgium. It is estimated that 2175 women will be registered to include 174 patients eligible for randomization. Accrual is expected to be completed in 2 years.
Methods:
The primary test will be a one-sided test to compare the trastuzumab arm to the observation arm for the CTC detection rate at week 18 (superiority test). The comparison for the primary endpoint will be performed on the intention-to-treat population using a one-sided test with overall a of 0.1. The odds ratio and its confidence interval will be estimated using a logistic regression model. The comparison of RFI, IDFS, DFS and OS will be done using a two-sided test in a proportional hazards model for cause specific hazard, adjusted for the stratification factors.
Perspectives:
Given the prognostic relevance of CTC in BC, the Treat CTC trial will be the first multicenter, randomized trial in which CTC are used to guide treatment decisions in EBC. The results of this trial will help to clarify the clinical utility of CTCs in early disease.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr OT1-3-02.
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Affiliation(s)
- B Rack
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - C Messina
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Litiere
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - C Dittrich
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - D Mavroudis
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - A Kong
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - C Sotiriou
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - J-Y Pierga
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Piccart
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Ignatiadis
- Ludwig-Maximilians-University, Munich, Germany; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Kaiser Franz Josef Spital, Vienna, Austria; University General Hospital Heraklion, Heraklion, Greece; Oxford University Hospitals NHS Trust - Churchill Hospital, Oxford, United Kingdom; Institut Curie, Paris, France; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
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Peeters DJE, Kumar P, Van der Aa N, Rothé F, Theunis K, Op de Beeck K, Van Laere SJ, Vermeulen PB, van Dam PA, Vincent D, Desmedt C, Sotiriou C, Dirix LY, Ignatiadis M, Voet T. Abstract P1-04-03: Genome-wide analysis of copy number variations and mutation profiles of single circulating tumour cells using massively parallel paired-end sequencing. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-p1-04-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION
Recent advances in single cell isolation techniques and next generation sequencing (NGS) have paved the way for the genome-wide molecular analysis of individual circulating tumour cells (CTCs) in patients with metastatic carcinomas. Here we present the results of a pilot study evaluating the feasibility and reliability of NGS of single CTC from whole blood samples.
MATERIALS & METHODS
Single cells of the human breast cancer cell line HCC38 were harvested from spiked blood samples in a semi-automated workflow consisting of immunomagnetic enrichment using the CellSearch system and dielectrophoretic cell sorting using the DEPArray system. DNA was isolated and amplified using the Ampli1 whole genome amplification (WGA) kit and subjected to low-coverage genome-wide paired-end sequencing for copy number variation (CNV) analysis and targeted re-sequencing of 200 cancer-related genes for somatic mutation analysis.
RESULTS
Single-cell WGA products of four HCC38 cells were subjected to whole genome sequencing for CNV analysis. Average coverage depth was 0,68x. At a binning window of 50 kb, detection results of CNVs in single-cell samples were highly consistent (>81% copy number concordance per bin genome wide) with CNV profiles from non-amplified multi-cell samples of the same cell line. We could demonstrate that part of the discordance was due to the acquisition of novel DNA-rearrangements in the single cells. Three of the single-cell WGA products were additionally subjected to targeted re-sequencing for mutation analysis of 200 selected genes, of which the analysis is currently ongoing.
DISCUSSION
Our study demonstrates the feasibility of a comprehensive genome-wide CNV analysis and targeted mutation analysis using NGS of single tumour cells isolated from whole blood samples in a highly automated isolation workflow. This approach provides a robust framework for the study of intercellular heterogeneity within the CTC population in blood samples of patients with (metastatic) breast cancer. In addition, our results document the extent of WGA-induced bias of a recently commercialized PCR-based WGA kit.
These authors contributed equally to the data presented in this abstract.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P1-04-03.
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Affiliation(s)
- DJE Peeters
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - P Kumar
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - N Van der Aa
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - F Rothé
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - K Theunis
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - K Op de Beeck
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - SJ Van Laere
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - PB Vermeulen
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - PA van Dam
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - D Vincent
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - C Desmedt
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - C Sotiriou
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - LY Dirix
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - M Ignatiadis
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
| | - T Voet
- Translational Cancer Research Unit, Oncology Center, GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University of Antwerp/Antwerp University Hospital, Antwerp, Belgium; Laboratory of Reproductive Genomics, KU Leuven, Leuven, Belgium; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Single-Cell Genomics Centre, Wellcome Trust Sanger Institute, Hinxton-Cambridge, United Kingdom; These authors contributed equally to the data presented in this abstract; Joint Senior Authors
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Bidard FC, Peeters D, Fehm T, Nole F, Gisbert-Criado R, Mavrudis D, Grisanti S, Generali D, Garcia-Saenz JA, Stebbing J, Caldas C, Gazzaniga P, Manso L, Zamarchi R, Antelo ML, de Mattos-Arruda L, Ignatiadis M, Lebofsky R, van Laere SJ, Meier-Stiegen F, Sandri MT, Vidal-Martinez J, Politaki E, Consoli F, Bottini A, Diaz-Rubio E, Krell J, Dawson SJ, Raimondi C, Rutten A, Janni W, Munzone E, Caranana V, Agelaki S, Almici C, Dirix L, Solomayer E, Zorzino L, Johannes H, Reis-Filho J, Pantel K, Pierga JY, Michiels S. Abstract PD6-5: Pooled analysis of circulating tumor cells in metastatic breast cancer: Findings from 1944 individual patients data. Cancer Res 2013. [DOI: 10.1158/0008-5472.sabcs13-pd6-5] [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: Clinical validity of CTCs (CellSearch®) in metastatic breast cancer (MBC) patients has previously been assessed in studies with limited statistical power. We aimed to pool all European studies to obtain high-level evidence on the prognostic value of CTCs, to investigate their effects across different clinico-pathological characteristics and therapies and to further validate the MD Anderson/Institut Curie/Fox Chase CTC-based prognostic nomogram established in first-line treated MBC patients (Giordano et al, Clin Cancer Res 2013).
Material and methods: Methods were predefined in a written protocol. In December 2012, we searched for eligible studies that accrued patients in 2003-2012. We contacted all European laboratories using CellSearch®. We used likelihood ratio tests (LR) in Cox regression models stratified by study to assess the independent prognostic value of CTC when added to a clinicopathological (CP) model for progression-free (PFS) and overall survival (OS). Landmark analyses were used to assess the prognostic effect of early changes in CTC. The CTC-based nomogram (http://cancernomograms.com/CTCOnline.html) score was retrieved for every patient; we calculated C-indices, drew calibration plots and Kaplan-Meier curves according to quintiles of the nomogram score.
Results: We collected individual data of 1944 MBC patients, from 20 different studies (some unpublished), from 17 centers in 7 European countries. We observed 1507 PFS events and 929 deaths. Baseline CTC count was significantly associated with several patient characteristics, such as performance status (PS, p<10-4), synchronous metastasis (p<10- 2) tumor subtype (p<10-4), liver & bone metastases (p<10-4), CEA & CA15-3 levels (p<10-4). The CP model for OS included PS, MBC subtypes, number of previous lines of treatment, patient's age, metastasis-free interval, metastatic sites (p<0.01 for all). In a multivariate analysis containing the CP model parameters and CTC count at baseline, elevated CTC count (≥5) was a significant independent predictor of OS (n = 1444, HR = 2.7, 95%CI [2.2-3.2], LR p<10-4). Baseline serum markers added either no or marginal effect to the CP plus baseline CTC model for OS. In contrast, early changes in CTC status at week 3-5 significantly added prognostic information for OS to the model with CP factors and baseline CTC+ (n = 569, HR = 1.8 [2.2-3.2], LR p<0.001). In the population of interest (MBC treated by first line chemotherapy, n = 402 patients, 176 deaths), the CTC-based nomogram exhibited a good C-index for OS (0.69), was well calibrated and showed clear separation of the survival curves. Additional results, including subgroup analyses by tumor subtype and treatments will be presented at the meeting.
Conclusions: This pooled analysis is the largest study ever reported on CTC in MBC, with a previously unreached statistical power. It provides a clear level-of-evidence 1 on the independent prognostic value of CTCs before and during treatment in MBC. Also, the CTC-based prognostic nomogram is independently validated.
Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr PD6-5.
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Affiliation(s)
- F-C Bidard
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - D Peeters
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - T Fehm
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - F Nole
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - R Gisbert-Criado
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - D Mavrudis
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - S Grisanti
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - D Generali
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - JA Garcia-Saenz
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J Stebbing
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - C Caldas
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - P Gazzaniga
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - L Manso
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - R Zamarchi
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - M-L Antelo
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - L de Mattos-Arruda
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - M Ignatiadis
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - R Lebofsky
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - SJ van Laere
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - F Meier-Stiegen
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - M-T Sandri
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J Vidal-Martinez
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - E Politaki
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - F Consoli
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - A Bottini
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - E Diaz-Rubio
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J Krell
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - S-J Dawson
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - C Raimondi
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - A Rutten
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - W Janni
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - E Munzone
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - V Caranana
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - S Agelaki
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - C Almici
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - L Dirix
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - E Solomayer
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - L Zorzino
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - H Johannes
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J Reis-Filho
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - K Pantel
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - J-Y Pierga
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
| | - S Michiels
- Institut Curie, Paris, France; GZA Hospitals Sint-Augustinus, Antwerp, Belgium; University Medical Center, Duesseldorf, Germany; European Institute of Oncology, Milan, Italy; Hospital Arnau de Vilanova, Valencia, Spain; University Hospital of Heraklion, Heraklion, Greece; Public Hospitals of Brescia, Brescia, Italy; Hospital Institute of Cremona, Cremona, Italy; Hospital Clinico San Carlos, Madrid, Spain; Imperial College, London, United Kingdom; University of Cambridge, Cambridge, United Kingdom; Sapienza University of Rome, Rome, Italy; University Hospital 12 de Octubre, Madrid, Spain; Venetian Institute of Oncology, Padua, Italy; Hospital de Navarra, Pamplona, Spain; Val d'Hebron Institute of Oncology, Barcelona, Spain; Institut Jules Bordet, Brussels, Belgium; University Medical Center, Tuebingen, Germany; University Medical Center, Ulm, Germany; University of Saarland, Homburg, Germany; IDDI - International Drug Development Institute, Louvain-La-Neuve, Belgium; Memorial Sloan-Kettering Cancer Center, Ne
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Drisis S, Ignatiadis M, Stathopoulos K, Chao S, Lemort M. MC13-0029 Diffusion Weighted Imaging (DWI) as a biomarker for evaluation of neoadjuvant treatement in localy advanced breast cancer. Eur J Cancer 2013. [DOI: 10.1016/s0959-8049(13)70143-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Metzger-Filho O, Michiels S, Bertucci F, Catteau A, Salgado R, Galant C, Fumagalli D, Singhal SK, Desmedt C, Ignatiadis M, Haussy S, Finetti P, Birnbaum D, Saini KS, Berlière M, Veys I, de Azambuja E, Bozovic I, Peyro-Saint-Paul H, Larsimont D, Piccart M, Sotiriou C. Genomic grade adds prognostic value in invasive lobular carcinoma. Ann Oncol 2013; 24:377-384. [PMID: 23028037 DOI: 10.1093/annonc/mds280] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/07/2023] Open
Abstract
BACKGROUND The prognostic value of histologic grade (HG) in invasive lobular carcinoma (ILC) remains uncertain, and most ILC tumors are graded as HG2. Genomic grade (GG) is a 97-gene signature that improves the prognostic value of HG. This study evaluates whether GG may overcome the limitations of HG in ILC. METHODS Gene expression data were generated from frozen tumor samples, and GG calculated according to the expression of 97 genes. The prognostic value of GG was assessed in a stratified Cox regression model for invasive disease-free survival (IDFS) and overall survival (OS). RESULTS A total of 166 patients were classified by GG. HG classified 33 (20%) tumors as HG1, 120 (73%) as HG2 and 12 (7%) as HG3. GG classified 106 (64%) tumors as GG low (GG1), 29 (17%) as GG high (GG3) and 31 (19%) as equivocal (cases not classified as GG1 or GG3). The median follow-up time was 6.5 years. In multivariate analyses, GG was associated with IDFS [HR(GG3 vs GG1) 5.6 (2.1-15.3); P < 0.001] and OS [HR(GG3 vs GG1) 7.2, 95% CI (1.6-32.2); P = 0.01]. CONCLUSIONS GG outperformed HG in ILC and added prognostic value to classic clinicopathologic variables, including nodal status.
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Affiliation(s)
- O Metzger-Filho
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Michiels
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - F Bertucci
- Department of Molecular Oncology, Institut Paoli-Calmettes, Marseille
| | | | - R Salgado
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - C Galant
- Department of Pathology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - D Fumagalli
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S K Singhal
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - C Desmedt
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Ignatiadis
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Haussy
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - P Finetti
- Department of Molecular Oncology, Institut Paoli-Calmettes, Marseille
| | - D Birnbaum
- Department of Molecular Oncology, Institut Paoli-Calmettes, Marseille
| | - K S Saini
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Berlière
- Department of Pathology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - I Veys
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - E de Azambuja
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - I Bozovic
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - D Larsimont
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - M Piccart
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - C Sotiriou
- Breast Cancer Translation Research Laboratory J. C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
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Sotiriou C, Ignatiadis M, Desmedt C, Azim JHA, Veys I, Larsimont D, Lyng M, Viale G, Leyland-Jones B, Ditzel H, Giobbie-Hurder A, Regan M, Piccart M, Michiels S. Abstract S4-4: Independent validation of Genomic Grade in the BIG 1-98 study. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-s4-4] [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: We have reported that a 97-gene signature, the Genomic Grade Index (GGI) can separate histological grade (HG) 2 breast tumors into low vs high GGI tumors with different outcomes. We have also developed a quantitative reverse transcriptase polymerase chain reaction (qRT-PCR) tool including 6 reporter and 3 control genes that can reliably evaluate Genomic Grade (GG) in paraffin embedded tumors.
Methods: We evaluated the qRT-PCR GG in women treated with either tamoxifen or letrozole monotherapy in the Breast International Group (BIG) 1–98 study with 8.1 year median follow-up. The association between continuous GG and distant recurrence-free interval (DRFI) was evaluated in Cox regression models stratified for the 2 vs 4 arm randomization option, chemotherapy and hormonotherapy use, with and without adjustment for clinicopathological characteristics. Estrogen, progesterone receptor (ER, PR), Ki67 and HG were centrally reviewed. The clinicopathological model included age and log2 tumor size, ER and PR as continuous variables, nodal status (N0 vs 1–3 vs >3), HG (1 vs 2 vs 3) and HER2 (negative vs positive). Similar analyses were performed for log2 Ki67 as continuous variable. Added prognostic value was assessed using the likelihood ratio statistic.
Results: We obtained GG in 883 (62%) of 1428 samples. Non evaluable results were due to pre-analytical issues or technical failure. Among the 883 patients, 521 (59%) had N0 disease, 435 (49%) were treated with tamoxifen and 84 (10%) had distant recurrences. The GG classified 502 patients with HG2 tumors as either GG1 (N = 202, 40%), equivocal (N = 220, 44%) or GG3 (N = 80, 16%). In univariate analysis, increasing GG and Ki67 were significantly associated with lower DRFI (Table). When the 773 N0/1-3 patients were analyzed based on HG, the Kaplan-Meier estimate for 10-year DRFI was 98% (95% confidence intervals 96–100%) for the 123 HG1, 92% (88–95%) for the 456 HG2 and 84% (78–90%) for the 194 HG3 patients. In the N0/1-3 population, 10 year DRFI based on GG was 95% (96–100%) for the 290 GG1, 92% (89–95%) for the 309 GG equivocal and 84% (77–90%) for the 178 GG3 patients. Interestingly, when the 456 HG2 and N0/1-3 patients were analyzed based on GG, the 10-year DRFI was 95% (92–100%) for the 185 HG2/GG1 patients, 92% (88–96%) for the 202 HG2/GG equivocal patients, 86% (76–96%) for the 69 HG2/GG3 patients. In all patients either GG or Ki67 as continuous variable significantly improved the clinicopathological model in predicting distant recurrence (Table).
Conclusion: Either Genomic Grade or centrally reviewed Ki67 provides independent prognostic information for risk of distant recurrence beyond clinicopathological characteristics in patients treated with endocrine therapy.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr S4-4.
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Affiliation(s)
- C Sotiriou
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - M Ignatiadis
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - C Desmedt
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - Jr HA Azim
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - I Veys
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - D Larsimont
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - M Lyng
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - G Viale
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - B Leyland-Jones
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - H Ditzel
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - A Giobbie-Hurder
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - M Regan
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - M Piccart
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
| | - S Michiels
- Universite Libre de Bruxelles; Institut Jules Bordet; University of Southern Denmark; University of Milan; Edith Sanford Research; Harvard Medical School
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Azim JHA, Singhal S, Michiels S, Ignatiadis M, Djazouli K, Fumagalli D, Desmedt C, Piccart M, Sotiriou C. Abstract P6-07-22: Association between SPARC mRNA expression, prognosis and response to neoadjuvant chemotherapy in early breast cancer (BC): a pooled in-silico analysis. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-07-22] [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: SPARC (Secreted Protein Acidic and Rich in Cysteine) is known to regulate cell growth and to inhibit cell-cycle progression. It has high affinity in binding albumin and hence has been suggested to predict benefit of albumin-bound cytotoxic agents. We conducted a pooled analysis to elucidate SPARC expression according to BC molecular subtypes and its association with clinical outcome in early BC.
Methods: We used publically available datasets and normalized microarray data as published by the original studies. Eligible patients were those who received no adjuvant systemic therapy (untreated series), were treated with tamoxifen (tam-treated series) or were treated with neoadjuvant anthracyclines ± paclitaxel or docetaxel (neoadjuvant series). We computed 2 SPARC modules, SPARC7 and SPARC8 that were composed of genes with an absolute correlation above 0.7 and 0.8 with SPARC, respectively. In the untreated series, we examined the expression of SPARC according to BC subtype defined by PAM50. We investigated the correlation with other gene modules representing diverse biological processes; proliferation (AURKA, GGI), immune (STAT1, IRM), and stroma (DCN, PLAU). We investigated the association with relapse-free survival (RFS) in univariate and multivariate models, both in the untreated and tam-treated series. This was performed in all patients and according to BC subtype. In the neoadjuvant series, we investigated the association with pathological complete response (pCR) in all patients and according to BC subtype. All multivariate models were adjusted for tumor size, nodal status, age and histological grade.
Results: 1008, 393 and 996 patients were included in the untreated, tam-treated and neoadjuvant series, respectively. SPARC expression was highest in luminal-A, small (< 2 cm) and low histological grade tumors (all p < 0.0001). We found high positive correlation between SPARC, SPARC modules and stroma-related modules (r = 0.90) but a negative correlation with proliferation (r = −0.66). No correlation was observed with immune-related modules. In the untreated series, SPARC was not associated with prognosis in the univariate model. However, restricting the analysis to the HER2 molecular subtype, high SPARC expression was associated with short RFS in both univariate and multivariate models (HR: 3; 95% CI [1.5–6.3], p = 0.002). In the tam-treated series, SPARC expression was not associated with clinical outcome neither in luminal-A nor luminal-B. In the neoadjuvant series, SPARC expression was not associated with pCR (p = 0.37) except in the HER2 subtype in which high expression was independently associated with low pCR rates in the multivariate model (OR: 0.32; 95% CI [0.1–0.9], p = 0.043). Similar associations were observed with SPARC7 and SPARC8 modules.
Conclusion: Two main conclusions could be drawn from our analysis 1) SPARC is highly expressed in low proliferative ER+ tumors; 2) High SPARC expression is associated with short RFS and poor response to neoadjuvant therapy in patients with HER2+ BC. These results could be relevant in the clinical development of albumin-bound compounds, in which SPARC expression is believed to identify patients who could benefit from these agents.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-22.
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Affiliation(s)
- Jr HA Azim
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; Celgene International
| | - S Singhal
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; Celgene International
| | - S Michiels
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; Celgene International
| | - M Ignatiadis
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; Celgene International
| | - K Djazouli
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; Celgene International
| | - D Fumagalli
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; Celgene International
| | - C Desmedt
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; Celgene International
| | - M Piccart
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; Celgene International
| | - C Sotiriou
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; Celgene International
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Azim JHA, Peccatori FA, Loi S, Lambrechts D, Majjaj S, Renne G, Desmedt C, Rotmensz N, Michiels S, Dell'Orto P, Ignatiadis M, Goldhirsch A, Piccart M, Viale G, Sotiriou C. Abstract P6-07-14: Mutational and transcriptomic characterization of breast cancer (BC) arising in young patients (pts) and during pregnancy and their associations with long-term outcome. Cancer Res 2012. [DOI: 10.1158/0008-5472.sabcs12-p6-07-14] [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: BC arising in young age is biologically distinct. Whether diagnosis during pregnancy has an impact on prognosis and tumor biology remains to be elucidated. We report for the first time mutational and transcriptomic profiling of BC arising in young pts and the impact of diagnosis during pregnancy. We also correlate these findings with clinical outcome.
Methods: 65 pts with BC during pregnancy diagnosed at the European Institute of Oncology in the period 1999–2009 were matched to 130 BC pts who were diagnosed and treated at the same period/institute. We screened for 84 somatic hotspot mutations on 17 cancer-related genes using mass spectroscopy-based sequencing (Sequenom). We evaluated the pattern of mutations in the two cohorts and according to BC subtype defined using central immunohistochemistry as follows: Luminal A (ER+, HER2−, Ki67 <14%), Luminal-B (ER+, HER2−, Ki67 >14%), HER2+ (HER2+ irrespective of ER), and triple negative (ER−, PgR−, HER2−). Survival endpoints included distant relapse free survival (DRFS) and overall survival (OS).
Results: Median age at diagnosis was 36 years (range: 28–47). At a median follow-up of 74 months (IQR: 42–96), 44 (23%) and 29 (15%) pts developed a DRFS and OS event respectively. Pts diagnosed during pregnancy had inferior DRFS (HR: 3.2 [1.5–6.7]) and OS (HR: 2.9 [1.1–7.9]) after adjusting for pT, pN, grade, BC subtype, and therapy. Mutational profiling was successful in 97% of pts. A total of 57 hotspot mutations (30%) were detected in 51 pts (15 [23%] pregnant and 36 [28%] controls). The differences in mutations between the two groups are summarized in the table.
PIK3CA mutations were the most common, occurring in 41 pts overall (21.5%). In a logistic regression model adjusted for BC subtype, pregnancy, pT, pN and grade, only BC subtype was associated with PIK3CA mutations (p = 0.005) but not pregnancy (p = 0.3). No mutations related to ERK signaling were detected (PTEN, KRAS, BRAF, ERBB2, EGFR). No significant association was observed between somatic mutations and breast cancer outcome, probably related to lack of power. Gene expression using Affymetrix are currently ongoing to validate our previous findings (Azim et al; CCR 2012) of a role of mammary stem cells, tumor microenvironment (immune, stroma) and RANKL signaling in BC arising in young breast cancer patients. This could also elucidate further mechanisms underlying differences in outcome between the pregnant and control groups.
Conclusion: This is the first report on mutational profiling of BC arising in young women and during pregnancy. Whilst pregnancy is associated with significantly poor prognosis compared with matched controls, there were no significant differences in the mutational profiles evaluated. Ongoing transcriptomic analysis will be presented at the meeting.
Citation Information: Cancer Res 2012;72(24 Suppl):Abstract nr P6-07-14.
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Affiliation(s)
- Jr HA Azim
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - FA Peccatori
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - S Loi
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - D Lambrechts
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - S Majjaj
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - G Renne
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - C Desmedt
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - N Rotmensz
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - S Michiels
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - P Dell'Orto
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - M Ignatiadis
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - A Goldhirsch
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - M Piccart
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - G Viale
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
| | - C Sotiriou
- Universite Libre de Bruxelles, Brussels, Belgium; Institut Jules Bordet, Brussels, Belgium; European Institute of Oncology, Milan, Italy; University of Leuven, Belgium
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Azim H, Michiels S, Bedard P, Singhal S, Criscitiello C, Ignatiadis M, Haibe-Kains B, Piccart M, Sotiriou C, Loi S. 14O_PR Biology of Breast Cancer Diagnosed in Young Women: Pooled Gene Expression Analysis From 3522 Patients. Ann Oncol 2012. [DOI: 10.1016/s0923-7534(19)65686-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Metzger O, Singhal SK, Michiels S, Ignatiadis M, Bertucci F, Galant C, Larsimont D, Salgado R, Veys I, Fumagalli D, Saini KS, Piccart M, Sotiriou C. P1-02-05: Invasive Lobular Carcinoma – A Luminal Breast Cancer Histotype Enriched for Epithelial-to-Mesenchymal Transition Features. Cancer Res 2011. [DOI: 10.1158/0008-5472.sabcs11-p1-02-05] [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: Invasive lobular carcinoma (ILC) represent the second most common breast cancer (BC) histotype, but little information is available about its molecular features. We sought to perform a comprehensive molecular classification of ILC and to investigate the molecular features that can differentiate ILC from invasive ductal carcinoma (IDC).
Methods: A consecutive series of 174 ILC tumors from three different centers with mininum 5-year follow-up was selected. Gene expression data were generated using Affymetrix U133 Plus 2.0 arrays. Data were analyzed by using frozen robust multiarray analysis (Matthew et al. 2009). ILC tumors were classified into BC molecular subtypes using the PAM50 classifier. Invasive Disease Free Survival (IDFS) was defined as the interval between the date of surgery and the date of any invasive recurrence or death. Multivariate analyses for 10-y IDFS containing classical clinico-pathologic characteristics were performed for different gene signatures, which were scaled so that 2.5 and 97.5% percentiles equal −1 and 1. A cohort of 90 IDC tumor samples, normalised with the same method, was used to compare expression data between ILC and IDC.
Results: ILCs were mainly characterized as luminal A (LA: 76%, n=133) and luminal B (LB:; 20%, n=34) followed by a minority of HER2−positive (2%, n=3), basal (1%, n=2) and normal-like (1%, n=2) based on Perou's classification. LB had inferior 10-y IDFS than LA in univariate cox regression analysis (HR = 1.99, 95% CI, 1.08−3.67, p=0.026). The EMT gene module was significantly higher expressed in ILC as compared to IDC (p < 0.001). Adjusted hazard ratios (HR) for different gene modules investigated are detailed in the table below.
Conclusions: ILC is mainly composed of luminal tumors and a minority of HER2−positive tumors. Similarly to IDC, proliferation remains a statistically significant prognostic factor for ILC. ILC tumors were enriched with an EMT phenotype, which is not observed among IDC luminals. Of interest IGF signaling, which is known to be associated with poor prognosis in ER-positive BC, added prognostic value in this population which may open new therapeutics avenues for ILC.
Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P1-02-05.
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Affiliation(s)
- O Metzger
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - SK Singhal
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - S Michiels
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - M Ignatiadis
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - F Bertucci
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - C Galant
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - D Larsimont
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - R Salgado
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - I Veys
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - D Fumagalli
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - KS Saini
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - M Piccart
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - C Sotiriou
- 1Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; Institut Paoli-Calmettes, Marseille, France; Cliniques Universitaires Saint Luc, Brussels, Belgium
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