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Ezeife D, Spackman E, Juergens R, Laskin J, Agulnik J, Hao D, Laurie S, Law J, Le L, Kiedrowski L, Melosky B, Shepherd F, Cohen V, Wheatley-Price P, Vandermeer R, Li J, Fernandes R, Shokoohi A, Lanman R, Leighl N. OA16.02 The Economic Value of Liquid Biopsy for Genomic Profiling in Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2021. [DOI: 10.1016/j.jtho.2021.08.087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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2
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Tran H, Lam V, Vasquez M, Hong L, Colen R, Elshafeey N, Hassan I, Papadimitrakopoulou V, Blumenschein G, Carter B, Simon G, Lanman R, Raymond V, Elamin Y, Altan M, Tsao A, Gibbons D, Zhang J, Heymach J. P1.01-98 Outcomes in Advanced NSCLC Patients Treated with 1st Line EGFR-TKI Based on Mutation Detection from Tissue or cfDNA-Based Genomic Sequencing. J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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3
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Saori M, Kawazoe A, Nakamura Y, Odegaard J, Lefterova M, Lanman R, Yoshino T, Strickler J. Cell-Free DNA to detect focal versus non-focal MET amplification in metastatic colorectal cancer patients: Combined analysis from Japan and the United States. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz239.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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4
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Damodaran S, Meric-Bernstam F, Hess KR, Litton JK, Raymond V, Lanman R, Ueno NT, Hamilton S, Wistuba II, Valero V, Moulder SL, Tripathy D. Abstract OT1-03-04: INTERACT- INTegrated Evaluation of Resistance and Actionability using Circulating Tumor DNA in hormone receptor (HR) positive metastatic breast cancers (MBC). Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-ot1-03-04] [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
Mutations in the ligand-binding domain of ESR1 have been demonstrated to mediate resistance to aromatase inhibitors (AI) and are associated with poor survival. Analyses of circulating tumor DNA (ctDNA) offer a minimally invasive and real-time approach to characterize genomic landscape, clonal evolution, and treatment response. Early detection and intervention with alternate therapy to overcome resistance at minimal disease burden progression could have a larger impact than treating higher burden disease at clinical progression. However, whether treatment decisions made based on the emergence of secondary resistance mutations or mutant allele fraction (MAF) changes in ctDNA can improve clinical outcomes is unknown. Currently, the most effective therapy for patients harboring ESR1 mutations is unclear; although, pre-clinical and retrospective clinical trial analyses have suggested that some of these mutations may exhibit greater sensitivity to fulvestrant, a selective estrogen receptor down-regulator, compared to AI. This study hypothesizes that real-time monitoring of ctDNA for secondary ESR1 alterations can identify subclinical progression and early intervention with a targeted-agent that has greater efficacy against ESR1 mutations can improve disease-free survival.
Trial Design
This is a randomized, open-label, Phase-2 study for HR-positive MBC patients who are on AI and CDK 4/6 inhibitor as first line therapy. Patients on treatment for at least 12 months without evidence of clinical progression would be screened for ESR1 mutations using Guardant360 ctDNA assay. Patients with positive ESR1 mutations would be randomized to change of endocrine therapy to fulvestrant vs. continuing AI.
Eligibility criteria
-Histologically confirmed HR-positive (ER and/or PR >10%) and HER2-negative MBC
-On AI with CDK4/6 inhibitor as first line therapy for 12 months without evidence of clinical progression
-Activating ESR1 mutation identified on ctDNA
-ECOG performance status ≤1
-Normal organ and marrow function
Specific aims
- To assess progression-free survival (PFS) with transition to fulvestrant compared with continuing AI therapy in patients with emergence of ESR1 mutations in plasma
-To assess ctDNA ESR1 mutant allele fraction and kinetics with transition to fulvestrant compared with AI
-To assess the prevalence of ESR1 mutations in patients with exposure to endocrine therapy
-To assess overall survival with fulvestrant transition compared with continuing AI therapy in patients with emergence of ESR1 mutations
Statistical methods
To detect a change in median PFS from 5 months (for AI arm) to 9 months (with fulvestrant arm) would require about 124 patients (5% two-sided alpha, 80% power, log rank testing). Interim analysis will be performed when 42 PFS events are observed. Using O'Brien-Fleming stopping boundaries, we will stop for futility if the log rank test p-value > 0.72 and stop for success if it is < 0.004.
Citation Format: Damodaran S, Meric-Bernstam F, Hess KR, Litton JK, Raymond V, Lanman R, Ueno NT, Hamilton S, Wistuba II, Valero V, Moulder SL, Tripathy D. INTERACT- INTegrated Evaluation of Resistance and Actionability using Circulating Tumor DNA in hormone receptor (HR) positive metastatic breast cancers (MBC) [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 OT1-03-04.
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Affiliation(s)
- S Damodaran
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - F Meric-Bernstam
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - KR Hess
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - JK Litton
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - V Raymond
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - R Lanman
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - NT Ueno
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - S Hamilton
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - II Wistuba
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - V Valero
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - SL Moulder
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
| | - D Tripathy
- The University of Texas MD Anderson Cancer Center, Houston, TX; Guardant Health, Redwood City
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Zatarain-Barrón Z, Barron F, Cardona A, Cruz-Rico G, Arrieta O, Flores-Veles K, Espenschied C, Raymond V, Lanman R, Vargas C. P1.09-21 Circulating Tumor DNA Improves Genotypification and Detection of Targetable Alterations in Selected Lung Cancer Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.797] [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: 10/28/2022]
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6
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Lopes G, Raymond V, Scott J, Matthews C, Doshi S, Wang E, Skrzypczak S, Lanman R, Gandara D. P2.15-16 Clinical Economic Impact of Improved Genotyping in Patients with Advanced Non-Small Cell Lung Adenocarcinoma (NSCLC). J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.1457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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7
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Piotrowska Z, Isozaki H, Lennerz J, Digumarthy S, Gainor J, Marcoux N, Banwait M, Dias-Santagata D, Iafrate A, Mino-Kenudson M, Nagy R, Lanman R, Evans E, Clifford C, Wolf B, Hata A, Sequist L. MA26.03 Activity of Osimertinib and the Selective RET Inhibitor BLU-667 in an EGFR-Mutant Patient with Acquired RET Rearrangement. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.540] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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8
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Kiedrowski L, Lam V, Piotrowska Z, Tsao A, Wells A, Lanman R, Papadimitrakopoulou V, Nagy R. MA16.01 Frequency and Genomic Context of Emerging Markers for Molecular Testing in Lung Adenocarcinoma in Cell-Free DNA NGS Analysis. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.448] [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: 11/25/2022]
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9
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Zatarain-Barrón Z, Barrón F, Cardona A, Cruz-Rico G, Flores-Veles K, Espenschied C, Raymond V, Lanman R, Vargas C, Arrieta O. PD.2.05 Circulating Tumor DNA Improves Genotypification and Detection of Targetable Alterations in Selected Lung Cancer Patients. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.07.037] [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: 10/28/2022]
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10
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Piotrowska Z, Nagy R, Fairclough S, Lanman R, Marcoux N, Gettinger S, Owonikoko T, Ramalingam S, Sequist L. OA 09.01 Characterizing the Genomic Landscape of EGFR C797S in Lung Cancer Using ctDNA Next-Generation Sequencing. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.375] [Citation(s) in RCA: 3] [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: 10/18/2022]
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11
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Mack P, Miao J, Banks K, Burich R, Politi K, Raymond V, Dix D, Lanman R, Moon J, Melnick M, Truini A, Redman M, Goldberg S, Gandara D, Kelly K. P3.01-046 Longitudinal Analysis of Plasma CtDNA in EGFR-Mutant NSCLC: SWOG S1403 Trial of Afatinib with or Without Cetuximab. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1487] [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: 11/26/2022]
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12
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Geva S, Rozenblum AB, Ilouze M, Roisman L, Dudnik E, Zer A, Twito T, Dvir A, Soussan-Gutman L, Lanman R, Peled N. P3.01-060 The Clinical Utility of ctDNA Gene Analysis in Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1501] [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: 10/18/2022]
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13
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Raymond V, Bivona T, Lanman R, Nagy R, Banks K, Chae Y, Clarke J, Crawford J, Gandara D, Heymach J. OA 12.05 Spectrum of 1,014 Somatic BRAF Alterations Detected in Cell-Free DNA of Patients with Advanced Non-Small Cell Lung Cancer. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.397] [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: 10/18/2022]
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14
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Pectasides E, Stachler MD, Derks S, Liu Y, Maron S, Islam M, Alpert L, Kwak H, Kindler H, Polite B, Sharma MR, Allen K, O'Day E, Lomnicki S, Maranto M, Kanteti R, Fitzpatrick C, Weber C, Setia N, Xiao SY, Hart J, Nagy RJ, Kim KM, Choi MG, Min BH, Nason KS, O'Keefe L, Watanabe M, Baba H, Lanman R, Agoston AT, Oh DJ, Dunford A, Thorner AR, Ducar MD, Wollison BM, Coleman HA, Ji Y, Posner MC, Roggin K, Turaga K, Chang P, Hogarth K, Siddiqui U, Gelrud A, Ha G, Freeman SS, Rhoades J, Reed S, Gydush G, Rotem D, Davison J, Imamura Y, Adalsteinsson V, Lee J, Bass AJ, Catenacci DV. Genomic Heterogeneity as a Barrier to Precision Medicine in Gastroesophageal Adenocarcinoma. Cancer Discov 2017; 8:37-48. [PMID: 28978556 DOI: 10.1158/2159-8290.cd-17-0395] [Citation(s) in RCA: 222] [Impact Index Per Article: 31.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 08/21/2017] [Accepted: 09/29/2017] [Indexed: 02/07/2023]
Abstract
Gastroesophageal adenocarcinoma (GEA) is a lethal disease where targeted therapies, even when guided by genomic biomarkers, have had limited efficacy. A potential reason for the failure of such therapies is that genomic profiling results could commonly differ between the primary and metastatic tumors. To evaluate genomic heterogeneity, we sequenced paired primary GEA and synchronous metastatic lesions across multiple cohorts, finding extensive differences in genomic alterations, including discrepancies in potentially clinically relevant alterations. Multiregion sequencing showed significant discrepancy within the primary tumor (PT) and between the PT and disseminated disease, with oncogene amplification profiles commonly discordant. In addition, a pilot analysis of cell-free DNA (cfDNA) sequencing demonstrated the feasibility of detecting genomic amplifications not detected in PT sampling. Lastly, we profiled paired primary tumors, metastatic tumors, and cfDNA from patients enrolled in the personalized antibodies for GEA (PANGEA) trial of targeted therapies in GEA and found that genomic biomarkers were recurrently discrepant between the PT and untreated metastases. Divergent primary and metastatic tissue profiling led to treatment reassignment in 32% (9/28) of patients. In discordant primary and metastatic lesions, we found 87.5% concordance for targetable alterations in metastatic tissue and cfDNA, suggesting the potential for cfDNA profiling to enhance selection of therapy.Significance: We demonstrate frequent baseline heterogeneity in targetable genomic alterations in GEA, indicating that current tissue sampling practices for biomarker testing do not effectively guide precision medicine in this disease and that routine profiling of metastatic lesions and/or cfDNA should be systematically evaluated. Cancer Discov; 8(1); 37-48. ©2017 AACR.See related commentary by Sundar and Tan, p. 14See related article by Janjigian et al., p. 49This article is highlighted in the In This Issue feature, p. 1.
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Affiliation(s)
- Eirini Pectasides
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Matthew D Stachler
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sarah Derks
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Department of Medical Oncology, VU University Medical Center, Amsterdam, the Netherlands
| | - Yang Liu
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Steven Maron
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Mirazul Islam
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts.,Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Lindsay Alpert
- Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Heewon Kwak
- Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Hedy Kindler
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Blase Polite
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Manish R Sharma
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Kenisha Allen
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Emily O'Day
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Samantha Lomnicki
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Melissa Maranto
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Rajani Kanteti
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Carrie Fitzpatrick
- Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Christopher Weber
- Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Namrata Setia
- Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Shu-Yuan Xiao
- Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - John Hart
- Department of Pathology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | | | - Kyoung-Mee Kim
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Min-Gew Choi
- Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Hoon Min
- Department of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Katie S Nason
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lea O'Keefe
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Masayuki Watanabe
- Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Rick Lanman
- Guardant Health, Inc., Redwood City, California
| | - Agoston T Agoston
- Department of Pathology, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - David J Oh
- University of New England College of Osteopathic Medicine, Biddeford, Maine
| | - Andrew Dunford
- Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Aaron R Thorner
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Matthew D Ducar
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Bruce M Wollison
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Haley A Coleman
- Center for Cancer Genome Discovery, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Yuan Ji
- Department of Public Health Sciences, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Mitchell C Posner
- Department of Surgery, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Kevin Roggin
- Department of Surgery, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Kiran Turaga
- Department of Surgery, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Paul Chang
- Department of Radiology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Kyle Hogarth
- Department of Medicine, Section of Pulmonary and Critical Care, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Uzma Siddiqui
- Department of Medicine, Section of Gastroenterology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Andres Gelrud
- Department of Medicine, Section of Gastroenterology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois
| | - Gavin Ha
- Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | | | - Justin Rhoades
- Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Sarah Reed
- Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Greg Gydush
- Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Denisse Rotem
- Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Jon Davison
- University of Pittsburgh Cancer Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Yu Imamura
- Gastroenterological Surgery, The Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan.,Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | | | - Jeeyun Lee
- Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Adam J Bass
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, Massachusetts. .,Eli and Edythe L. Broad Institute, Cambridge, Massachusetts
| | - Daniel V Catenacci
- Department of Medicine, Section of Hematology/Oncology, University of Chicago Medical Center and Biological Sciences, Chicago, Illinois.
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Agarwal N, Pal S, Sonpavde G, Kiedrowski L, Nagy R, Banks K, Lanman R, Grivas P. Comparison of circulating tumor DNA (ctDNA) profile in metastatic urothelial carcinoma (mUC) derived from the upper tract (UT) and lower tract (LT). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx371.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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16
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Uccello M, Kushnir M, Mak G, Murias Henriquez C, Abbosh C, Papadatos-Pastos D, Newsom-Davis T, Ahmad T, Swanton C, Forster M, Lanman R, Faull I, Arkenau HT. Circulating tumour DNA (ctDNA) in the clinical management of patients (pts) with advanced non-small cell lung cancer (NSCLC): A single centre experience. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx363.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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17
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Pal S, Brooks C, Chudova D, Odegaard J, Gandara D, Mack P, Mortimer S, Banks K, Nagy R, Baca A, Lanman R, Eltoukhy H, Talasaz A. Clinical implications of genomic variants identified in over 30,000 advanced-stage cancer patients by next-generation sequencing of circulating tumor DNA. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx391.002] [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: 11/14/2022] Open
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18
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Hanker AB, Red Brewer M, Sheehan JH, Koch JP, Lanman R, Hyman DM, Cutler RE, Lalani AS, Cross D, Lovly CM, Meiler J, Arteaga CL. Abstract P3-03-03: An acquired HER2 T798I gatekeeper mutation induces resistance to neratinib in a patient with HER2 mutant-driven breast cancer. Cancer Res 2017. [DOI: 10.1158/1538-7445.sabcs16-p3-03-03] [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
ERBB2, the gene encoding HER2, is mutated in 2-4% of breast cancers. The HER2 irreversible tyrosine kinase inhibitor (TKI) neratinib has shown clinical activity against breast cancer cells harboring HER2 activating mutations. Here, we report for the first time an acquired gatekeeper HER2T798I mutation in a patient with HER2-mutant breast cancer after an initial exceptional response to neratinib.
A patient with ER+/PR+/HER2-negative invasive lobular breast cancer progressing on standard therapy was found to harbor a L869R kinase domain mutation in HER2. HER2L869R is homologous to the known activating mutation EGFRL861R/Q. MCF10A breast epithelial cells expressing HER2L869R displayed enhanced HER2-mediated signaling and were resistant to lapatinib and trastuzumab but sensitive to neratinib. The patient was enrolled in the phase II SUMMIT trial (NCT01953926) and treated with neratinib, achieving a partial response lasting 16 months before developing progression. Next gen sequencing of DNA from both a new skin metastasis and plasma cell-free DNA (cfDNA) identified HER2L869R (8.7% cfDNA), whereas a novel HER2T798I mutation was detected only in plasma at 1.3%. Deep sequencing of pre-therapy tumor tissue and plasma did not detect HER2T798I, suggesting that this mutation arose upon resistance. HER2T798I has not been reported in TCGA, COSMIC, or among plasma samples from 17,345 cancer patients subjected to digital DNA sequencing using the Guardant360 assay.
HER2T798I is homologous to the EGFRT790M, KITT670I and BCR-ABLT315I gatekeeper mutations known to mediate resistance to erlotinib/gefitinib and imatinib. To examine if HER2T798I mediates resistance to neratinib, we employed biochemical and biological assays and molecular modeling of wild-type (WT) HER2 and HER2T798I. Structural modeling showed the increased bulk of the isoleucine at position 798 would result in a steric clash with neratinib, thus reducing drug binding. We stably expressed HER2WT, HER2T798I, HER2L869R and HER2L869R/T798I in MCF10A cells and NR6 mouse fibroblasts. Neratinib (10-100 nM) blocked HER2-mediated signaling in cells expressing HER2WT or HER2L869R but did not in cells expressing HER2T798I. The EGFR irreversible TKI osimertinib (100 nM), which isselective for mutant EGFR (including EGFRT790M) and approved for treatment of NSCLC expressing EGFRT790M, failed to inhibit HER2WT, HER2L869R or HER2T798I. In contrast, either the EGFR/HER2 irreversible TKI afatinib or AZ5104, a metabolite of osimertinib, strongly blocked signaling induced by HER2WT, HER2L869R or HER2T798I. Cells expressing HER2T798M displayed a significantly higher IC50 to neratinib than cells expressing HER2WT, whereas afatinib or AZ5014 were very active against all cells (IC50<10 nM).
Conclusions: The acquisition of a T798I gatekeeper mutation in HER2 upon development of clinical resistance to neratinib in a breast cancer with an initial activating mutation in HER2 strongly suggests that HER2L869R is a driver mutation. We speculate that HER2T798I may arise as a secondary mutation following response to effective HER2 TKIs in other cancers with HER2 activating mutations. Certain irreversible EGFR inhibitors may be effective in patients with HER2-driven breast cancer resistant to neratinib.
Citation Format: Hanker AB, Red Brewer M, Sheehan JH, Koch JP, Lanman R, Hyman DM, Cutler, Jr. RE, Lalani AS, Cross D, Lovly CM, Meiler J, Arteaga CL. An acquired HER2 T798I gatekeeper mutation induces resistance to neratinib in a patient with HER2 mutant-driven 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 P3-03-03.
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Affiliation(s)
- AB Hanker
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - M Red Brewer
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - JH Sheehan
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - JP Koch
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - R Lanman
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - DM Hyman
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - RE Cutler
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - AS Lalani
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - D Cross
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - CM Lovly
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - J Meiler
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
| | - CL Arteaga
- Vanderbilt University Medical Center, Nashville, TN; Guardant Health, Redwood City, CA; Memorial Sloan Kettering Cancer Center, New York, NY; Puma Biotechnology, Inc., Los Angeles, CA; Astra Zeneca, Cambridge, United Kingdom
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Shah A, Lanman R, Bhargava V, Weir S, Hahne W. Pharmacokinetics of dolasetron following single- and multiple-dose intravenous administration to normal male subjects. Biopharm Drug Dispos 1995; 16:177-89. [PMID: 7787130 DOI: 10.1002/bdd.2510160303] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [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: 01/27/2023]
Abstract
Dolasetron, Anzemet, a 5-hydroxytryptamine receptor antagonist, is under investigation as an antiemetic agent. The keto-reduced metabolite of dolasetron has been identified in human plasma and is probably responsible for the majority of the antiemetic activity. This study evaluated the pharmacokinetics of dolasetron and the reduced metabolite following single and multiple intravenous (IV) infusions of dolasetron mesylate in healthy male subjects. Four groups of subjects (six active/two placebo) received either dolasetron mesylate or placebo in single IV doses ranging from 0.30 to 0.60 mg kg-1 on day 1 and multiple IV doses ranging from 0.60 to 1.20 mg kg-1 d-1 on days 2-9. Dolasetron could be detected for less than 1 h, while the reduced metabolite appeared rapidly in the plasma, reaching a maximal plasma concentration in less than 1 h. Reduced metabolic maximal plasma concentration was proportional to the dose and the area under plasma concentration curve was linear based on regression analysis. The half-life of reduced metabolite ranged from 3.82 to 7.46 h. The mean renal clearance of reduced metabolite was 2.20-4.43 mL min-1 kg-1 and was dose independent. All of the evidence supports dose independent pharmacokinetics for the reduced metabolite. Upon multiple dosing, the reduced metabolite AUC can be predicted from the single-dose pharmacokinetics of this metabolite.
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Affiliation(s)
- A Shah
- Marion Merrell Dow Inc., Kansas City, MO 64134-0627, USA
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