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Rugo HS, Im SA, Joy AA, Shparyk Y, Walshe JM, Sleckman B, Loi S, Theall KP, Kim S, Huang X, Bananis E, Mahtani R, Finn RS, Diéras V. Effect of palbociclib plus endocrine therapy on time to chemotherapy across subgroups of patients with hormone receptor‒positive/human epidermal growth factor receptor 2‒negative advanced breast cancer: Post hoc analyses from PALOMA-2 and PALOMA-3. Breast 2022; 66:324-331. [PMID: 36463643 PMCID: PMC9720565 DOI: 10.1016/j.breast.2022.11.005] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 11/11/2022] [Accepted: 11/14/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Previous analyses from the PALOMA-2 and PALOMA-3 studies showed that palbociclib (PAL) plus endocrine therapy (ET) prolongs time to first subsequent chemotherapy (TTC) versus placebo (PBO) plus ET in the overall population of patients with hormone receptor‒positive/human epidermal growth factor receptor 2‒negative (HR+/HER2-) advanced breast cancer (ABC). Here, we evaluated TTC in relevant patient subgroups. METHODS These post hoc analyses evaluated TTC by subgroup using data from 2 randomized, phase 3 studies of women with HR+/HER2- ABC. In PALOMA-2, postmenopausal patients previously untreated for ABC were randomized 2:1 to receive PAL (125 mg/day, 3/1-week schedule) plus letrozole (LET; 2.5 mg/day; n = 444) or PBO plus LET (n = 222). In PALOMA-3, premenopausal or postmenopausal patients whose disease had progressed after prior ET were randomized 2:1 to receive PAL (125 mg/day, 3/1-week schedule) plus fulvestrant (FUL; 500 mg; n = 347) or PBO plus FUL (n = 174). RESULTS First subsequent chemotherapy was received by 35.5% and 56.2% in PALOMA-2 and PALOMA-3 after progression on palbociclib plus ET or placebo plus ET. Across all subgroups analyzed, the median progression-free survival (PFS) was longer in the PAL plus ET arm than the PBO plus ET arm. TTC was longer with PAL plus ET versus PBO plus ET across the same patient subgroups in both studies. CONCLUSIONS Across all subgroups, PAL plus ET versus PBO plus ET had longer median PFS and resulted in prolonged TTC in both the PALOMA-2 and PALOMA-3 studies. Pfizer Inc (NCT01740427, NCT01942135).
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Affiliation(s)
- Hope S. Rugo
- University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Department of Medicine (Hematology/Oncology), 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94158, USA,Corresponding author. University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, Department of Medicine (Hematology/Oncology), 1825 4th Street, 3rd Floor, Box 1710, San Francisco, CA, 94158-1710, USA.
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, 101 Daehak-ro, Jonro-gu, Seoul 03080, Republic of Korea
| | - Anil A. Joy
- Cross Cancer Institute, University of Alberta, 11560 University Ave NW, Edmonton, AB T6G1Z2, Canada
| | - Yaroslav Shparyk
- Lviv State Oncologic Regional Treatment and Diagnostic Center, Lviv, Ukraine
| | - Janice M. Walshe
- Cancer Trials Ireland, St Vincent's University Hospital, Elm Park, Dublin 4, Ireland
| | - Bethany Sleckman
- Mercy Hospital St. Louis, 607 S New Ballas Road, Suite 3300, St. Louis, MO, 63141, USA
| | - Sherene Loi
- Peter MacCallum Cancer Centre, University of Melbourne, Australia
| | | | - Sindy Kim
- Pfizer Inc, 10555 Science Center Dr, San Diego, CA 92121, USA
| | - Xin Huang
- Pfizer Inc, 10555 Science Center Dr, San Diego, CA 92121, USA
| | | | - Reshma Mahtani
- Miami Cancer Institute, Baptist Health South Florida, Member, Memorial Sloan Kettering Cancer Alliance, 1228 South Pine Island Road, Plantation, FL, 33324, USA
| | - Richard S. Finn
- David Geffen School of Medicine, 2825 Santa Monica Blvd, Suite 200, Santa Monica, CA, 90404, USA
| | - Véronique Diéras
- Unicancer Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, CS 44229, 35042, Rennes Cedex, France
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Di Cosimo S, Pizzamiglio S, Sotiriou C, Ciniselli C, Triulzi T, de Cecco L, El-Abed S, Izquierdo M, de Azambuja E, Saura C, Huober J, Untch M, Lang I, Loi S, Tagliabue E, Rubio I, Vingiani A, Colombo M, Verderio P, Pruneri G. Gene expression profile at week 2 of neoadjuvant therapy course predicts outcome in HER2-positive breast cancer patients: an explorative analysis from NeoALTTO. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01561-1] [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: 11/19/2022]
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Hurvitz SA, Bachelot T, Bianchini G, Harbeck N, Loi S, Park YH, Prat A, Gilham L, Boulet T, Gochitashvili N, Monturus E, Lambertini C, Nyawira B, Knott A, Restuccia E, Schmid P. ASTEFANIA: adjuvant ado-trastuzumab emtansine and atezolizumab for high-risk, HER2-positive breast cancer. Future Oncol 2022; 18:3563-3572. [PMID: 36382554 DOI: 10.2217/fon-2022-0485] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There is a strong rationale for combining HER2-targeted therapies with cancer immunotherapy to increase efficacy in breast cancer, particularly in the early-stage setting, where the immune system has not been weakened by heavy pretreatment. ASTEFANIA aims to evaluate the efficacy of adjuvant atezolizumab in combination with ado-trastuzumab emtansine in patients with high-risk, HER2-positive early breast cancer and residual disease following HER2-based neoadjuvant therapy. Eligible patients will be randomized to receive ado-trastuzumab emtansine in combination with either atezolizumab or placebo for 14 cycles within 12 weeks of primary surgery. The primary outcome is invasive disease-free survival and secondary outcomes include additional efficacy end points, safety and pharmacokinetics. The study plans to enroll 1700 patients across 32 counties. Clinical Trial Registration: NCT04873362 (ClinicalTrials.gov).
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Affiliation(s)
- Sara A Hurvitz
- University of California Los Angeles/Jonsson Comprehensive Cancer Centre (UCLA/JCCC), 10833 Le Conte Ave., Los Angeles, CA 900024, USA
| | - Thomas Bachelot
- Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008, Lyon, France
| | | | - Nadia Harbeck
- Department of Gynecology & Obstetrics & CCC Munich, Breast Center, LMU University Hospital, Marchioninistraße 15, 81377, Munich, Germany
| | - Sherene Loi
- Division of Cancer Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, Victoria, 3000, Australia
- The Sir Peter MacCallum Department of Medical Oncology, University of Melbourne, Grattan Street, Parkville, Victoria, 3010, Australia
| | - Yeon Hee Park
- Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, South Korea
| | - Aleix Prat
- Hospital Clínic Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | | | - Thomas Boulet
- F.Hoffmann-La Roche Ltd, Gartenstrasse 9, CH-4052, Basel, Switzerland
| | - Nino Gochitashvili
- Roche Products Limited, Hexagon Place, Shire Park, Falcon Way, Welwyn Garden City, AL7 1TW, UK
| | | | - Chiara Lambertini
- F.Hoffmann-La Roche Ltd, Gartenstrasse 9, CH-4052, Basel, Switzerland
| | - Beatrice Nyawira
- F.Hoffmann-La Roche Ltd, Gartenstrasse 9, CH-4052, Basel, Switzerland
| | - Adam Knott
- Roche Products Limited, Hexagon Place, Shire Park, Falcon Way, Welwyn Garden City, AL7 1TW, UK
| | | | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, Charterhouse Square, London, EC1M 5PZ, UK
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Tolaney S, de Azambuja E, Emens L, Loi S, Pan W, Huang J, Sun S, Lai C, Schmid P. 276TiP ASCENT-04/KEYNOTE-D19: Phase III study of sacituzumab govitecan (SG) plus pembrolizumab (pembro) vs treatment of physician’s choice (TPC) plus pembro in first-line (1L) programmed death-ligand 1-positive (PD-L1+) metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1860] [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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Rediti M, Venet D, Joaquin Garcia A, Agbor-tarh D, Maetens M, Vincent D, Majjaj S, El-Abed S, Liu M, Di Cosimo S, Piccart M, Pusztai L, Loi S, Salgado R, Viale G, Rothé F, Sotiriou C. 139MO Identification of biologically-driven HER2-positive breast cancer subgroups associated with prognosis after adjuvant trastuzumab in the ALTTO trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.174] [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: 11/30/2022] Open
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Joaquin Garcia A, Rediti M, Venet D, Majjaj S, Kammler R, Colleoni M, Loi S, Viale G, Regan M, Rothé F, Sotiriou C. 136MO Differential benefit of low-dose cyclophosphamide and methotrexate maintenance chemotherapy among TNBC subtypes in the context of the IBCSG 22-00 study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.171] [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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Cristofanilli M, Rugo HS, Im SA, Slamon DJ, Harbeck N, Bondarenko I, Masuda N, Colleoni M, DeMichele A, Loi S, Iwata H, O'Leary B, André F, Loibl S, Bananis E, Liu Y, Huang X, Kim S, Lechuga Frean MJ, Turner NC. Overall Survival with Palbociclib and Fulvestrant in Women with HR+/HER2- ABC: Updated Exploratory Analyses of PALOMA-3, a Double-blind, Phase III Randomized Study. Clin Cancer Res 2022; 28:3433-3442. [PMID: 35552673 PMCID: PMC9662922 DOI: 10.1158/1078-0432.ccr-22-0305] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 04/01/2022] [Accepted: 05/09/2022] [Indexed: 01/07/2023]
Abstract
PURPOSE To conduct an updated exploratory analysis of overall survival (OS) with a longer median follow-up of 73.3 months and evaluate the prognostic value of molecular analysis by circulating tumor DNA (ctDNA). PATIENTS AND METHODS Patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) advanced breast cancer (ABC) were randomized 2:1 to receive palbociclib (125 mg orally/day; 3/1 week schedule) and fulvestrant (500 mg intramuscularly) or placebo and fulvestrant. This OS analysis was performed when 75% of enrolled patients died (393 events in 521 randomized patients). ctDNA analysis was performed among patients who provided consent. RESULTS At the data cutoff (August 17, 2020), 258 and 135 deaths occurred in the palbociclib and placebo groups, respectively. The median OS [95% confidence interval (CI)] was 34.8 months (28.8-39.9) in the palbociclib group and 28.0 months (23.5-33.8) in the placebo group (stratified hazard ratio, 0.81; 95% CI, 0.65-0.99). The 6-year OS rate (95% CI) was 19.1% (14.9-23.7) and 12.9% (8.0-19.1) in the palbociclib and placebo groups, respectively. Favorable OS with palbociclib plus fulvestrant compared with placebo plus fulvestrant was observed in most subgroups, particularly in patients with endocrine-sensitive disease, no prior chemotherapy for ABC and low circulating tumor fraction and regardless of ESR1, PIK3CA, or TP53 mutation status. No new safety signals were identified. CONCLUSIONS The clinically meaningful improvement in OS associated with palbociclib plus fulvestrant was maintained with >6 years of follow-up in patients with HR+/HER2- ABC, supporting palbociclib plus fulvestrant as a standard of care in these patients.
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Affiliation(s)
- Massimo Cristofanilli
- Weill Cornell Medicine, New York, New York
- Corresponding Author: Massimo Cristofanilli, Medicine-Hematology & Oncology, Weill Cornell Medicine, 420 E 70th St, New York, NY 10021. Phone: 646-962-2330; E-mail:
| | - Hope S. Rugo
- University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of South Korea
| | - Dennis J. Slamon
- David Geffen School of Medicine at University of California Los Angeles, Santa Monica, California
| | - Nadia Harbeck
- Brustzentrum, Frauenklinik and CCC Munich, LMU University Hospital, Munich, Germany
| | - Igor Bondarenko
- Dnipropetrovsk Medical Academy, City Multiple-Discipline Clinical Hospital #4, Dnipropetrovsk, Ukraine
| | - Norikazu Masuda
- Nagoya University Graduate School of Medicine, Showa-ku, Nagoya, Japan
| | | | - Angela DeMichele
- Abramson Cancer Center, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Sherene Loi
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Hiroji Iwata
- Aichi Cancer Center Hospital, Chikusa-ku, Nagoya, Japan
| | - Ben O'Leary
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
| | | | | | | | - Yuan Liu
- Pfizer Inc, San Diego, California
| | | | | | | | - Nicholas C. Turner
- Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom
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Cui W, Phillips KA, Francis PA, Anderson RA, Partridge AH, Loi S, Loibl S, Keogh L. Understanding the barriers to, and facilitators of, ovarian toxicity assessment in breast cancer clinical trials. Breast 2022; 64:56-62. [PMID: 35597179 PMCID: PMC9127191 DOI: 10.1016/j.breast.2022.05.002] [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] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/08/2022] [Accepted: 05/12/2022] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND Detailed toxicity data are routinely collected in breast cancer (BC) clinical trials. However, ovarian toxicity is infrequently assessed, despite the adverse impacts on fertility and long-term health from treatment-induced ovarian insufficiency. OBJECTIVES To determine the barriers to and facilitators of ovarian toxicity assessment in BC trials of anti-cancer drugs. METHODS Semi-structured interviews were conducted with purposively selected stakeholders from multiple countries involved in BC clinical trials (clinicians, consumers, pharmaceutical company representatives, members of drug-regulatory agencies). Participants were asked to describe the perceived benefits and barriers to evaluating ovarian toxicity. Interviews were transcribed verbatim, coded in NVivo software and analysed using inductive thematic analysis. RESULTS Saturation of the main themes was reached and the final sample size included 25 participants from 14 countries (9 clinicians, 7 consumers, 5 members of regulatory agencies, 4 pharmaceutical company representatives); half were female. The main reported barrier to ovarian toxicity assessment was that the issue was rarely considered. Reasons included that these data are less important than survival data and are not required for regulatory approval. Overall, most participants believed evaluating the impact of BC treatments on ovarian function is valuable. Suggested strategies to increase ovarian toxicity assessment were to include it in clinical trial design guidelines and stakeholder advocacy. CONCLUSION Lack of consideration about measuring ovarian toxicity in BC clinical trials that include premenopausal women suggest that guidelines and stronger advocacy from stakeholders, including regulators, would facilitate its more frequent inclusion in future trials, allowing women to make better informed treatment decisions.
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Affiliation(s)
- Wanyuan Cui
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan St, Melbourne, 3000, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Kelly-Anne Phillips
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan St, Melbourne, 3000, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia; Breast Cancer Trials Australia New Zealand (BCT-ANZ), Level 4, 175 Scott St, Newcastle, 2300, NSW, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Prudence A Francis
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan St, Melbourne, 3000, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia; Breast Cancer Trials Australia New Zealand (BCT-ANZ), Level 4, 175 Scott St, Newcastle, 2300, NSW, Australia
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK
| | - Ann H Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA
| | - Sherene Loi
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, 305 Grattan St, Melbourne, 3000, VIC, Australia; Department of Medical Oncology, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia; Division of Research, Peter MacCallum Cancer Centre, 305 Grattan Street, Melbourne, VIC, 3000, Australia
| | - Sibylle Loibl
- German Breast Group, Martin Behaim Strasse 12, 63263, Neu-Isenburg, Germany; Centre for Haematology and Oncology, Bethanien, Im Prüfling 17, 60389, Frankfurt, Germany
| | - Louise Keogh
- Centre for Health Equity, The University of Melbourne, Parkville, VIC, 3010, Australia.
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Winship AL, Alesi LR, Sant S, Stringer JM, Cantavenera A, Hegarty T, Requesens CL, Liew SH, Sarma U, Griffiths MJ, Zerafa N, Fox SB, Brown E, Caramia F, Zareie P, La Gruta NL, Phillips KA, Strasser A, Loi S, Hutt KJ. Checkpoint inhibitor immunotherapy diminishes oocyte number and quality in mice. Nat Cancer 2022; 3:1-13. [PMID: 36008687 DOI: 10.1038/s43018-022-00413-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 06/23/2022] [Indexed: 06/15/2023]
Abstract
Loss of fertility is a major concern for female reproductive-age cancer survivors, since a common side-effect of conventional cytotoxic cancer therapies is permanent damage to the ovary. While immunotherapies are increasingly becoming a standard of care for many cancers-including in the curative setting-their impacts on ovarian function and fertility are unknown. We evaluated the effect of immune checkpoint inhibitors blocking programmed cell death protein ligand 1 and cytotoxic T lymphocyte-associated antigen 4 on the ovary using tumor-bearing and tumor-free mouse models. We find that immune checkpoint inhibition increases immune cell infiltration and tumor necrosis factor-α expression within the ovary, diminishes the ovarian follicular reserve and impairs the ability of oocytes to mature and ovulate. These data demonstrate that immune checkpoint inhibitors have the potential to impair both immediate and future fertility, and studies in women should be prioritized. Additionally, fertility preservation should be strongly considered for women receiving these immunotherapies, and preventative strategies should be investigated in future studies.
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Affiliation(s)
- Amy L Winship
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Lauren R Alesi
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Sneha Sant
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jessica M Stringer
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Aldana Cantavenera
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Teharn Hegarty
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Carolina Lliberos Requesens
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Seng H Liew
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Urooza Sarma
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Meaghan J Griffiths
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Nadeen Zerafa
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Stephen B Fox
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Emmaline Brown
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Franco Caramia
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia
| | - Pirooz Zareie
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Nicole L La Gruta
- Department of Biochemistry and Molecular Biology, Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia
| | - Kelly-Anne Phillips
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Andreas Strasser
- The Walter and Eliza Hall Institute of Medical Research, Parkville, Victoria, Australia
- Department of Medical Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Sherene Loi
- Division of Research, Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, Victoria, Australia.
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia.
| | - Karla J Hutt
- Development and Stem Cell Program and Department of Anatomy and Developmental Biology, Biomedicine Discovery Institute, Monash University, Clayton, Victoria, Australia.
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Cortes J, Rugo HS, Cescon DW, Im SA, Yusof MM, Gallardo C, Lipatov O, Barrios CH, Perez-Garcia J, Iwata H, Masuda N, Torregroza Otero M, Gokmen E, Loi S, Guo Z, Zhou X, Karantza V, Pan W, Schmid P. Pembrolizumab plus Chemotherapy in Advanced Triple-Negative Breast Cancer. N Engl J Med 2022; 387:217-226. [PMID: 35857659 DOI: 10.1056/nejmoa2202809] [Citation(s) in RCA: 239] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In an interim analysis of this phase 3 trial, the addition of pembrolizumab to chemotherapy resulted in longer progression-free survival than chemotherapy alone among patients with advanced triple-negative breast cancer whose tumors expressed programmed death ligand 1 (PD-L1) with a combined positive score (CPS; the number of PD-L1-staining tumor cells, lymphocytes, and macrophages, divided by the total number of viable tumor cells, multiplied by 100) of 10 or more. The results of the final analysis of overall survival have not been reported. METHODS We randomly assigned patients with previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer in a 2:1 ratio to receive pembrolizumab (200 mg) every 3 weeks plus the investigator's choice of chemotherapy (nanoparticle albumin-bound paclitaxel, paclitaxel, or gemcitabine-carboplatin) or placebo plus chemotherapy. The primary end points were progression-free survival (reported previously) and overall survival among patients whose tumors expressed PD-L1 with a CPS of 10 or more (the CPS-10 subgroup), among patients whose tumors expressed PD-L1 with a CPS of 1 or more (the CPS-1 subgroup), and in the intention-to-treat population. Safety was also assessed. RESULTS A total of 847 patients underwent randomization: 566 were assigned to the pembrolizumab-chemotherapy group, and 281 to the placebo-chemotherapy group. The median follow-up was 44.1 months. In the CPS-10 subgroup, the median overall survival was 23.0 months in the pembrolizumab-chemotherapy group and 16.1 months in the placebo-chemotherapy group (hazard ratio for death, 0.73; 95% confidence interval [CI], 0.55 to 0.95; two-sided P = 0.0185 [criterion for significance met]); in the CPS-1 subgroup, the median overall survival was 17.6 and 16.0 months in the two groups, respectively (hazard ratio, 0.86; 95% CI, 0.72 to 1.04; two-sided P = 0.1125 [not significant]); and in the intention-to-treat population, the median overall survival was 17.2 and 15.5 months, respectively (hazard ratio, 0.89; 95% CI, 0.76 to 1.05 [significance not tested]). Adverse events of grade 3, 4, or 5 that were related to the trial regimen occurred in 68.1% of the patients in the pembrolizumab-chemotherapy group and in 66.9% in the placebo-chemotherapy group, including death in 0.4% of the patients in the pembrolizumab-chemotherapy group and in no patients in the placebo-chemotherapy group. CONCLUSIONS Among patients with advanced triple-negative breast cancer whose tumors expressed PD-L1 with a CPS of 10 or more, the addition of pembrolizumab to chemotherapy resulted in significantly longer overall survival than chemotherapy alone. (Funded by Merck Sharp and Dohme; KEYNOTE-355 ClinicalTrials.gov number, NCT02819518.).
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Affiliation(s)
- Javier Cortes
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Hope S Rugo
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - David W Cescon
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Seock-Ah Im
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Mastura M Yusof
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Carlos Gallardo
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Oleg Lipatov
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Carlos H Barrios
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Jose Perez-Garcia
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Hiroji Iwata
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Norikazu Masuda
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Marco Torregroza Otero
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Erhan Gokmen
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Sherene Loi
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Zifang Guo
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Xuan Zhou
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Vassiliki Karantza
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Wilbur Pan
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Peter Schmid
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
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van Geelen CT, Savas P, Teo ZL, Luen SJ, Weng CF, Ko YA, Kuykhoven KS, Caramia F, Salgado R, Francis PA, Dawson SJ, Fox SB, Fellowes A, Loi S. Correction to: Clinical implications of prospective genomic profiling of metastatic breast cancer patients. Breast Cancer Res 2022; 24:50. [PMID: 35841108 PMCID: PMC9284837 DOI: 10.1186/s13058-022-01539-7] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | - Peter Savas
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Zhi Ling Teo
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen J Luen
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Chen-Fang Weng
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Yi-An Ko
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Keilly S Kuykhoven
- Australian Centre for Disease Preparedness, Commonwealth Scientific and Industrial Research Organisation (CSIRO) Health and Biosecurity, Geelong, Australia
| | - Franco Caramia
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Roberto Salgado
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Sarah-Jane Dawson
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Stephen B Fox
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan St, Melbourne, VIC, 3000, Australia
| | - Andrew Fellowes
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sherene Loi
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia. .,Sir Peter MacCallum Department of Oncology, University of Melbourne, 305 Grattan St, Melbourne, VIC, 3000, Australia.
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Takano T, Cortes J, Cescon DW, Im SA, Yusof MM, Iwata H, Masuda N, Huang CS, Chung CF, Tsugawa K, Park YH, Matsumoto K, Inoue K, Kwong A, Loi S, Fu W, Pan W, Karantza V, Rugo HS, Schmid P. PS2-2 KEYNOTE-355 Asian subset: Pembrolizumab + chemotherapy vs placebo + chemotherapy for triple-negative breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.05.065] [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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Savas P, Lo LL, Luen SJ, Blackley EF, Callahan J, Moodie K, van Geelen CT, Ko YA, Weng CF, Wein L, Silva MJ, Zivanovic Bujak A, Yeung MM, Ftouni S, Hicks RJ, Francis PA, Lee CK, Dawson SJ, Loi S. Alpelisib monotherapy for PI3K-altered, pre-treated advanced breast cancer: a phase 2 study. Cancer Discov 2022; 12:2058-2073. [PMID: 35771551 DOI: 10.1158/2159-8290.cd-21-1696] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 05/12/2022] [Accepted: 06/26/2022] [Indexed: 11/16/2022]
Abstract
There is limited knowledge on the benefit of the α-subunit specific PI3K inhibitor alpelisib in later lines of therapy for advanced ER+HER2- and triple negative breast cancer (TNBC). We conducted a phase 2 multi-cohort study of alpelisib monotherapy in patients with advanced PI3K pathway mutant ER+HER2- and TNBC. In the intention to treat ER+ cohort, the overall response rate was 30% and the clinical benefit rate was 36%. Decline in PI3K pathway mutant ctDNA levels from baseline to week 8 while on therapy was significantly associated with a partial response, clinical benefit and improved progression free-survival (HR 0.24 95% CI 0.083 - 0.67, P = 0.0065). Detection of ESR1 mutations at baseline in plasma was also associated with clinical benefit and improved progression free survival (HR 0.22 95% CI 0.078 - 0.60, P = 0.003).
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Affiliation(s)
- Peter Savas
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Louisa L Lo
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen J Luen
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | | | | | - Kate Moodie
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Yi-An Ko
- Peter MacCallum Cancer Centre, Australia
| | | | - Lironne Wein
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Sarah Ftouni
- Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia
| | | | | | - Chee Khoon Lee
- University of Sydney, Sydney, New South Wales, Australia
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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Dixon-Douglas J, Loibl S, Denkert C, Telli M, Loi S. Integrating Immunotherapy Into the Treatment Landscape for Patients With Triple-Negative Breast Cancer. Am Soc Clin Oncol Educ Book 2022; 42:1-13. [PMID: 35649211 DOI: 10.1200/edbk_351186] [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: 11/20/2022]
Abstract
Triple-negative breast cancer (TNBC) is the most aggressive histologic subtype of breast cancer for which, until recently, treatment options have been limited to chemotherapy. In recent years, an improved understanding of the importance of tumor-infiltrating lymphocytes and the tumor microenvironment in TNBC has led to investigation of immune checkpoint inhibitors for treatment. There is now evidence from several randomized controlled trials that supports the addition of immune checkpoint inhibitors to first-line treatment of advanced TNBC and to neoadjuvant chemotherapy for stage II-III TNBC. In parallel, the PARP inhibitors have emerged as a targeted therapy option for patients with HER2-negative breast cancer harboring mutations in BRCA1, BRCA2, and PALB2. Here, we review the recent clinical trials that inform the integration of immune checkpoint inhibitors into treatments for TNBC and discuss ongoing challenges-including patient selection, management of resistance to post-checkpoint inhibitor therapy, and combining immunotherapy with targeted therapies, including PARP inhibitors.
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Affiliation(s)
- Julia Dixon-Douglas
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sibylle Loibl
- Goethe University Frankfurt, Germany.,Centre for Haematology and Oncology, Bethanein, Frankfurt, Germany.,German Breast Group, Neu-Isenburg, Germany
| | - Carsten Denkert
- Institute of Pathology, Philipps-Universität Marburg and University Hospital of Giessen and Marburg, Marburg, Germany
| | - Melinda Telli
- Division of Medical Oncology, Stanford University School of Medicine, Stanford, CA
| | - Sherene Loi
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Molinero L, Emens LA, Goldstein LD, Abbas AR, Koeppen H, Rugo HS, Adams S, Chui SY, Schmid P, Loi S. Mechanisms of action and acquired resistance to atezolizumab plus nab-paclitaxel in metastatic triple-negative breast cancer (mTNBC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1078] [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: 11/20/2022] Open
Abstract
1078 Background: In the IMpassion130 study (NCT02425891) first-line atezolizumab plus nab-paclitaxel (A+nP) provided clinical benefit compared with placebo plus nP (P+nP) in patients with mTNBC whose tumors were PD-L1+ (Schmid NEJM 2018). However, in many patients, disease that was initially controlled eventually progressed. The mechanism of action of A+nP and nP in the mTNBC tumor microenvironment (TME) and the biological changes associated with tumor progression with these therapies remain largely unknown. The goal of the current study was to evaluate biological changes in the TME induced by atezolizumab and nP early on treatment (OT) and at the time of progressive disease (PD) in IMpassion130. Methods: Paired tumor biopsies from IMpassion130 collected pre-treatment at baseline (BL), after 4 weeks OT, and at clinical PD were evaluated histologically for PD-L1 expression, CD8 content, stromal tumor infiltrating lymphocytes and immune phenotypes. RNA sequencing was also used to evaluate TNBC molecular subtypes and gene expression (hallmark gene sets, and immune cell and stromal gene signatures). Matched tumor pair samples from BL and PD were further analyzed by next-generation sequencing for genomic changes using the FoundationOne gene panel. Wilcoxon, Fisher, and McNemar’s tests were used for statistical analysis. Results: OT A+nP (n = 24 pairs), but not P+nP (n = 18 pairs) increased PD-L1 in both tumor-infiltrating immune cells and tumor cells, and increased frequency of immune-inflamed tumors. RNA-based signatures for A+nP showed an increase in lymphocytes (T-, B-, and NK cell), as well as IFN-α and IFN-γ responses, driven mainly by responders. While P+nP increased RNA-based stromal signatures (cancer-associated fibroblasts, pericytes, and angiogenesis) and epithelial mesenchymal transition, these changes were not observed with A+nP. OT A+nP and P+nP both reduced cell proliferation but only A+nP reduced metabolic pathways. At PD there was a significant reduction of RNA-based immune and stromal signatures in both A+nP (n = 59) and P+nP (n = 55) arms. Cell proliferation and DNA repair signatures were increased with A+nP but not P+nP. Evaluation of genomic changes suggested that both A+nP and P+nP increased tumor mutational burden (TMB), but only A+nP increased genomic scarring. At PD, the tumor immune phenotypes changed at PD with no directionality, while TNBC subtypes remained stable. Conclusions: A+nP boosted tumor immune inflammation and decreased tumor cell proliferation and metabolism in mTNBC patients, particularly in responders. Addition of atezolizumab prevented early stromal recruitment induced by nP. While decreased immune and stromal components and increased TMB were observed with both nP and A+nP, A+nP tumor escape was characterized by increased cell proliferation and DNA scarring. Clinical trial information: NCT02425891.
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Affiliation(s)
| | - Leisha A. Emens
- University of Pittsburgh Medical Center Hillman Cancer Center/Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | | | | | | | - Hope S. Rugo
- University ofSan Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Sylvia Adams
- NYU Perlmutter Cancer Center, NYU Langone Health, New York, NY
| | | | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Andre F, Hamilton EP, Loi S, Im SA, Sohn J, Tseng LM, Anders CK, Schmid P, Boston S, Darilay A, Herbolsheimer PM, Konpa A, Patel G, Yu T, Wrona M, Jhaveri KL. Dose-finding and -expansion studies of trastuzumab deruxtecan in combination with other anti-cancer agents in patients (pts) with advanced/metastatic HER2+ (DESTINY-Breast07 [DB-07]) and HER2-low (DESTINY-Breast08 [DB-08]) breast cancer (BC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.3025] [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: 11/20/2022] Open
Abstract
3025 Background: Trastuzumab deruxtecan (T-DXd), an antibody-drug conjugate composed of a humanized anti-HER2 monoclonal antibody and a topoisomerase I inhibitor payload, is approved for pts with unresectable or metastatic HER2+ BC with ≥2 prior anti-HER2–based therapies. T-DXd showed improved progression-free survival vs trastuzumab emtansine (T-DM1) as an earlier-line treatment (tx) for pts with HER2+ metastatic BC in the phase 3 DESTINY-Breast03 trial (Cortes J, et al. Ann Oncol. 2021;32:S1283-S1346. Abstract LBA1). Preliminary antitumor activity of T-DXd was shown in heavily pretreated pts with HER2-low advanced/metastatic BC in the phase 1 DS8201-A-J101 trial (Modi S, et al. J Clin Oncol. 2020;38:1887-1896). We report preliminary results from the dose-finding phase of 2 trials investigating T-DXd combination tx in HER2+ or HER2-low metastatic BC. Methods: DB-07 (phase 1b/2; NCT04538742) and DB-08 (phase 1b; NCT04556773) are 2-part, modular, open-label, multicenter trials of T-DXd combined with other anticancer tx in pts with advanced/metastatic BC that is HER2+ (DB-07) or HER2 low (DB-08). Part 1 of each study is an ongoing dose-finding phase; pts must have ≥1 prior tx for metastatic BC. Part 2 of each study is a dose-expansion phase; pts must have no (DB-07) or ≤1 (DB-08) prior tx for metastatic BC. We report preliminary results from the T-DXd + pertuzumab module of DB-07 part 1 (data cutoff: Oct 15, 2021) and T-DXd + anastrozole and T-DXd + fulvestrant modules of DB-08 part 1 (data cutoff: Sep 27, 2021); pts in the DB-08 modules must be hormone receptor positive. The part 1 primary objective was to assess safety and tolerability and determine the recommended phase 2 dose (RP2D) according to the modified toxicity probability interval-2 algorithm. Pts were followed up beyond the 21-day dose-limiting toxicity (DLT) period (28 days for T-DXd + fulvestrant) for safety events. Results: In DB-07, 7 pts were enrolled and received T-DXd 5.4 mg/kg + pertuzumab 420 mg (loading dose: 840 mg) every 3 wk (q3w; not evaluable for DLTs, n = 1). In DB-08, 6 pts were enrolled and received T-DXd 5.4 mg/kg q3w + anastrozole 1 mg daily (not evaluable for DLTs, n = 1); another 6 pts were enrolled and received T-DXd 5.4 mg/kg q3w + fulvestrant 500 mg every 4 wk (loading dose: 500 mg cycle 1 days 1 and 15). For all 3 modules, no DLTs were reported in any DLT-evaluable pts; the dose levels used in part 1 were approved to be the RP2Ds for use in the dose-expansion part of each corresponding module. No deaths on study or cases of interstitial lung disease/pneumonitis were reported to date. Conclusions: The RP2Ds for the T-DXd combinations were the standard doses for BC of each individual drug. These studies are ongoing, with additional T-DXd combinations being evaluated and further follow-up underway. Clinical trial information: NCT04538742; NCT04556773.
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Affiliation(s)
- Fabrice Andre
- Gustave Roussy, Université Paris-Sud, Villejuif, France
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Seock-Ah Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University, College of Medicine, Seoul, South Korea
| | - Joohyuk Sohn
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | | | | | - Peter Schmid
- Barts Cancer Institute, Centre for Experimental Cancer Medicine, Queen Mary University of London, London, United Kingdom
| | | | | | | | - Adam Konpa
- AstraZeneca, Warsaw, Mazowieckie, Poland
| | - Gargi Patel
- AstraZeneca Pharmaceuticals LP, Cambridge, United Kingdom
| | - Tinghui Yu
- AstraZeneca Pharmaceuticals LP, Gaithersburg, MD
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Harding JJ, Piha-Paul SA, Shah RH, Cleary JM, Quinn DI, Brana I, Moreno V, Borad MJ, Loi S, Spanggaard I, Ford JM, DiPrimeo D, Berger MF, Eli LD, Meric-Bernstam F, Solit DB, Abou-Alfa GK. Targeting HER2 mutation–positive advanced biliary tract cancers with neratinib: Final results from the phase 2 SUMMIT basket trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.4079] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
4079 Background: HER2 mutations are infrequent genomic events in biliary tract cancers (BTCs) and are associated with poor overall survival (OS) in patients with metastatic disease. HER2 overexpression is associated with an increased risk of disease recurrence in patients with resected BTC. There is limited data on targeting HER2 in BTC harboring activating somatic HER2 mutations. Neratinib, an irreversible, pan-HER, oral tyrosine kinase inhibitor, interferes with constitutive receptor kinase activation and has demonstrated activity in several HER2-mutant solid tumors. Methods: SUMMIT is an open-label, single-arm, multi-cohort, phase 2, ‘basket’ trial of neratinib in patients with solid tumors harboring oncogenic HER2 somatic mutations. The primary objective of the BTC cohort was to estimate objective response rate (ORR). Secondary objectives were clinical benefit rate (CBR), progression-free survival (PFS), OS, response duration, safety, and tolerability. Retrospective central confirmation of locally reported HER2 mutation (next-generation sequencing on archival or fresh tumor tissue using MSK-IMPACT or in cfDNA extracted from plasma by MSK-ACCESS) and association with outcome was an exploratory endpoint. This trial is registered with ClinicalTrials.gov (NCT01953926). Results: 25 treatment-refractory patients with metastatic BTC were enrolled (11 cholangiocarcinoma, 10 gallbladder, 4 ampullary cancers). ORR was 16% (95% CI 4.5–36.1%) and CBR was 28% (95% CI 12.1–49.4%). Median PFS and OS were 2.8 (95% CI 1.1–3.7) and 5.4 (95% CI 3.7–11.7) months, respectively. Median PFS for the gallbladder, cholangiocarcinoma and ampulla cohorts was 3.7 (95% CI 0.8–6.4), 1.4 (95% CI 0.5–9.1), and 1.1 (95% CI 1.1–3.8) months, respectively. Corresponding median OS values in these cohorts were 9.8 (95% CI 2.4–NE), 5.4 (95% CI 0.8–16.2), and 5.0 (95% CI 3.7–10.2) months, respectively. Central mutation confirmation was feasible for 23 of 25 patients; 22 were concordant with enrolment assays. The most common HER2 mutations were S310F (n = 11; 48%) and V777L (n = 4; 17%). Exploratory analyses suggested worse outcomes for HER2-mutant tumors with co-occurring oncogenic TP53 and CDKN2A alterations. Loss of amplified HER2 S310F and acquisition of multiple previously undetected oncogenic co-mutations were identified at progression in one of four responders. Diarrhea (56% any grade) was the most common toxicity. Conclusions: Neratinib is tolerable with modest antitumor activity in patients with BTC harboring HER2 mutations. Although the primary endpoint was met, future studies should evaluate rational combinations to augment and/or prolong responses. Clinical trial information: NCT01953926.
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Affiliation(s)
- James J. Harding
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
| | | | - Ronak H. Shah
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - David I. Quinn
- University of Southern California Norris Comprehensive Cancer Center, Los Angeles, CA
| | - Irene Brana
- Vall d’Hebron University Hospital and Institute of Oncology (VHIO), Medical Oncology Department, Barcelona, Spain
| | - Victor Moreno
- START Madrid-FJD, Fundación Jiménez Díaz Hospital, Madrid, Spain
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Iben Spanggaard
- Rigshospitalet – Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Michael F. Berger
- Memorial Sloan Kettering Cancer Center, Kravis Center for Molecular Oncology, Sloan Kettering Institute, New York, NY
| | | | | | - David B. Solit
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, Kravis Center for Molecular Oncology, Sloan Kettering Institute, New York, NY
| | - Ghassan K. Abou-Alfa
- Memorial Sloan Kettering Cancer Center, Weill Cornell Medical College, New York, NY
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Jhaveri KL, Goldman JW, Hurvitz SA, Guerrero-Zotano A, Unni N, Brufsky A, Park H, Waisman JR, Yang ESH, Spanggaard I, Reid SA, Burkard ME, Prat A, Loi S, Crown J, Hanker A, Ma CX, Bose R, Eli LD, Wildiers H. Neratinib plus fulvestrant plus trastzuzumab (N+F+T) for hormone receptor-positive (HR+), HER2-negative, HER2-mutant metastatic breast cancer (MBC): Outcomes and biomarker analysis from the SUMMIT trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1028 Background: N is an oral, irreversible pan-HER TKI with activity against HER2 mutations. Genomic analyses from the SUMMIT MBC cohort following N±F suggest that resistance to N may occur via mutant allele amplification or secondary HER2 mutations. Adding T to N+F in SUMMIT showed encouraging durable responses in patients (pts) with HR+, HER2-mutant MBC and prior CDK4/6 inhibitors (CDK4/6i). Methods: SUMMIT (NCT01953926) enrolled pts with HR+, HER2-negative MBC with activating HER2 mutation(s) and prior CDK4/6i. Pts received N+F+T (oral N 240 mg/d with loperamide prophylaxis, im F 500 mg d1&15 of cycle 1 then q4w, iv T 8 mg/kg initially then 6 mg/kg q3w). During the small, randomized portion of the trial, pts received N+F+T, F+T or F (1:1:1 ratio). Pts randomized to F+T or F could crossover to N+F+T at progression. Efficacy endpoints: investigator-assessed ORR and CBR (RECIST v1.1); DOR; best overall response. Pre-treatment tumor tissue was centrally assessed retrospectively by next-generation sequencing. ctDNA from patient samples was assessed by NGS. Results: SUMMIT has completed enrolment; we report efficacy from 45 pts in the N+F+T cohort, plus 10 pts who progressed on F (n=6) or F+T (n=4) and crossed over to N+F+T (Table). HER2 allelic variants in the 45 N+F+T pts and ORR (%) (pts may have >1 mutation) were: V777L (n=6, 50%), L755S/P (n=15, 40%), S310F (n=4, 50%), exon 20 insertion (n=11, 36%), other KD missense (n=6, 33%), TMD missense (n=2, 0%), exon 19 deletion (n=1, 0%). Conclusions: N+F+T is a promising combination for HR+, HER2-mutated MBC with prior exposure to CDK4/6i, across a range of activating HER2 mutations. Results from the upcoming Apr 2022 data cut, including biomarkers, safety, mechanisms of acquired resistance, and preclinical mechanism of N+T, will be presented. Clinical trial information: NCT01953926. [Table: see text]
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Affiliation(s)
| | | | - Sara A. Hurvitz
- David Geffen School of Medicine; University of California, Los Angeles; Jonsson Comprehensive Cancer Center, Santa Monica, CA
| | | | - Nisha Unni
- The University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Haeseong Park
- Washington University School of Medicine, St. Louis, MO
| | | | | | - Iben Spanggaard
- Rigshospitalet – Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Mark E. Burkard
- University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Aleix Prat
- Hospital Clínic de Barcelona, Barcelona, Spain
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - John Crown
- St. Vincent's Private Hospital, Dublin, Ireland
| | - Ariella Hanker
- University of Texas Southwestern Medical Center, Dallas, TX
| | | | - Ron Bose
- Washington University, St. Louis, MO
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Regan MM, Niman SM, Fleming GF, Walley B, Viale G, Thurlimann BJK, Loi S, Colleoni M, Pagani O, Francis PA. Historical early treatment effects of adjuvant endocrine therapy for breast cancer in high-risk subgroups: Reanalysis of BIG 1-98, SOFT and TEXT. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.508] [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: 11/20/2022] Open
Abstract
508 Background: Clinical trials testing adjuvant endocrine therapy (ET) have not historically limited enrollment to patients with clinically high-risk breast cancer (BC), nor estimated treatment (trt) effects prior to 5 yrs. In light of recent trial results for adjuvant CDK4/6 inhibitors, we estimated early relative and absolute trt effects of aromatase inhibitor (AI) vs tamoxifen (T), with ovarian suppression (OFS) if premenopausal, in high risk subgroups. Methods: From pts enrolled in adjuvant phase 3 randomized clinical trials BIG 1-98 (postmenopausal, 5yr AI v T), TEXT (5yr AI+OFS v T+OFS) and SOFT (5yr AI+OFS v T+OFS v T), we identified subgroups with HR+/HER2- BC and high risk features (≥4 pLN; or 1-3 pLN with grade 3, pT≥5 cm and/or Ki-67≥20% [retrospectively centrally assessed]). TEXT randomized at start of adjuvant trt; BIG 1-98 and SOFT after chemotherapy. Disease-free survival (DFS) was defined from randomization to invasive recurrence at local, regional, distant or contralateral breast, second non-breast malignancy or death. We estimated trt effects as differences in 2, 3 and 5yr DFS Kaplan-Meier estimates (KM diffs at t yrs) and hazard ratios over time intervals of 0-2, 0-3 and 0-5 yrs (HRs over 0 to t yrs) to approximate the maturity of trial results with increasing follow-up. Results: The high-risk HR+/HER2- subgroups were 695/4922, 707/2660 and 526/3047 pts in BIG 1-98, TEXT and SOFT with 202, 122, 142 DFS events observed by 5 yrs since randomization. 60%, 46% and 44% of pts had ≥4 pLNs; 42%, 90% and 92% had chemotherapy. The table summarizes results. Conclusions: In re-analysis of clinical high risk HR+/HER2- subgroups of 3 trials each ̃700 pts, 5 yrs AI vs T had similar magnitude of early trt effects after 2-3 yrs follow-up of all pts vs trt effects observed after 27 mos median follow-up in monarchE trial (HR=0.70; KM diffs 2.7% at 2 yrs, 5.4% at 3 yrs; n=5637). Relative and absolute trt effects sometimes diminished when estimated over 5 yrs rather than over 2 yrs, but meaningful absolute differences remained at 5 yrs in contrast to Penelope-B trial results. Design and interpretation of high risk HR+/HER2- early BC trials may depend on timing of randomization and selection of backbone adjuvant trts; follow-up >5 yrs must remain standard. [Table: see text]
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Affiliation(s)
- Meredith M. Regan
- Dana-Farber Cancer Institute and International Breast Cancer Study Group, Boston, MA
| | | | | | | | - Giuseppe Viale
- European Institute of Oncology, University of Milan, Milan, Italy
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Marco Colleoni
- Senologia Medica, IEO, Istituto Europeo di Oncologia, IRCCS, Milano, Italy
| | - Olivia Pagani
- Geneva University Hospitals, SAKK, Lugano Viganello, Switzerland
| | - Prudence A. Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Rogerson S, Turner H, Bilkhu A, Monturus E, Knott A, Restuccia E, Quashie N, Wheatley D, Gilham L, Hurvitz SA, Schmid P, Bachelot T, Bianchini G, Harbeck N, Loi S, Park YH, Prat A, Simkins T. Diversity, inclusion, and patient (pt)-centricity in the randomized, double-blind, phase III ASTEFANIA study of ado-trastuzumab emtansine (T-DM1) ± atezolizumab in pts with HER2-positive early breast cancer (EBC) with residual invasive disease after preoperative chemotherapy and anti-HER2 therapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e12504] [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: 11/20/2022] Open
Abstract
e12504 Background: Representative pt populations in clinical trials are essential to address healthcare disparities between different racial/ethnic groups, including treatment access and pt outcomes. Many clinical trials mainly include White pts, which may limit the generalizability of the results to the global population. A framework that was recently developed by Genentech for improving inclusion of underrepresented pt groups, as well as the CHIMES (NCT04377555) and EMPACTA (NCT04372186) studies, have all shown the feasibility of inclusive studies. ASTEFANIA (NCT04873362) is a pt-centric study, which includes pt/investigator collaboration to keep a pt focus and tactics to recruit a diverse population and enable participation of underserved communities. We report early recruitment data. Methods: Global/local initiatives and inclusive eligibility criteria remove barriers to enrollment of underserved pts and support treatment journeys. Eligible pts (Eastern Cooperative Oncology Group performance status of 0/1; no prior immune checkpoint inhibitor treatment) are randomized 1:1 to T-DM1 (3.6 mg/kg) + atezolizumab (1200 mg)/placebo every 3 weeks for 14 cycles (stratification factors: clinical stage, hormone receptor status, preoperative anti-HER2 therapy, PD-L1 status). Primary endpoints: IDFS in intention-to-treat and PD-L1-positive populations. Secondary endpoints include overall survival, patient-reported outcomes (PROs), and safety. To remove pt access barriers and ease pt burden, consent and PRO forms are available in multiple languages, mobile nursing/telemedicine is planned for pts in rural areas, a wellness app and culturally sensitive support videos are being created, and financial support is provided for study-related expenses and loss of earnings. Results: Recruitment began in May 2021. By Feb 9, 2022, 236 pts were randomized: 147 White (62%), 72 Asian (31%; Indian [n = 4], Korean [46], Chinese [16], other [6]), 10 Hispanic (4%; 5 of whom also identify as American Indian), 2 Black (1%), and 5 pts (2%) whose race/ethnicity was unreported/unknown. Of these, 27 (11%) have received financial support. Enrollment in Africa begins later this year. Mobile nursing/telemedicine is planned for 14 countries. Conclusions: As the first study of its kind in HER2-positive EBC, ASTEFANIA actively aims to be accessible and include pts from a range of races/ethnicities and socially underserved backgrounds. There is a growing need for more compassionate and inclusive research. To do this, forward planning of pt-centric studies is essential to reduce the burden on study resources. We hope that the tactics outlined here will allow us to achieve our goals of inclusive research. Clinical trial information: NCT04873362.
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Affiliation(s)
| | - Howard Turner
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | | | | | - Adam Knott
- Roche Products, Ltd., Welwyn Garden City, United Kingdom
| | | | - Nigel Quashie
- Roche Products Ltd, Welwyn Garden City, United Kingdom
| | | | | | - Sara A. Hurvitz
- University of California, Los Angeles/Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | | | | | - Nadia Harbeck
- Ludwig-Maximilian University of Munich, Munich, Germany
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Aleix Prat
- Hospital Clinic of Barcelona, Barcelona, Spain
| | - Tracy Simkins
- Roche Products Ltd, Welwyn Garden City, United Kingdom
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Molinero L, Guan X, Deurloo R, Gozlan Y, Sharim H, Emens LA, Cameron DA, Schmid P, Miles D, Adams S, Chui SY, Mariathasan S, O'Shaughnessy J, Andre F, Loi S. Impact of steroid premedication on atezolizumab (atezo)-induced immune cell activation: A comparative analysis of IMpassion130 and IMpassion131 peripheral blood mononuclear cells (PBMCs). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1083] [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: 11/20/2022] Open
Abstract
1083 Background: The immune checkpoint inhibitor (ICI) atezo showed disparate outcomes as first-line therapy for metastatic TNBC when combined with nab-paclitaxel (nPac) in IMpassion130 [Schmid 2018] vs solvent-based paclitaxel (Pac) in IMpassion131 [Miles 2021]. A key difference between the trials was use of steroid premedication for Pac in IMpassion131 but not for nPac in IMpassion130. In patients (pts) receiving ICIs, prior steroid exposure has been linked to worse outcome [Drakaki 2020]. Further, IMpassion130 and IMpassion131 subgroup analyses suggested reduced atezo treatment effect in taxane-pretreated pts. This post hoc biomarker study explored the impact of: 1) steroids on systemic immune cell activation with atezo+taxane; 2) prior taxane exposure on atezo-induced immune cell activation. Methods: PBMCs collected at baseline and at day 1, cycle 2 (wk 4) were selected from matched pts (RECIST responders, PD-L1+, no liver metastases) from IMpassion130 and IMpassion131. Single-cell RNAseq was performed and the transcriptomic profile of immune cells was analyzed using GSEA pathway analyses, cell proportion and TCR clonality. Results: CITEseq from 695,851 single cells was generated from 39 IMpassion130 PBMC pairs (29 atezo+nPac; 10 placebo [Pla]+nPac) and 35 IMpassion131 pairs (26 atezo+Pac; 9 Pla+Pac). At wk 4, atezo+nPac resulted in increased IFNα and IFNγ responses across multiple cell types (CD4+ and CD8+ T cells, B cells, NK cells and monocytes) and proliferation in NK cells, but reduced TNF signaling across multiple cell types. In contrast, 4 wks of Pla+nPac increased TNF signaling but decreased IFNα and IFNγ responses. In the presence of steroids, 4 wks of atezo+Pac also increased IFNα and IFNγ responses mainly in NK cells and monocytes, but not T cells, and reduced proliferative pathways across B and T cells and TNF signaling. Pla+Pac increased TNF signaling only in NK cells, but reduced proliferative signatures across cell types. The only on-treatment change differing significantly between atezo+nPac vs atezo+Pac was the increase in proliferation pathways in NK, T and B cells with atezo+nPac. There were no significant changes in proportions of cell subsets or TCR clonality. PBMCs from taxane-pretreated pts had higher RNA-based metabolic profile (OxPhos, DNA repair and IFNα). Taxane-naive but not taxane-pretreated immune cells had increased IFNγ and IFNα response after atezo+taxane. Conclusions: Our results suggest that atezo+taxane promotes IFNα and IFNγ responses and that steroid co-administration reduces proliferation pathways across immune cells. Prior taxane exposure was associated with an increased metabolic status, possibly rendering immune cells less sensitive to atezo-induced activation. The immune context of taxane-naive TNBC may result in more potent immune activation with atezo. Clinical trial information: NCT02425891 and NCT03125902.
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Affiliation(s)
| | | | | | | | | | - Leisha A. Emens
- University of Pittsburgh Medical Center Hillman Cancer Center/Department of Medicine, University of Pittsburgh, Pittsburgh, PA
| | - David A. Cameron
- Edinburgh University Cancer Centre, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, United Kingdom
| | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - David Miles
- Mount Vernon Cancer Centre, London, United Kingdom
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY
| | | | | | - Joyce O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology Network, Dallas, TX
| | - Fabrice Andre
- Gustave Roussy, Université Paris-Sud, Villejuif, France
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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72
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Loi S, Francis PA, Zdenkowski N, Gebski V, Fox SB, White M, Kiely BE, Woodward NE, Hui R, Redfern AD, Calvert R, Rennie L, Boyle FM. Neoadjuvant ipilimumab and nivolumab in combination with paclitaxel following anthracycline-based chemotherapy in patients with treatment resistant early-stage triple-negative breast cancer (TNBC): A single-arm phase 2 trial. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.602] [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: 11/20/2022] Open
Abstract
602 Background: We examined the efficacy and safety of neoadjuvant ipilimumab and nivolumab combined with paclitaxel following suboptimal response to anthracycline-based chemotherapy in patients with early-stage TNBC. Methods: This single arm multicentre phase 2 study enrolled 34 patients in 8 sites. Patients were aged ≥18 years with previously untreated stage 3 TNBC and were required to have ≥15mm of tumor remaining or 10mm of tumor with one positive lymph node after 4 cycles of anthracycline-based therapy. A suboptimal response subset at baseline was defined as < 50% reduction in tumor volume after initial anthracycline-based chemotherapy. Patients received neoadjuvant ipilimumab 1mg/kg IV 6 weekly for 2 doses and nivolumab 240mg every 2 weeks for 6 doses, with weekly paclitaxel at 80mg/m2 for 12 weeks, followed by surgery. Nivolumab (480mg 4-weekly) continued post operatively for further 9 months. Primary endpoint was pathological complete response (pCR) in breast and axilla, with secondary endpoints pCR in the suboptimal responders, pCR in PD-L1 positive patients (≥1% by SP142 assay), clinical response in the breast (ORR by RECIST), event-free (EFS) and overall survival (OS). Results: Between December 2018 and April 2020, 34 patients were enrolled, 33 were evaluable for the primary endpoint. Median age was 46.6yrs. At diagnosis, all patients were clinical stage III (AJCC v8), 16/34 (47%) were node positive, 8/31 (26%) were PD-L1 positive. At study entry (following anthracycline-based chemo), the median tumor size by ultrasound was 28mm (12-62). 16/33 (48%) were considered suboptimal responders. The pCR rate (ypT0ypN0) was 24.2% (95% CI, 11.09-42.26) in all evaluable, 37.5% [3/11] in PD-L1+ and 23% [5/22] in PD-L1- patients. In patients with suboptimal anthracycline response (< 50% tumor reduction), the pCR rate was 18.8% (95% CI, 8.52-75.51) (3/16). ORR in the breast was 57.6% (19/33) in all evaluable patients and 43.7% (8/20) in the suboptimal responders. The number of patients with residual cancer burden (RCB) class 0,1,2,3 was 8 (24%), 1 (3%), 19 (57.5%) and 5 (15%) respectively. With 14 months median follow up, 12-months EFS was estimated at 85% and OS 94%. For patients with pCR vs non-pCR, the hazard ratio (HR) for EFS was 0.62, 12 mo EFS was 100% vs 75%. In the neoadjuvant phase, 15/33 (45%) patients experienced at least one grade 3-4 adverse event. Most common immune-related event was grade 1 or 2 pneumonitis 9/33 (27%), which generally occurred with fever after the first dose of ipilimumab, and resolved. There was one case of grade 3 colitis. Conclusions: In these high risk patients, the addition of ipilimumab and nivolumab to neoadjuvant paclitaxel resulted in promising ORR and pCR rates, regardless of PD-L1 status. Rates of low grade pneumonitis were high. Follow up continues. Clinical trial information: ACTRN12617000651381.
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Affiliation(s)
- Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Prudence A. Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Val Gebski
- NHMRC Clinical Trials Centre, University of Sydney, Sydney, Australia
| | | | | | | | | | - Rina Hui
- Westmead Breast Cancer Institute, Westmead Hospital and the University of Sydney, Sydney, NSW, Australia
| | | | - Raewyn Calvert
- Breast Cancer Trials - Australia and New Zealand, Newcastle, NSW, Australia
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Cescon D, Schmid P, Rugo H, Im SA, Md Yusof M, Gallardo C, Lipatov O, Barrios C, Perez Garcia J, Iwata H, Masuda N, Torregroza Otero M, Gokmen E, Loi S, Haiderali A, Zhou X, Guo Z, Martin Nguyen A, Cortés J. 164O Health-related quality of life (HRQoL) with pembrolizumab (pembro) + chemotherapy (chemo) vs placebo (pbo) + chemo as 1L treatment for advanced triple-negative breast cancer (TNBC): Results from KEYNOTE-355. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.183] [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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74
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Murray N, Francis P, Zdenkowski N, Wilcken N, Boyle F, Gebski V, Tiley S, Gilham L, Dawson SJ, Loi S, Redfern A, Lombard J, Spillane A, Shadbolt C, Badger H. 91MO Randomized trial of neoadjuvant chemotherapy with or without concurrent aromatase inhibitor therapy to downstage ER+ve breast cancer: Breast Cancer Trials Group ANZ 1401 ELIMINATE trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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75
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Gelber RD, Wang XV, Cole BF, Cameron D, Cardoso F, Tjan-Heijnen V, Krop I, Loi S, Salgado R, Kiermaier A, Frank E, Fumagalli D, Caballero C, de Azambuja E, Procter M, Clark E, Restuccia E, Heeson S, Bines J, Loibl S, Piccart-Gebhart M. Six-year absolute invasive disease-free survival benefit of adding adjuvant pertuzumab to trastuzumab and chemotherapy for patients with early HER2-positive breast cancer: A Subpopulation Treatment Effect Pattern Plot (STEPP) analysis of the APHINITY (BIG 4-11) trial. Eur J Cancer 2022; 166:219-228. [DOI: 10.1016/j.ejca.2022.01.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 01/11/2022] [Accepted: 01/14/2022] [Indexed: 11/17/2022]
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76
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Greil R, Lin NU, Murthy RK, Abramson V, Anders C, Bachelot T, Bedard PL, Borges V, Cameron D, Carey L, Chien AJ, Curigliano G, DiGiovanna MP, Gelmon K, Hortobagyi G, Hurvitz S, Krop I, Loi S, Loibl S, Mueller V, Oliveira M, Paplomata E, Pegram M, Slamon D, Zelnak A, Ramos J, Feng W, Winer E. Aktualisierte Ergebnisse von Tucatinib versus Placebo in Kombination
mit Trastuzumab und Capecitabin bei Patienten mit vorbehandeltem, metastasierten
HER2-positiven Brustkrebs mit ZNS-Metastasen (HER2CLIMB). Geburtshilfe Frauenheilkd 2022. [DOI: 10.1055/s-0042-1746156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Affiliation(s)
- R Greil
- Dritte medizinische Abteilung, Paracelsus Medizinische
Universität Salzburg, Salzburger Krebsforschungsinstitut –
Zentrum für Klinische Krebs- und Immunologiestudien und Cancer Cluster
Salzburg, Salzburg. Österreich
| | - N U Lin
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - R K Murthy
- MD Anderson Cancer Center, Houston, Texas, USA
| | - V Abramson
- Vanderbilt University Medical Center, Nashville, Tennessee,
USA
| | - C Anders
- Duke Cancer Institute, Durham, North Carolina, USA
| | | | - P L Bedard
- University Health Network, Princess Margaret Cancer Centre, Toronto,
Ontario, Kanada
| | - V Borges
- University of Colorado Cancer Center, Aurora, Colorado,
USA
| | - D Cameron
- Edinburgh Cancer Research Centre, Edinburgh, Vereinigtes
Königreich
| | - L Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, North
Carolina, USA
| | - A J Chien
- University of California at San Francisco, San Francisco, Kalifornien,
USA
| | - G Curigliano
- Istituto Europeo di Oncologia, IRCCS, University of Milano, Mailand,
Italien
| | | | - K Gelmon
- British Columbia Cancer – Vancouver Centre, British Columbia,
Kanada
| | | | - S Hurvitz
- UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los
Angeles, Kalifornien, USA
| | - I Krop
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - S Loi
- Peter MacCallum Cancer Centre, Melbourne, Australien
| | - S Loibl
- Deutsche Brust-Gruppe, Neu-Isenburg. Deutschland
| | - V Mueller
- Universitätsklinikum Hamburg-Eppendorf, Hamburg,
Deutschland
| | - M Oliveira
- Hospital Universitario Vall D‘Hebron, Barcelona,
Spanien
| | - E Paplomata
- Carbone Cancer Center University of Wisconsin, Madison, Wisconsin,
USA
| | - M Pegram
- Stanford Comprehensive Cancer Institute Palo Alto, Kalifornien,
USA
| | - D Slamon
- UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los
Angeles, Kalifornien, USA
| | - A Zelnak
- Northside Hospital, Sandy Springs, Georgia, USA
| | - J Ramos
- Seagen Inc., Bothell, Washington, USA
| | - W Feng
- Seagen Inc., Bothell, Washington, USA
| | - E. Winer
- Dana-Farber Cancer Institute, Boston, Massachusetts, USA
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77
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Salgado R, Loi S. What's in a name? That which we call Immune Cells by any other name would all smell as sweet. Clin Cancer Res 2022; 28:2728-2729. [PMID: 35442426 DOI: 10.1158/1078-0432.ccr-22-0783] [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] [Received: 03/28/2022] [Revised: 04/12/2022] [Accepted: 04/14/2022] [Indexed: 11/16/2022]
Abstract
In the FUTURE-C-Plus phase 2 trial, patients with advanced previously untreated immune-enriched TNBC achieved an overall objective response rate of 81.3% with the combination of camrelizumab, famitinib and nab-paclitaxel. This supports that quantity of immune cells is important for identifying those with response to treatments combined with PD-1 targeting immunotherapy.
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Affiliation(s)
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
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78
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Beavis PA, Derrick EB, Loi S. Challenges of Creating New Tumor-Infiltrating Lymphocyte for Combating Breast Cancer. J Clin Oncol 2022; 40:1812-1815. [PMID: 35439032 DOI: 10.1200/jco.22.00284] [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: 11/20/2022] Open
Affiliation(s)
- Paul A Beavis
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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79
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de Jong VMT, Wang Y, Ter Hoeve ND, Opdam M, Stathonikos N, Jóźwiak K, Hauptmann M, Cornelissen S, Vreuls W, Rosenberg EH, Koop EA, Varga Z, van Deurzen CHM, Mooyaart AL, Córdoba A, Groen EJ, Bart J, Willems SM, Zolota V, Wesseling J, Sapino A, Chmielik E, Ryska A, Broeks A, Voogd AC, Loi S, Michiels S, Sonke GS, van der Wall E, Siesling S, van Diest PJ, Schmidt MK, Kok M, Dackus GMHE, Salgado R, Linn SC. Prognostic Value of Stromal Tumor-Infiltrating Lymphocytes in Young, Node-Negative, Triple-Negative Breast Cancer Patients Who Did Not Receive (neo)Adjuvant Systemic Therapy. J Clin Oncol 2022; 40:2361-2374. [PMID: 35353548 PMCID: PMC9287283 DOI: 10.1200/jco.21.01536] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [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] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Triple-negative breast cancer (TNBC) is considered aggressive, and therefore, virtually all young patients with TNBC receive (neo)adjuvant chemotherapy. Increased stromal tumor-infiltrating lymphocytes (sTILs) have been associated with a favorable prognosis in TNBC. However, whether this association holds for patients who are node-negative (N0), young (< 40 years), and chemotherapy-naïve, and thus can be used for chemotherapy de-escalation strategies, is unknown. METHODS We selected all patients with N0 TNBC diagnosed between 1989 and 2000 from a Dutch population–based registry. Patients were age < 40 years at diagnosis and had not received (neo)adjuvant systemic therapy, as was standard practice at the time. Formalin-fixed paraffin-embedded blocks were retrieved (PALGA: Dutch Pathology Registry), and a pathology review including sTILs was performed. Patients were categorized according to sTILs (< 30%, 30%-75%, and ≥ 75%). Multivariable Cox regression was performed for overall survival, with or without sTILs as a covariate. Cumulative incidence of distant metastasis or death was analyzed in a competing risk model, with second primary tumors as competing risk. RESULTS sTILs were scored for 441 patients. High sTILs (≥ 75%; 21%) translated into an excellent prognosis with a 15-year cumulative incidence of a distant metastasis or death of only 2.1% (95% CI, 0 to 5.0), whereas low sTILs (< 30%; 52%) had an unfavorable prognosis with a 15-year cumulative incidence of a distant metastasis or death of 38.4% (32.1 to 44.6). In addition, every 10% increment of sTILs decreased the risk of death by 19% (adjusted hazard ratio: 0.81; 95% CI, 0.76 to 0.87), which are an independent predictor adding prognostic information to standard clinicopathologic variables (χ2 = 46.7, P < .001). CONCLUSION Chemotherapy-naïve, young patients with N0 TNBC with high sTILs (≥ 75%) have an excellent long-term prognosis. Therefore, sTILs should be considered for prospective clinical trials investigating (neo)adjuvant chemotherapy de-escalation strategies. Young cancer patients with TNBC and high sTILs have an excellent outcome, even without systemic treatment![]()
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Affiliation(s)
- Vincent M T de Jong
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Yuwei Wang
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Natalie D Ter Hoeve
- Division of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Mark Opdam
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Nikolas Stathonikos
- Division of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Katarzyna Jóźwiak
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Michael Hauptmann
- Institute of Biostatistics and Registry Research, Brandenburg Medical School Theodor Fontane, Neuruppin, Germany
| | - Sten Cornelissen
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Willem Vreuls
- Department of Pathology, Canisius Wilhelmina Ziekenhuis, Nijmegen, Netherlands
| | - Efraim H Rosenberg
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Esther A Koop
- Department of Pathology, Gelre Ziekenhuizen, Apeldoorn, Netherlands
| | - Zsuzsanna Varga
- Departement of Pathology and Molecular Pathology, University Hospital Zurich, Zurich, Switzerland
| | | | - Antien L Mooyaart
- Department of Pathology, Erasmus University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Alicia Córdoba
- Department of Pathology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Emma J Groen
- Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Joost Bart
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, Netherlands
| | - Stefan M Willems
- University of Groningen, University Medical Center Groningen, Department of Pathology and Medical Biology, Groningen, Netherlands
| | - Vasiliki Zolota
- Department of Pathology, Rion University Hospital, Patras, Greece
| | - Jelle Wesseling
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Pathology, Leiden University Medical Center, Leiden, Netherlands
| | - Anna Sapino
- Department of Medical Sciences, University of Torino, Torino, Italy.,Candiolo Cancer Institute, FPO-IRCCS, Candiolo, Italy
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial National Research Institute of Oncology, Gliwice, Poland
| | - Ales Ryska
- Charles University Medical Faculty and University Hospital, Hradec Kralove, Czech Republic
| | - Annegien Broeks
- Core Facility Molecular Pathology and Biobanking, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Adri C Voogd
- Department of Epidemiology, Maastricht University, Maastricht, Netherlands.,Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, Netherlands
| | - Sherene Loi
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Inserm, Paris-Saclay University, labeled Ligue Contre le Cancer, Villejuif, France
| | - Gabe S Sonke
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | | | - Sabine Siesling
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Health Technology and Services Research, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Paul J van Diest
- Division of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Marjanka K Schmidt
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands.,Department of Clinical Genetics, Leiden University Medical Centre, Leiden, Netherlands
| | - Marleen Kok
- Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Gwen M H E Dackus
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands.,Division of Pathology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Roberto Salgado
- Division of Clinical Medicine and Research, Peter MacCallum Cancer Centre, Melbourne, Australia.,Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - Sabine C Linn
- Department of Molecular Pathology, Netherlands Cancer Institute, Amsterdam, Netherlands.,Division of Pathology, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Medical Oncology, Netherlands Cancer Institute, Amsterdam, Netherlands
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Malorni L, Tyekucheva S, Hilbers FS, Ignatiadis M, Neven P, Colleoni M, Henry S, Ballestrero A, Bonetti A, Jerusalem G, Papadimitriou K, Bernardo A, Seles E, Duhoux FP, MacPherson IR, Thomson A, Davies DM, Bergqvist M, Migliaccio I, Gebhart G, Zoppoli G, Bliss JM, Benelli M, McCartney A, Kammler R, De Swert H, Ruepp B, Fumagalli D, Maibach R, Cameron D, Loi S, Piccart M, Regan MM. Serum thymidine kinase activity in patients with hormone receptor-positive and HER2-negative metastatic breast cancer treated with palbociclib and fulvestrant. Eur J Cancer 2022; 164:39-51. [DOI: 10.1016/j.ejca.2021.12.030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Revised: 12/23/2021] [Accepted: 12/26/2021] [Indexed: 12/26/2022]
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Goh PK, Wiede F, Zeissig MN, Britt KL, Liang S, Molloy T, Goode N, Xu R, Loi S, Muller M, Humbert PO, McLean C, Tiganis T. PTPN2 elicits cell autonomous and non-cell autonomous effects on antitumor immunity in triple-negative breast cancer. Sci Adv 2022; 8:eabk3338. [PMID: 35196085 PMCID: PMC8865802 DOI: 10.1126/sciadv.abk3338] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Accepted: 12/24/2021] [Indexed: 05/22/2023]
Abstract
The tumor-suppressor PTPN2 is diminished in a subset of triple-negative breast cancers (TNBCs). Paradoxically, PTPN2-deficiency in tumors or T cells in mice can facilitate T cell recruitment and/or activation to promote antitumor immunity. Here, we explored the therapeutic potential of targeting PTPN2 in tumor cells and T cells. PTPN2-deficiency in TNBC associated with T cell infiltrates and PD-L1 expression, whereas low PTPN2 associated with improved survival. PTPN2 deletion in murine mammary epithelial cells TNBC models, did not promote tumorigenicity but increased STAT-1-dependent T cell recruitment and PD-L1 expression to repress tumor growth and enhance the efficacy of anti-PD-1. Furthermore, the combined deletion of PTPN2 in tumors and T cells facilitated T cell recruitment and activation and further repressed tumor growth or ablated tumors already predominated by exhausted T cells. Thus, PTPN2-targeting in tumors and/or T cells facilitates T cell recruitment and/or alleviates inhibitory constraints on T cells to combat TNBC.
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Affiliation(s)
- Pei Kee Goh
- Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Florian Wiede
- Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Mara N. Zeissig
- Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Kara L. Britt
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Shuwei Liang
- Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Tim Molloy
- St. Vincent’s Centre for Applied Medical Research, Darlinghurst, New South Wales 2010, Australia
| | - Nathan Goode
- Department of Biochemistry and Genetics, La Trobe Institute for Molecular Science, La Trobe University, Melbourne, Victoria 3086, Australia
| | - Rachel Xu
- Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
| | - Sherene Loi
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
| | - Mathias Muller
- Institute of Animal Breeding and Genetics, University of Veterinary Medicine Vienna, Vienna, Austria
| | - Patrick O. Humbert
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, 3010, Australia
- Research Centre for Molecular Cancer Prevention, La Trobe University, Melbourne, Victoria 3086, Australia
- Department of Biochemistry and Molecular Biology, University of Melbourne, Melbourne, Victoria 3010, Australia
- Department of Clinical Pathology, University of Melbourne, Melbourne, Victoria 3010, Australia
| | - Catriona McLean
- Anatomical Pathology, Alfred Hospital, Prahran, Victoria 3004, Australia
| | - Tony Tiganis
- Monash Biomedicine Discovery Institute, Monash University, Clayton, Victoria 3800, Australia
- Department of Biochemistry and Molecular Biology, Monash University, Clayton, Victoria 3800, Australia
- Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, Victoria 3000, Australia
- Corresponding author.
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Regan MM, Walley BA, Fleming GF, Francis PA, Colleoni MA, Láng I, Gómez HL, Tondini CA, Burstein HJ, Goetz MP, Ciruelos EM, Stearns V, Bonnefoi HR, Martino S, Geyer CE, Chini C, Minisini AM, Spazzapan S, Ruhstaller T, Winer EP, Ruepp B, Loi S, Coates AS, Goldhirsch A, Gelber RD, Pagani O. Abstract GS2-05: Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): update of the combined TEXT and SOFT trials. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs2-05] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [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 updated combined SOFT+TEXT analysis, after 9 years median follow-up (MFU), revealed that adjuvant E+OFS vs T+OFS significantly improved disease-free survival (DFS) and distant recurrence-free interval (DRFI) but not overall survival (OS) in premenopausal women with HR+ early BC (Francis et al NEJM 2018). Given the high rate of OS in both arms and the long-term risk of relapse in HR+ BC, continued follow-up is key to assessing treatment benefit. We report a planned update analysis including OS with database lock of May 2021, after 13 years MFU.. Methods TEXT and SOFT enrolled premenopausal women with HR+ early BC from November 2003 to April 2011 (2660 in TEXT, 3047 in SOFT intention-to-treat (ITT) populations). TEXT randomized women within 12 weeks of surgery to 5 years E+OFS vs T+OFS; chemotherapy (CT) was optional and concurrent with OFS. SOFT randomized women to 5 years E+OFS vs T+OFS vs T alone, within 12 weeks of surgery if no CT planned, or within 8 months of completing (neo)adjuvant CT. Both trials were stratified by CT use. For the combined analysis of E+OFS vs T+OFS, the primary endpoint was DFS defined as invasive local, regional, distant recurrence, contralateral BC, second malignancy, death. Secondary endpoints included invasive breast cancer-free interval (BCFI), DRFI and OS.. Results: At database lock there were 953 DFS events and 473 deaths among 4690 pts assigned to T+OFS or E+OFS. In the ITT population, DFS, BCFI and DRFI outcomes for pts assigned E+OFS (n=2346) continued to be significantly improved over T+OFS (n=2344). 12-yr DFS was 80.5% vs. 75.9% (4.6% absolute improvement; HR 0.79 95% CI 0.70-0.90), 12-yr BCFI was improved by 4.1% and 12-yr DRFI by 1.8%. At 12 years OS was excellent in both groups, 90.1% in pts assigned E+OFS vs 89.1% in pts assigned T+OFS (HR 0.93; 95% CI, 0.78-1.11). There was heterogeneity of relative treatment effect according to HER2 status. When enrollment commenced, anti-HER2 adjuvant therapy was not standard; 53% of 583 pts with HER2+ tumors received HER2-targeted therapy. Below are Kaplan-Meier 12-yr estimates for patients with HER2 negative tumors by trial and chemotherapy stratum and for those with high-grade tumours, as an example of high-risk feature (Table). There is an emerging OS benefit for E+OFS vs T+OFS in pts with HER2 negative tumors who received chemotherapy in both trials.In pts with HER2-negative tumors, clinically-relevant outcome benefits were also seen in other high-risk subgroups: 12-yr DFS and OS were improved by 7.4% and 2.7%, respectively, in pts with pN1a disease, and by 10.6% and 4.5%, respectively, in those with tumors >2cm.
Conclusions After 13 years MFU, adjuvant E+OFS, as compared with T+OFS, shows a sustained reduction in the risk of recurrence, more consistent in HER2 negative patients and in those with high-risk disease features, e.g., indication for adjuvant chemotherapy and G3 tumors. Oncologists may use this information to discuss potential benefits of E+OFS with individual patients. Follow-up continues for 5 additional years.
Chemotherapy HER2-negativeSOFTT+OFS (n=424)E+OFS (n=411)Absolute difference12-yr DFS67.4%74.1%6.7%12-yr OS81.1%84.4%3.3%TEXTT+OFS (n=656)E+OFS (n=661)Absolute difference12-yr DFS71.0%78.4%7.4%12-yr OS83.5%86.8%3.3%No chemotherapy HER2-negativeSOFTT+OFS (n=445)E+OFS (n=447)Absolute difference12-yr DFS82.9%88.2%5.3%12-yr OS96.1%96.9%0.9%TEXTT+OFS (n=499)E+OFS (n=492)Absolute difference12-yr DFS80.2%86.7%6.5%12-yr OS95.9%96.2%0.2%G3 HER2-negativeT+OFS (n=423)E+OFS (n=405)Absolute difference12-yr DFS62.7%73.0%10.3%12-yr OS78.1%83.6%5.5%
Citation Format: Meredith M Regan, Barbara A Walley, Gini F Fleming, Prudence A Francis, Marco A Colleoni, István Láng, Henry L Gómez, Carlo A Tondini, Harold J Burstein, Matthew P Goetz, Eva M Ciruelos, Vered Stearns, Hervé R Bonnefoi, Silvana Martino, Charles E Geyer, Jr, Claudio Chini, Alessandro M Minisini, Simon Spazzapan, Thomas Ruhstaller, Eric P Winer, Barbara Ruepp, Sherene Loi, Alan S Coates, Aron Goldhirsch, Richard D Gelber, Olivia Pagani. Randomized comparison of adjuvant aromatase inhibitor exemestane (E) plus ovarian function suppression (OFS) vs tamoxifen (T) plus OFS in premenopausal women with hormone receptor-positive (HR+) early breast cancer (BC): update of the combined TEXT and SOFT trials [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS2-05.
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Affiliation(s)
- Meredith M Regan
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Barbara A Walley
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Gini F Fleming
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Prudence A Francis
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Marco A Colleoni
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - István Láng
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Henry L Gómez
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Carlo A Tondini
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Harold J Burstein
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Matthew P Goetz
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Eva M Ciruelos
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Vered Stearns
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Hervé R Bonnefoi
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Silvana Martino
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Charles E Geyer
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Claudio Chini
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Alessandro M Minisini
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Simon Spazzapan
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Thomas Ruhstaller
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Eric P Winer
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Barbara Ruepp
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Sherene Loi
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Alan S Coates
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Aron Goldhirsch
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Richard D Gelber
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
| | - Olivia Pagani
- SOFT and TEXT Investigators, International Breast Cancer Study Group, Breast International Group, and North American Breast Cancer Groups, Bern, Switzerland
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Savas P, Lo LL, Luen SJ, Blackley EF, van Geelen CT, Ko YA, Moodie K, Callahan JW, Weng CF, Bujak AZ, Yeung MM, Ftouni S, Francis PA, Dawson SJ, Loi S. Abstract P1-18-14: Alpelisib monotherapy for PI3K-altered, pre-treated advanced breast cancer: A phase II study. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p1-18-14] [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: The PI3Kα subunit specific inhibitor alpelisib in combination with fulvestrant is approved in advanced breast cancer harbouring PIK3CA mutations, but predictive biomarkers are lacking. We performed a phase II single arm study of alpelisib monotherapy in previously treated advanced hormone receptor-positive HER2-negative (HR+HER2-) and triple negative breast cancer (TNBC) cohorts. Methods: Eligible patients with genomic aberrations in the PI3K pathway determined via tumour sequencing or ctDNA were given alpelisib 350mg oral daily as monotherapy. The primary endpoint was RECIST objective response rate (ORR) by central review. Secondary endpoints were clinical benefit rate (CBR), defined as complete or partial response or stable disease for ≥24 weeks, and progression free survival (PFS). Positron emission tomography (FDG-PET) was performed at baseline and 8 weeks. Efficacy was analysed according to baseline tumour alterations and serial ctDNA assays. Analyses were conducted separately for the HR+HER2- and TNBC cohorts. Stated p values are nominal without multiplicity adjustment. Results: 43 patients were recruited in total (33 in ER+HER2-, 10 in TNBC). Median follow-up was 44.6 months. In the TNBC cohort ORR and CBR were 0%, hence the cohort was stopped early. Data will be presented here for the HR+HER2- cohort. Of 33 ER+HER2- patients recruited, 28 (85%) were evaluable and 26 (79%) were evaluable for ORR after central review. PI3K pathway aberrations at study entry were mutations in PIK3CA (26/28; 93%) and PTEN (2/28; 7%). The median age was 60 (41 - 77yrs) and 27/28 of patients were female. 85.7% of cases had visceral disease, and 57% had >3 metastatic sites. 100% of patients had received prior endocrine therapy and 78.6% prior chemotherapy, with a median of 3 prior lines (range 1 - 9). All patients were endocrine refractory. The ORR was 38% and CBR 43%. Median PFS was 4.6 months (95% CI, 3.7 - 7.3) and median OS 16.0 months (95% CI, 8.5 - 34.4). In patients with PET scans at baseline and 8 weeks, 67% (17/25) achieved a partial metabolic response but this was not associated with clinical benefit. In patients with partial response by RECIST, serial ctDNA levels at week 8 declined from baseline (p = 0.008) compared to patients with stable or progressive disease (p = 0.17), with similar results seen for patients with clinical benefit. Decline in ctDNA at week 8 was also associated with improved PFS (HR 0.24 [95% CI 0.08-0.67], p = 0.0065; 5.6 v 3.6 months). Multiple PIK3CA mutations were detected in plasma in 31% (8/26) of patients but had no impact on ORR/CBR. 39% (11/28) of patients had mutations in ESR1 detected in plasma at baseline, and this was associated with clinical benefit (p = 0.019) and improved PFS (HR=0.22 [95% CI 0.078-0.60], P=0.0032, 8.21 v 4.53 months). ctDNA assays detected 11 cases with ESR1 mutations compared to tumour sequencing which detected 5 cases only. No other baseline alterations were significantly associated with outcomes, although no patients (0/4) with PTEN alterations achieved clinical benefit. End of treatment ctDNA analysis identified multiple new alterations including MAP3K1 in 39% (11/28), TP53 in 32% (9/28) and PTEN in 25% (7/28). Adverse events included 20.9% grade ≥3 hyperglycaemia and 25.6% ≥grade 3 rash consistent with reported data. Permanent discontinuation of alpelisib for toxicity occurred in 15.2% (5/33) of patients. Conclusions: Alpelisib monotherapy in pre-treated ER+HER2- disease showed evidence of clinical efficacy. Decline in the levels of PIK3CA mutations detected with ctDNA on therapy are significantly associated with clinical benefit, as are the presence of ESR1 mutations at baseline. ctDNA improves the yield of ESR1 mutation detection and warrants further study as a biomarker of alpelisib monotherapy benefit in endocrine-refractory populations.
Citation Format: Peter Savas, Louisa Lisa Lo, Stephen James Luen, Elizabeth Fay Blackley, Courtney Templeton van Geelen, Yi-An Ko, Kate Moodie, Jason William Callahan, Chen-Fang Weng, Andjelija Zivanovic Bujak, Miriam Manning Yeung, Sarah Ftouni, Prudence Anne Francis, Sarah-Jane Dawson, Sherene Loi. Alpelisib monotherapy for PI3K-altered, pre-treated advanced breast cancer: A phase II study [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P1-18-14.
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Affiliation(s)
- Peter Savas
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Louisa Lisa Lo
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Stephen James Luen
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Yi-An Ko
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kate Moodie
- The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | | | - Chen-Fang Weng
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | - Sarah Ftouni
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Sarah-Jane Dawson
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sherene Loi
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
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Loi S. Abstract ES6-3: Immunotherapy vs Capecitabine for Triple Negative Breast Cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-es6-3] [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
Immunotherapy vs capecitabine for triple negative breast cancer. Educational session. Sherene Loi, MD, PhDPeter MacCallum Cancer Centre, Melbourne, Australia. Neoadjuvant treatment is now standard of care for the majority of early stage triple negative breast cancer (TNBC), with the achievement of non-pathological complete response (pCR) the main indicator to escalate treatment. Until recently only capecitabine was used in this setting. 2021 has seen reporting of the OlympiA adjuvant study, which reports major benefits for olaparib in germline BRCA positive TNBC patients, though a minority. KEYNOTE522 has now set the scene for incorporating neoadjuvant pembrolizumab with chemotherapy in early stage TNBC, with significantly improved event free survival, particularly those that do not achieve pCR. In this talk I will examine how we can rationally think about treating these patients with the available options.
Citation Format: S Loi. Immunotherapy vs Capecitabine for Triple Negative Breast Cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr ES6-3.
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Affiliation(s)
- S Loi
- Peter MacCallum Cancer Centre, Camberwell, Australia
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Turner NC, Loi S, Moore HM, Chang CW, Eng-Wong J, Bardia A, Boni V, Sohn J, Jhaveri KL, Lim E. Abstract PD13-07: Activity and biomarker analyses from a phase Ia/b study of giredestrant (GDC-9545; G) with or without palbociclib (palbo) in patients with estrogen receptor-positive, HER2-negative locally advanced/metastatic breast cancer (ER+/HER2- LA/mBC). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd13-07] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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 mainstay of ER+ BC treatment is to target ER activity and/or estrogen synthesis; however, during or after endocrine therapy (ET), many patients either relapse or develop resistance to such treatments due to several mechanisms, including ESR1 mutations which can be drivers of estrogen-independent transcription and proliferation. The majority of tumors remain dependent on ER signaling, and it is possible that patients will be responsive to second- or third-line ET after they have progressed on previous therapies. The highly potent, nonsteroidal oral selective ER antagonist and degrader G achieves robust ER occupancy and is active in patients with either ESR1-wildtype or -mutant tumors and in patients who had previously been treated with ET. G was well tolerated as a single agent and in combination with palbo, with antitumor activity shown in the nonrandomized, open-label, dose-escalation and -expansion, phase Ia/b GO39932 study (NCT03332797). We present updated activity and biomarker analyses in patients treated with 30 mg G monotherapy and those treated with 100 mg G + 125 mg palbo ± luteinizing hormone-releasing hormone (LHRH) agonists (clinical cutoff: Apr 16, 2021); 30 mg has since been selected as the dose in both the single agent and combination settings. Methods Eligible patients had ≤2 prior therapies for LA/mBC, disease recurrence, or progression while on adjuvant ET for ≥24 months and/or ET for LA/mBC, and tumor response or stable disease ≥6 months. All were postmenopausal (premenopausal women were allowed co-administered LHRH agonists with 100 mg G). Oral G was given daily on Days (D)1-28 of each 28-day cycle (C); 125 mg palbo, on a 21-day on/7-day off schedule. Modulation of ER signaling and proliferation of paired pre- and on-treatment (C2D8) tumor biopsies were assessed with immunohistochemistry for ER, progesterone receptor (PgR), and the proliferation marker Ki67, as well as with gene expression analysis of a predefined set of 38 ER target genes using the Illumina TruSeq RNA Access method. Plasma samples collected pre- and on-treatment (C1D15 and/or C2D1) were assessed for circulating tumor (ct)DNA using a digital PCR BEAMing assay detecting a total of 22 mutations across ESR1, AKT1, and PIK3CA. Results Objective response rates in patients with measurable disease at baseline were 20.0% in the 30 mg G group (6/30 patients) and 47.7% in the 100 mg G + palbo ± LHRH (combination) group (21/44). Clinical benefit rates were 55.0% (22/40 patients) and 81.3% (39/48), respectively. Overall, 21 pre- and on-treatment-paired tumor biopsies were collected in the 30 mg (n=13) and combination (n=8) groups. Consistent downregulation of ER, PgR, Ki67, and ER pathway activity was observed at C2D8, regardless of clinical benefit or baseline ESR1 mutation, demonstrating consistent on-target activity of G. Stronger Ki67, ER, and PgR suppression was seen with the addition of palbo to G. Of the 36 patients across both cohorts with a detectable ctDNA baseline ESR1 mutation, 16 had >1 baseline ESR1 mutation. Of the eight unique ESR1 mutations detected, none showed an association with response. At C2D1, 34 patients had a decrease in ESR1 ctDNA levels from baseline, of which 27 became undetectable for ESR1 ctDNA. Early changes in PIK3CA and AKT1 ctDNA levels, but not ESR1, trended with response. Conclusions Encouraging clinical activity was observed with single agent G at 30 mg and with G at 100 mg in combination with palbo. Biomarker analyses demonstrated consistent biologic activity of G, and largely consistent decreases of ESR1 ctDNA levels. Further updated activity and biomarker data, including PAM50 subtype classifications, will be presented.
Citation Format: Nicolas C Turner, Sherene Loi, Heather M Moore, Ching-Wei Chang, Jennifer Eng-Wong, Aditya Bardia, Valentina Boni, Joohyuk Sohn, Komal L Jhaveri, Elgene Lim. Activity and biomarker analyses from a phase Ia/b study of giredestrant (GDC-9545; G) with or without palbociclib (palbo) in patients with estrogen receptor-positive, HER2-negative locally advanced/metastatic breast cancer (ER+/HER2- LA/mBC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD13-07.
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Affiliation(s)
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Boston, MA
| | - Valentina Boni
- START Madrid-CIOCC, Centro Integral Oncologico Clara Campal, HM Hospitales Sanchinarro, Madrid, Spain
| | - Joohyuk Sohn
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea, Republic of
| | | | - Elgene Lim
- Garvan Institute of Medical Research, St Vincent's Clinical School, Faculty of Medicine, UNSW Sydney, Darlinghurst, Australia
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Cui W, Phillips KA, Francis PA, Loi S, Anderson RA, Partridge AH, Keogh LA. Abstract P5-19-03: What are the barriers to assessment of ovarian toxicity in breast cancer clinical trials? Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p5-19-03] [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
Background Toxicity data are routinely collected in phase 3 (neo)adjuvant breast cancer (BC) clinical trials, but ovarian toxicity is infrequently assessed, despite its impact on fertility and long-term health. Thus, little is known about the ovarian effects of newer BC therapies. This results in an information gap for women when making treatment decisions. We explored the barriers to collecting ovarian toxicity data and/or including ovarian function as an endpoint in BC trials of anti-cancer drugs. Methods Semi structured interviews were conducted with key stakeholders involved in BC clinical trials (clinicians, consumers, pharmaceutical companies, drug regulatory advisors). Participants were asked detailed questions about how trial endpoints are selected, whether effects on the ovary are assessed, and barriers to and benefits of collecting ovarian function data to assess ovarian toxicity. Interviews were transcribed verbatim, coded in NVivo software and analysed using inductive thematic analysis. Results Saturation was reached after 25 interviews (9 clinicians, 7 consumers, 5 drug regulatory advisors, 4 pharmaceutical company advisors); half were female. Participants were from North America (20%), Europe (52%), Australia (24%), Asia (4%). Median age was 50 years and median time in breast cancer research or drug regulation was 16 years. The main reported barrier to the collection of ovarian toxicity data in clinical trials was that this issue was rarely considered. Reasons included that these data are considered less important than survival data and are not required for regulatory approval. Other barriers included limited resources, lack of knowledge regarding how to assess ovarian side effects and lack of relevance in certain settings (further detail in Table 1). Most participants believed assessing ovarian toxicity in trials would be beneficial to clinicians and to patients (eg. assisting treatment and family planning decisions). Strategies to increase ovarian toxicity assessment included its inclusion in clinical trial design guidelines, improving familiarity with ovarian function markers among trial design decision makers, and increased stakeholder interest. A stronger consumer voice and regulatory and clinician advocacy were regarded as important. Regarding trial endpoint selection, pharmaceutical companies were almost always identified as the main decision maker, but clinicians including cooperative trial group researchers, consumers, regulators, and statisticians were also important contributors. While most consumers and pharmaceutical company advisors felt clinicians and consumers influenced trial design, in contrast, some clinicians and regulators reported consumers and clinicians had little influence. Factors identified as important considerations in determining trial endpoints included the main goal of the trial (eg. regulatory approval), established standardised endpoints, resources, and the investigational agent studied. All pharmaceutical advisors reported that meeting the requirements for regulatory approval was the major factor considered during endpoint selection. Conclusion This qualitative analysis evaluates the barriers to including measures of ovarian function in BC clinical trials. Increased awareness, stronger advocacy and guidelines might lead to more frequent inclusion of this important endpoint in future trials that include premenopausal women with early BC.
Table 1.Emergent themes regarding ovarian toxicity assessment in BC trialsThemeDomainCategory 1: Barriers to assessment of ovarian function Not prioritisedNot discussed or thought about;Not the primary question studied by clinical trial;Less important than other endpoints/data;Not required for regulatory approval;Data not related to survival is infrequently published;More appropriate for a follow up/registry studyToo resource intensive A burden on investigators and patients;Difficult to collect good quality data;Assessment not considered feasible;Time to obtaining results too long;Too costlyLack of knowledgeLack of clinician knowledge regarding ovarian function side effects;Lack of consensus regarding which markers to assess;Lack of preclinical data suggestive of ovarian toxicityData not relevant in certain settingsConcurrent use of gonadotoxic chemotherapy;Trials mandate contraception use;Want to suppress ovarian function in some breast cancer phenotypes;Low numbers of premenopausal women enrolled;Investigational agent already known to cause ovarian toxicity/suppressionCategory 2: Perceived benefits of assessing ovarian function Data important to patientsImproved ability to make informed cancer treatment decisions;Improved ability to make fertility and ovarian preservation decisions;Infertility and early menopause are relevant and important to patients;Preservation of ovarian function is important for quality of life;To avoid potential harm to patientsData important to cliniciansImproved ability to counsel patients;Improved understanding of the investigational agent;Improved understanding of the impact of ovarian function on disease outcomes;Holistic understanding of a patient’s experience on treatment;Prospective information is more robust than retrospective dataCategory 3: Strategies to improve inclusionIncreased stakeholder interestIncreased clinician advocacy;Increased consumer voice;Increased regulatory buy in;Increased cooperative trial group interest;Increased reproductive specialist involvement;Increased pharmaceutical company interestIncreased awareness regarding ovarian function and onco-fertilityTrial design guidelines and recommendations;Increased discussion and education;Improved familiarity with ovarian markers and ease of incorporation/collection;Use of social media and internet resources
Citation Format: Wanyuan Cui, Kelly-Anne Phillips, Prudence A Francis, Sherene Loi, Richard A Anderson, Ann H Partridge, Louise A Keogh. What are the barriers to assessment of ovarian toxicity in breast cancer clinical trials? [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P5-19-03.
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Affiliation(s)
- Wanyuan Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne; The Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Kelly-Anne Phillips
- Department of Medical Oncology Peter MacCallum Cancer Centre; The Sir Peter MacCallum Department of Oncology University of Melbourne; Breast Cancer Trials Australia & New Zealand; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre; The Sir Peter MacCallum Department of Oncology, The University of Melbourne; Breast Cancer Trials Australia & New Zealand (BCT-ANZ), Melbourne, Australia
| | - Sherene Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre; The Sir Peter MacCallum Department of Oncology, The University of Melbourne; Division of Research, Peter MacCallum Cancer Centre; Breast Cancer Trials Australia & New Zealand (BCT-ANZ), Melbourne, Australia
| | - Richard A Anderson
- MRC Centre for Reproductive Health, University of Edinburgh, Edinburgh, United Kingdom
| | | | - Louise A Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
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Hurvitz SA, Boni V, Comen E, Im SA, Jung KH, Kim SB, Lee KS, Loi S, Rugo HS, Sonnenblick A, Telli ML, DuPree K, Fasso M, Lin YC, Nikanjam M, Schimmoller F, Zhang X, Zhu J, Schmid P. Abstract PD10-04: Phase Ib/II open-label, randomized trial of atezolizumab (atezo) with ipatasertib (ipat) and fulvestrant (fulv) vs control in MORPHEUS-HR+ breast cancer (M-HR+ BC) and atezo with ipat vs control in MORPHEUS triple negative breast cancer (M-TNBC). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd10-04] [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: The MORPHEUS platform consists of multiple, global, open-label, randomized Phase Ib/II trials designed to gauge safety and identify early efficacy signals in treatment (tx) combinations across cancers. Within MORPHEUS, atezo (anti-PD-L1) was evaluated with ipat, an oral AKT inhibitor, with (M-HR+ BC) and without (M-TNBC) fulv. Methods: In 2 separate randomized trials, eligible immune checkpoint inhibitor naive pts with either 2L/3L HR+ chemotherapy-naive BC who had prior CDK4/6 inhibitor treatment or 2L TNBC, received atezo (840 mg D1, 15) with ipat (400 mg D1-21); pts with HR+ BC also received fulv monthly. Control tx for M-HR+ BC (NCT03280563) was fulv and for M-TNBC (NCT03424005) was capecitabine; given the adaptive nature of the MORPHEUS platform only some of the control arm pts were enrolled concurrently with pts in the ipat arms for M-HR+ BC. Primary endpoints were ORR (overall response rate; investigator-assessed RECIST 1.1) and safety. Progression-free survival (PFS) and overall survival (OS) were secondary endpoints. Results: Median duration of survival follow-up was 7.6 months for M-HR+ BC (data cutoff: Aug 2020) and 10.8 for M-TNBC (data cutoff: Mar 2021). In M-HR+ BC, none of whom received prior fulvestrant, 26 pts received atezo + ipat + fulv and 15 received fulv. Confirmed ORRs were 23.1% (95% CI: 9.0, 43.7) and 0% (95% CI: 0, 21.8), respectively. Median PFS was 4.4 mo (95% CI: 1.6, not evaluable) and 1.9 mo (95% CI: 1.6, 3.9), respectively. Updated survival data will be presented. Respectively, 61.5% and 20.0% of pts had Gr 3-4 AEs; no G5 AEs were observed; serious AEs (SAEs) occurred in 38.5% and 13.3% of pts; 7.7% and 0% of pts had tx-related AEs leading to tx withdrawal. The most common tx-related AEs were rash (73.0%), diarrhea (53.8%), nausea (42.3%), fatigue (26.9%), vomiting (23.1%), decreased appetite (19.2%), headache (15.4%), pyrexia (11.5%), hyperglycemia (11.5%), and aspartate aminotransferase (AST) increase (11.5%), in the combination arm; of these, rash (38.4%), diarrhea (7.7%), and AST increase (7.7%) included Grade 3-4 tx-related AEs. In M-TNBC, 29 pts received atezo + ipat and 24 received capecitabine. Confirmed ORRs were 3.4% (95% CI: 0.1, 17.8) and 20.8% (95% CI: 7.1, 42.2), respectively. Median PFS was 1.7 mo (95% CI: 1.5, 2.8) and 4.1 mo (95% CI: 2.3, 5.7), respectively. Median OS was 10.8 mo (95% CI: 7.0, 18.1) and 15.2 mo (95% CI: 14.4, 20.8). Gr 3-4 AEs were seen in 51.7% and 37.5% of pts, respectively; Gr 5 AEs were seen in 1 pt in the combination arm (encephalitis due to atezo). SAEs occurred in 51.7% and 16.7% of pts, respectively; 6.9% and 4.2% of pts had tx-related AEs leading to tx withdrawal. The most common tx-related AEs were rash (55.2%), diarrhea (48.3%), nausea (37.9%), pyrexia (31.0%), and fatigue (24.1%) in the combination arm; of these, rash (24.1%), fatigue (3.4%), and pyrexia (3.4%) included Gr 3-4 tx-related AEs. Biomarker data, including PI3K pathway status, PD-L1 and CD8-panCK expression, will also be presented. Conclusion: Atezo + ipat + fulv was tolerable with a preliminary efficacy signal in HR+ BC. Atezo + ipat had limited efficacy in biomarker unselected TNBC.
Citation Format: Sara A. Hurvitz, Valentina Boni, Elizabeth Comen, Seock-Ah Im, Kyung Hae Jung, Sung-Bae Kim, Keun Seok Lee, Sherene Loi, Hope S. Rugo, Amir Sonnenblick, Melinda L. Telli, Kelly DuPree, Marcella Fasso, Ya-Chen Lin, Mina Nikanjam, Frauke Schimmoller, Xiaosong Zhang, Jing Zhu, Peter Schmid. Phase Ib/II open-label, randomized trial of atezolizumab (atezo) with ipatasertib (ipat) and fulvestrant (fulv) vs control in MORPHEUS-HR+ breast cancer (M-HR+ BC) and atezo with ipat vs control in MORPHEUS triple negative breast cancer (M-TNBC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD10-04.
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Affiliation(s)
- Sara A. Hurvitz
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | - Valentina Boni
- START Madrid CIOCC, Centro Integral Oncológico Clara Campal, HM Hospitales Sanchinarro, Madrid, Spain
| | | | - Seock-Ah Im
- Seoul National University College of Medicine, Seoul, Korea, Republic of
| | - Kyung Hae Jung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of
| | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of
| | - Keun Seok Lee
- National Cancer Center, Goyang-si, Korea, Republic of
| | - Sherene Loi
- Peter MacCallum Cancer Center, Melbourne, Australia
| | - Hope S. Rugo
- University of California San Francisco, San Francisco, CA
| | - Amir Sonnenblick
- Tel Aviv Sourasky Medical Center and Sackler Faculty of Medicine, Tel Aviv, Israel
| | | | | | | | | | | | | | | | - Jing Zhu
- Genentech, Inc, South San Francisco, CA
| | - Peter Schmid
- Barts Health NHS Trust - St Bartholomew's Hospital, London, United Kingdom
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Lin NU, Murthy RK, Abramson V, Anders C, Bachelot T, Bedard P, Borges V, Cameron D, Cameron D, Carey L, Chien AJ, Curigliano G, DiGiovanna M, Gelmon K, Hortobagyi G, Hurvitz S, Krop I, Loi S, Loibl S, Mueller V, Oliveira M, Paplomata E, Pegram M, Slamon D, Zelnak A, Ramos J, Feng W, Winer E. Abstract PD4-04: Updated results of tucatinib vs placebo added to trastuzumab and capecitabine for patients with previously treated HER2-positive metastatic breast cancer with brain metastases (HER2CLIMB). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd4-04] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [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: Tucatinib is an oral tyrosine kinase inhibitor highly specific for HER2 that is approved for use in combination with trastuzumab and capecitabine in adults with advanced or metastatic HER2+ breast cancer, including patients with brain metastases, who have received one or more prior anti-HER2-based regimens in the metastatic setting. In the HER2CLIMB trial, the tucatinib regimen significantly prolonged progression-free survival (PFS) and overall survival (OS) in patients with HER2+ metastatic breast cancer (Murthy, NEJM 2020), including in patients with untreated, treated stable, and treated progressing brain metastases (Lin, J Clin Oncol, 2020). With an additional 15.6 months of follow-up, addition of tucatinib continued to show clinically meaningful prolongation of PFS and OS in the total study population (Curigliano, ASCO Meeting, 2021). We report updated results of exploratory efficacy analyses in patients with brain metastases. Methods: All patients in HER2CLIMB had a baseline brain MRI. Patients with brain metastases were eligible and classified as untreated, treated stable, or treated progressing. Patients were randomized 2:1 to receive tucatinib 300 mg twice daily or placebo, in combination with trastuzumab and capecitabine. Following the primary analysis, the protocol was amended to unblind sites to treatment assignment and allowed crossover from the placebo regimen to the tucatinib regimen. Efficacy analyses in patients with brain metastases at baseline were performed at approximately 2 years from the last patient randomized by applying RECIST 1.1 to the brain based on investigator evaluation. OS and CNS-PFS (progression in the brain or death) were evaluated in all patients with brain metastases. Patients without CNS-PFS events were censored at the last brain MRI. Confirmed intracranial (IC) objective response rate (ORR-IC) was evaluated in patients with measurable IC disease. Results: At a median follow-up of 29.6 months, median OS was 21.6 months vs 12.5 months in all patients with brain metastases (HR: 0.60; 95% CI: 0.44, 0.81), 21.4 months vs 11.8 months in patients with untreated/treated progressing brain metastases (HR: 0.52; 95% CI: 0.36, 0.77), and 21.6 months vs 16.4 months in patients with treated stable brain metastases (HR: 0.70; 95% CI: 0.42, 1.16). Median CNS-PFS was 9.9 months vs 4.2 months in all patients with brain metastases (HR: 0.39; 95% CI: 0.27, 0.56), 9.6 months vs 4.0 months in patients with untreated/treated progressing brain metastases (HR: 0.34; 95% CI: 0.22, 0.54), and 13.9 months vs 5.6 months in patients with treated stable brain metastases (HR: 0.41; 95% CI: 0.19, 0.85). ORR-IC was higher in the tucatinib arm (47.3%; 95% CI: 33.7, 61.2) vs the placebo arm (20.0%; 95% CI: 5.7, 43.7) for patients with brain metastases, and median duration of response (DOR) was 8.6 months (95% CI: 5.5, 10.3) vs 3.0 months (95% CI: 3.0, 10.3). Conclusions: With 15.6 months of additional follow-up, the tucatinib-trastuzumab-capecitabine regimen resulted in a robust and durable prolongation of OS for all patients with HER2+ metastatic breast cancer and brain metastases. Additionally, this benefit was maintained in patients with untreated/treated progressing and treated stable brain metastases. Treatment with tucatinib continued to show clinically meaningful benefit in CNS-PFS consistent with the primary analysis.
Citation Format: Nancy U Lin, Rashmi K Murthy, Vandana Abramson, Carey Anders, Thomas Bachelot, Philippe Bedard, Virginia Borges, David Cameron, David Cameron, Lisa Carey, A Jo Chien, Giuseppe Curigliano, Michael DiGiovanna, Karen Gelmon, Gabriel Hortobagyi, Sara Hurvitz, Ian Krop, Sherene Loi, Sibylle Loibl, Volkmar Mueller, Mafalda Oliveira, Elisavet Paplomata, Mark Pegram, Dennis Slamon, Amelia Zelnak, Jorge Ramos, Wentao Feng, Eric Winer. Updated results of tucatinib vs placebo added to trastuzumab and capecitabine for patients with previously treated HER2-positive metastatic breast cancer with brain metastases (HER2CLIMB) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD4-04.
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Affiliation(s)
| | | | | | | | | | - Philippe Bedard
- University Health Network, Princess Margaret Cancer Centre,, Toronto, ON, Canada
| | | | - David Cameron
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - David Cameron
- Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Lisa Carey
- UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - A Jo Chien
- University of California at San Francisco, San Francisco, CA
| | | | | | - Karen Gelmon
- British Columbia Cancer - Vancouver Centre, Vancouver, BC, Canada
| | | | - Sara Hurvitz
- UCLA Medical Center/Jonsson Comprehensive Cancer Center,, Los Angeles, CA
| | - Ian Krop
- Dana-Farber Cancer Institute, Boston, MA
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | | | - Mark Pegram
- Stanford Comprehensive Cancer Institute, Palo Alto, CA
| | - Dennis Slamon
- UCLA Medical Center/Jonsson Comprehensive Cancer Center, Los Angeles, CA
| | | | | | | | - Eric Winer
- Dana-Farber Cancer Institute, Boston, MA
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Bardia A, Schmid P, Harbeck N, Rimawi MF, Hurvitz SA, Loi S, Saji S, Jung KH, Werutsky G, Stroyakovskii D, López-Valverde V, Tesarowski D, Ye C, Davis M, Crnjevic TB, Perez-Moreno PD, Geyer CE. Abstract OT2-11-09: Lidera breast cancer: A phase III adjuvant study of giredestrant (GDC-9545) vs physician’s choice of endocrine therapy (ET) in patients (pts) with estrogen receptor-positive, HER2-negative early breast cancer (ER+/HER2- EBC). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-11-09] [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
BACKGROUND ETs that target ER activity and/or estrogen synthesis are the mainstay of ER+ BC treatment. Despite best management, up to 20% of pts with ER+/HER2- eBC develop resistance (in some cases due to the acquisition of tumor mutations in ESR1 that can drive estrogen-independent transcription and proliferation) and still have high recurrence rates on standard ETs. New treatment alternatives for ER+/HER2- eBC are needed to reduce risk of recurrence and improve survival, tolerability, quality of life, and adherence. Giredestrant is a highly potent, nonsteroidal oral selective ER antagonist and degrader (SERD). It achieves robust ER occupancy and is active against tumors that retain ER-sensitivity or have ESR1 mutation(s). Giredestrant has been demonstrated to be more potent in vitro and achieves higher ER occupancy in vivo than fulvestrant, the only currently approved SERD. Early phase clinical studies have demonstrated that single-agent giredestrant (30 mg daily) has promising clinical and pharmacodynamic activity, and is well-tolerated in the ER+/HER2- eBC and metastatic BC settings. TRIAL DESIGN This is a phase III, global, randomized, open-label, multicenter study evaluating the efficacy and safety of adjuvant giredestrant vs physician’s choice of adjuvant ET in pts with medium- and high-risk stage I-III histologically confirmed ER+/HER2- eBC. Pts are randomized 1:1 to oral 30 mg daily giredestrant or physician’s choice of standard ET (tamoxifen, anastrozole, letrozole, or exemestane, given according to prescribing information). Stratification factors are risk (medium vs high, based on anatomic [tumor size, nodal status] and biologic features [grade, Ki67, gene signatures if available]); geographic region (US/Canada/Western Europe vs Asia-Pacific vs rest of the world); prior chemotherapy (no vs yes); and menopausal status (pre-/perimenopausal vs postmenopausal). Beginning on Day 1 of Cycle 1, pts will be treated with giredestrant or physician’s choice of standard ET for at least 5 years. Continuing physician’s choice of standard ET after 5 years is at discretion of the investigator and per local standard of care. ELIGIBILITY Female/male pts with medium-/high-risk stage I-III ER+/HER2- eBC; prior curative surgery; completion of (neo)adjuvant chemotherapy (if administered) and/or surgery <12 months prior to enrolment; no prior ET (up to 4 weeks of [neo]adjuvant ET is allowed). For men and pre-/perimenopausal women, a luteinizing hormone-releasing hormone agonist will be given per local prescribing information (mandatory for pts in the giredestrant arm). AIMS Primary endpoint: Invasive disease-free survival (IDFS). Secondary endpoints: Overall survival; IDFS (STEEP definition, including second non-primary BC); disease-free survival; distant recurrence-free survival; locoregional recurrence-free interval; safety; pharmacokinetics; pt-reported outcomes. In addition, this study aims to improve health equity in research and expand clinical trial access. The study will also use/develop digital healthcare solutions, which will enable better understanding of patients’ needs and their adherence to ET. STATISTICAL METHODS The primary endpoint analysis will use a stratified log-rank test at an overall 0.05 significance level (two-sided). An interim analysis and a futility analysis are planned, and an independent data monitoring committee will be in place. ACCRUAL Target enrollment is 4100 pts globally once the study is open for enrollment. CONTACT INFORMATION For more information or to refer a patient, email global.rochegenentechtrials@roche.com or call 1-888-662-6728 (USA only). Clinicaltrials.gov number NCT04961996.
Citation Format: Aditya Bardia, Peter Schmid, Nadia Harbeck, Mothaffar F Rimawi, Sara A Hurvitz, Sherene Loi, Shigehira Saji, Kyung Hae Jung, Gustavo Werutsky, Daniil Stroyakovskii, Vanesa López-Valverde, David Tesarowski, Chenglin Ye, Michael Davis, Tanja Badovinac Crnjevic, Pablo Diego Perez-Moreno, Charles E Geyer, Jr. Lidera breast cancer: A phase III adjuvant study of giredestrant (GDC-9545) vs physician’s choice of endocrine therapy (ET) in patients (pts) with estrogen receptor-positive, HER2-negative early breast cancer (ER+/HER2- EBC) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-11-09.
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Affiliation(s)
- Aditya Bardia
- Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | | | - Nadia Harbeck
- Breast Center, Department of Obstetrics and Gynecology and CCCMunich, LMU University Hospital, Munich, Germany
| | - Mothaffar F Rimawi
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX
| | - Sara A Hurvitz
- University of California, Los Angeles/Jonsson Comprehensive Cancer Center (UCLA/JCCC), Los Angeles, CA
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourn, Australia
| | | | - Kyung Hae Jung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of
| | | | | | | | | | | | | | | | | | - Charles E Geyer
- NSABP Foundation and Houston Methodist Cancer Center, Houston, TX
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Cortes J, Cescon DW, Rugo HS, Nowecki Z, Im SA, Yusof MM, Gallardo C, Lipatov O, Barrios CH, Perez-Garcia J, Iwata H, Masuda N, Otero MT, Gokmen E, Loi S, Guo Z, Zhou X, Karantza V, Pan W, Schmid P. Abstract GS1-02: Final results of KEYNOTE-355: Randomized, double-blind, phase 3 study of pembrolizumab + chemotherapy vs placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-gs1-02] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In the phase 3 KEYNOTE-355 trial (NCT02819518), pembrolizumab (pembro) combined with chemotherapy (chemo) showed statistically significant improvements in OS and PFS compared to placebo + chemo in patients with previously untreated locally recurrent inoperable or metastatic TNBC whose tumors expressed PD-L1 with a combined positive score (CPS) ≥10. There were no statistically significant differences between treatment groups in the CPS ≥1 population, and statistical significance was not tested in the ITT population due to the prespecified testing strategy. Here, we compare outcomes in subgroups of patients by additional CPS cut-offs to the primary results of KEYNOTE-355. Methods: 847 patients with measurable disease per RECIST v1.1, ECOG PS 0-1, and ≥6 month disease-free interval were randomized 2:1 to pembro + chemo (nab-paclitaxel 100 mg/m2 days 1, 8, and 15 every 28 days; paclitaxel 90 mg/m2 days 1, 8, and 15 every 28 days; or gemcitabine 1000 mg/m2 + carboplatin AUC 2 days 1 and 8 every 21 days) or placebo + chemo for up to 35 administrations of pembro/placebo or until progression/intolerable toxicity. Patients were stratified by chemo type (taxane or gemcitabine-carboplatin), PD-L1 status (CPS ≥1 or <1), and prior neoadjuvant/adjuvant treatment with same-class chemo (yes or no). Dual primary endpoints were OS and PFS (RECIST v1.1, blinded independent central review) in patients with PD-L1-positive tumors (CPS ≥10 and ≥1) and in the ITT population. Hazard ratios (HRs) and 95% CIs in the additional CPS subgroups were based on an unstratified Cox model. Results: At the time of the final analysis (data cutoff, June 15, 2021), the median time from randomization to data cutoff was 44 months. Baseline characteristics of the CPS 1-9, 10-19, and ≥20 subgroups were generally similar to those of the ITT population. In the primary analyses, the HRs (95% CI) for OS were 0.73 (0.55-0.95) in the CPS ≥10 subgroup, 0.86 (0.72-1.04) in the CPS ≥1 subgroup, and 0.89 (0.76-1.05) in the ITT population; HRs (95% CI) for PFS were 0.66 (0.50-0.88), 0.75 (0.62-0.91), and 0.82 (0.70-0.98), respectively. Efficacy data are presented for the additional CPS subgroups in the Table. For OS, results in the CPS 1-9 subgroup showed comparable efficacy for pembro + chemo and placebo + chemo; however, results in the CPS 10-19 and CPS ≥20 subgroups showed a similar treatment benefit with the addition of pembro. Results for PFS were generally consistent with those observed for OS.
Conclusions: These results provide support that CPS ≥10 is a reasonable cut-off to define the population of patients with metastatic TNBC expected to derive treatment benefit from pembro + chemo.
Table. Efficacy in additional subgroups of patients by PD-L1 CPSCPS subgroupTreatmentMedian OS, mo (95% CI)OS HR (95% CI)*Median PFS, mo (95% CI)PFS HR (95% CI)*1-9†Pembro + Chemo. n = 20513.9. (12.2-16.6)1.09 (0.85-1.40)5.7. (5.4-7.4)0.85 (0.65-1.11)Placebo + Chemo n = 10815.5. (12.4-17.6)5.6. (5.3-7.6)10-19†Pembro + Chemo. n = 8020.3. (15.2-29.0)0.71 (0.46-1.09)9.9. (7.4-11.8)0.70 (0.44-1.09)Placebo + Chemo n = 3917.6. (10.3-25.8)7.6. (5.3-9.7)≥20‡Pembro + Chemo. n = 14024.0 (19.0-28.3)0.72 (0.51-1.01)9.2 (7.6-11.8)0.62 (0.44-0.88)Placebo + Chemo n = 6415.6. (12.3-20.8)5.4 (3.9-7.2)*Analyses based on an unstratified Cox model. †Post-hoc analyses. ‡Prespecified exploratory analyses.
Citation Format: Javier Cortes, David W. Cescon, Hope S. Rugo, Zbigniew Nowecki, Seock-Ah Im, Mastura Md Yusof, Carlos Gallardo, Oleg Lipatov, Carlos Henrique Barrios, Jose Perez-Garcia, Hiroji Iwata, Norikazu Masuda, Marco Torregroza Otero, Erhan Gokmen, Sherene Loi, Zifang Guo, Xuan Zhou, Vassiliki Karantza, Wilbur Pan, Peter Schmid. Final results of KEYNOTE-355: Randomized, double-blind, phase 3 study of pembrolizumab + chemotherapy vs placebo + chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr GS1-02.
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Affiliation(s)
- Javier Cortes
- International Breast Cancer Center, Quiron Group, Madrid and Barcelona, Spain and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA
| | - Zbigniew Nowecki
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Seock-Ah Im
- Seoul National University Hospital, Seoul, Korea, Republic of
| | | | | | - Oleg Lipatov
- Republican Clinical Oncology Dispensary, Republic of Bashkortostan, Russian Federation
| | | | | | | | - Norikazu Masuda
- National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | | | - Sherene Loi
- Peter McCallum Cancer Institute, Melbourne, Australia
| | | | | | | | | | - Peter Schmid
- Barts Cancer Institute, Centre for Experimental Cancer Medicine, London, United Kingdom
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David S, Savas P, Siva S, White M, Neeson MW, White S, Marx G, Cheuk R, Grogan M, Farrell M, Foudoulis J, Dempsey A, Neeson PJ, Bressel M, Loi S. Abstract PD10-02: A randomised phase II trial of single fraction or multi-fraction SABR (stereotactic ablative body radiotherapy) with atezolizumab in patients with advanced triple negative breast cancer (AZTEC trial). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-pd10-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
A randomised phase II trial of single fraction or multi-fraction SABR (stereotactic ablative body radiotherapy) with atezolizumab in patients with advanced triple negative breast cancer (AZTEC trial) Abstract: BACKGROUND: In patients with advanced triple negative breast cancer (TNBC), immunotherapy has shown acceptable safety and efficacy in a PD-L1 (programmed death-ligand 1) positive population. Pre-clinical evidence has demonstrated that SABR can prime a more effective systemic anti-tumor response in combination with checkpoint inhibition. It is currently unknown if single or multi-fraction SABR scheduling synergises best with atezolizumab therapy. METHODS: This was a multi-centre, open label, phase 2 randomised trial of patients with advanced TNBC, unselected for (PD-L1) status, who had recurred at least 6 months post completion of (neo) adjuvant chemotherapy and received less than 2 lines of treatment in the metastatic setting. Participants were randomised to 20Gy SABR in 1 fraction or 24Gy SABR in 3 fractions to 1-4 sites of disease, with at least one metastasis left unirradiated. Within 5 days following the final fraction of radiotherapy atezolizumab was commenced at a dose of 1200 mg every 21 days and continued for up to 24 months, or until progression or intolerable toxicity. The primary endpoint is progression- free survival (PFS). Secondary endpoints include efficacy according to PD-L1 IHC status (positive: SP142 ≥1%) and TIL (tumour infiltrating lymphocyte) quantity, response assessment, overall survival and safety. Results presented are from interim analysis performed 18 weeks after the last patient commenced treatment. RESULTS: Fifty evaluable patients were recruited and randomised between 20th November 2018 and 12thApril 2021 with a median age of 57 [35 - 79] yrs. Thirty (60%) and 20 (40%) patients had received none or one previous line of chemotherapy in the metastatic setting, respectively. 14/40 (35%) patients were PD-L1 positive at baseline and 26/42 (62%) had TIL≥5%. Median follow-up was 17 months. The median PFS for the 20 Gy arm was 2.5 (90% CI: 1.7-4.5) months, 3.1 (90% CI: 1.8-3.9) months for the 24 Gy arm. For both arms combined, the PFS was 3.1 (90% CI: 1.8-3.9) months, with no difference between the arms, HR 1.2 (95% CI: 0.6-2.1), p=0.64. PFS by PD-L1 IHC status and TIL<5% vs ≥5% was similar. There were 11 (22%) patients with clinical benefit (no PD within 24 weeks of C1D1), these were not significantly different by arm (p=0.74), nor by PD-L1 status (p=0.44) or TIL quantity (p=0.92) (Table 1). Overall survival is immature: estimated 12 months was 78% (95% CI:54-90) for the 20 Gy arm and 57% (95% CI: 33-75) for the 24 Gy arm.. In patients who were PD-L1 positive the ORR was 1/12 (8%) and DC was 3/14 (21%) compared with ORR of 1/14 (7%) and DC of 3/26 (12%) in patients who were PD-L1 negative.
CONCLUSIONS: The efficacy between single and multi-fraction SABR in combination with Atezolizumab was similar and toxicity was acceptable. Efficacy was seen in PD-L1 positive and negative patients. Longer follow-up is required to assess the effect on OS.. (Research support and funding provided by the imCORE Network on behalf of F. Hoffmann-La Roche; AZTEC ClinicalTrials.gov Identifier: NCT03464942)
Table 1.Response AssessmentResponse, n (%)All patients (n = 50)Patients with measurable disease (n = 32)Best objective response (non-SABR lesion)CR3 (6)2 (6)PR2 (4)2(6)NCR/NPD8 (16)0SD13 (26)13 (41)PD24 (48)15 (47)ORR (CR + PR)5 (10); 95% CI: 3-224 (12%); 95% CI: 4-29DCR (CR + PR + SD + non-CR/non-PD ≥24 weeks)a11 (22%); 95% CI: 12-377 (23%); 95% CI: 10-41aOne patient withdrew at 8 weeks and was not assessable for DCR.
Citation Format: Steven David, Peter Savas, Shankar Siva, Michelle White, Michael W Neeson, Shane White, Gavin Marx, Robyn Cheuk, Michelle Grogan, Maria Farrell, Jessica Foudoulis, Annette Dempsey, Paul J Neeson, Mathias Bressel, Sherene Loi. A randomised phase II trial of single fraction or multi-fraction SABR (stereotactic ablative body radiotherapy) with atezolizumab in patients with advanced triple negative breast cancer (AZTEC trial) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr PD10-02.
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Affiliation(s)
- Steven David
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Savas
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Shankar Siva
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | | | | | - Gavin Marx
- Sydney Adventist Hospital Clinical Trials Unit & Integrated Cancer Centre, Wahroonga, Australia
| | - Robyn Cheuk
- Department of Radiation Oncology, Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Michelle Grogan
- Department of Radiation Oncology, Cancer Care Services, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | | | | | | | | | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
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Siva S, Bressel M, Wood ST, Shaw MG, Loi S, Sandhu SK, Tran B, A Azad A, Lewin JH, Cuff KE, Liu HY, Moon D, Goad J, Wong LM, LimJoon M, Mooi J, Chander S, Murphy DG, Lawrentschuk N, Pryor D. Stereotactic Radiotherapy and Short-course Pembrolizumab for Oligometastatic Renal Cell Carcinoma-The RAPPORT Trial. Eur Urol 2021; 81:364-372. [PMID: 34953600 DOI: 10.1016/j.eururo.2021.12.006] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/08/2021] [Accepted: 12/03/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Stereotactic ablative body radiotherapy (SABR) is an option for oligometastatic clear cell renal cell carcinoma (ccRCC) but is limited by a lack of prospective clinical trial data. OBJECTIVE The RAPPORT trial evaluated the safety and efficacy of total metastatic irradiation followed by short-course anti-programmed death receptor-1 immunotherapy in patients with oligometastatic ccRCC. DESIGN SETTING, AND PARTICIPANTS RAPPORT was a single-arm multi-institutional phase I/II trial (NCT02855203). Patients with two or fewer lines of prior systemic therapy and one to five oligometastases from ccRCC were eligible. INTERVENTION A single fraction of 20 Gy SABR (or if not feasible, ten fractions of 3 Gy) was given to all metastatic sites, followed by pembrolizumab 200 mg administered Q3W for eight cycles. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The endpoints were adverse events (AEs), disease control rate (DCR) for at least 6 mo, objective response rate (ORR), progression-free survival (PFS), and overall survival (OS). The Kaplan-Meier method was used for time-to-event endpoints. Freedom from local progression (FFLP) was assessed per lesion adding patient as a cluster effect. RESULTS AND LIMITATIONS Thirty evaluable patients, with a median age of 62 yr, were enrolled. The median follow-up was 28 mo. There were 44% of patients with intermediate-risk and 56% with favorable-risk disease. Eighty-three oligometastases were irradiated (median three per patient): eight adrenal, 11 bone, 43 lung, 12 lymph node, and nine soft tissue. Four patients (13%) had grade 3 treatment-related AEs: pneumonitis (n = 2), dyspnea (n = 1), and elevated alkaline phosphatase/alanine transaminase (n = 1). There were no grade 4 or 5 AEs. FFLP at 2 yr was 92%. ORR was 63% and DCR was 83%. Estimated 1- and 2-yr OS was 90% and 74%, respectively, and PFS was 60% and 45%, respectively. Limitations include a single-arm design and selected patient population. CONCLUSIONS SABR and short-course pembrolizumab in oligometastatic ccRCC is well tolerated, with excellent local control. Durable responses and encouraging PFS were observed, warranting further investigation. PATIENT SUMMARY The RAPPORT trial investigated the combination of high-dose precision radiotherapy and a short course of immunotherapy in patients with low-volume metastatic kidney cancer. We found that this treatment regimen was well tolerated, with excellent cancer control in sites of known disease. A proportion of patients were free from cancer relapse in the longer term, and these encouraging findings warrant further investigation.
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Affiliation(s)
- Shankar Siva
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia.
| | | | - Simon T Wood
- Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Mark G Shaw
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Shahneen K Sandhu
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Ben Tran
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Arun A Azad
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Jeremy H Lewin
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Katharine E Cuff
- Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Howard Y Liu
- Princess Alexandra Hospital, Brisbane, QLD, Australia; University of Queensland, Brisbane, QLD, Australia
| | - Daniel Moon
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Jeremy Goad
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Lih-Ming Wong
- Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | | | - Jennifer Mooi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Sarat Chander
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Declan G Murphy
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; The Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, VIC, Australia
| | - Nathan Lawrentschuk
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - David Pryor
- Princess Alexandra Hospital, Brisbane, QLD, Australia; Queensland University of Technology, Brisbane, QLD, Australia
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El Bairi K, Haynes HR, Blackley E, Fineberg S, Shear J, Turner S, de Freitas JR, Sur D, Amendola LC, Gharib M, Kallala A, Arun I, Azmoudeh-Ardalan F, Fujimoto L, Sua LF, Liu SW, Lien HC, Kirtani P, Balancin M, El Attar H, Guleria P, Yang W, Shash E, Chen IC, Bautista V, Do Prado Moura JF, Rapoport BL, Castaneda C, Spengler E, Acosta-Haab G, Frahm I, Sanchez J, Castillo M, Bouchmaa N, Md Zin RR, Shui R, Onyuma T, Yang W, Husain Z, Willard-Gallo K, Coosemans A, Perez EA, Provenzano E, Ericsson PG, Richardet E, Mehrotra R, Sarancone S, Ehinger A, Rimm DL, Bartlett JMS, Viale G, Denkert C, Hida AI, Sotiriou C, Loibl S, Hewitt SM, Badve S, Symmans WF, Kim RS, Pruneri G, Goel S, Francis PA, Inurrigarro G, Yamaguchi R, Garcia-Rivello H, Horlings H, Afqir S, Salgado R, Adams S, Kok M, Dieci MV, Michiels S, Demaria S, Loi S. The tale of TILs in breast cancer: A report from The International Immuno-Oncology Biomarker Working Group. NPJ Breast Cancer 2021; 7:150. [PMID: 34853355 PMCID: PMC8636568 DOI: 10.1038/s41523-021-00346-1] [Citation(s) in RCA: 101] [Impact Index Per Article: 33.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/28/2021] [Indexed: 02/08/2023] Open
Abstract
The advent of immune-checkpoint inhibitors (ICI) in modern oncology has significantly improved survival in several cancer settings. A subgroup of women with breast cancer (BC) has immunogenic infiltration of lymphocytes with expression of programmed death-ligand 1 (PD-L1). These patients may potentially benefit from ICI targeting the programmed death 1 (PD-1)/PD-L1 signaling axis. The use of tumor-infiltrating lymphocytes (TILs) as predictive and prognostic biomarkers has been under intense examination. Emerging data suggest that TILs are associated with response to both cytotoxic treatments and immunotherapy, particularly for patients with triple-negative BC. In this review from The International Immuno-Oncology Biomarker Working Group, we discuss (a) the biological understanding of TILs, (b) their analytical and clinical validity and efforts toward the clinical utility in BC, and (c) the current status of PD-L1 and TIL testing across different continents, including experiences from low-to-middle-income countries, incorporating also the view of a patient advocate. This information will help set the stage for future approaches to optimize the understanding and clinical utilization of TIL analysis in patients with BC.
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Affiliation(s)
- Khalid El Bairi
- Department of Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco.
| | - Harry R Haynes
- Department of Cellular Pathology, Great Western Hospital, Swindon, UK
- Translational Health Sciences, University of Bristol, Bristol, UK
| | - Elizabeth Blackley
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Susan Fineberg
- Department of Pathology, Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY, USA
| | - Jeffrey Shear
- Chief Information Officer, WISS & Company, LLP and President J. Shear Consulting, LLC-Ardsley, Ardsley, NY, USA
| | | | - Juliana Ribeiro de Freitas
- Department of Pathology and Legal Medicine, Medical School of the Federal University of Bahia, Salvador, Brazil
| | - Daniel Sur
- Department of Medical Oncology, University of Medicine "I. Hatieganu", Cluj Napoca, Romania
| | | | - Masoumeh Gharib
- Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Indu Arun
- Department of Histopathology, Tata Medical Center, Kolkata, India
| | - Farid Azmoudeh-Ardalan
- Department of Pathology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
| | - Luciana Fujimoto
- Pathology and Legal Medicine, Amazon Federal University, Belém, Brazil
| | - Luz F Sua
- Department of Pathology and Laboratory Medicine, Fundacion Valle del Lili, and Faculty of Health Sciences, Universidad ICESI, Cali, Colombia
| | | | - Huang-Chun Lien
- Department of Pathology, National Taiwan University Hospital, Taipei, Taiwan
| | - Pawan Kirtani
- Department of Histopathology, Manipal Hospitals Dwarka, New Delhi, India
| | - Marcelo Balancin
- Department of Pathology, Faculty of Medicine, University of São Paulo, São Paulo, Brazil
| | | | - Prerna Guleria
- Army Hospital Research and Referral, Delhi Cantt, New Delhi, India
| | | | - Emad Shash
- Breast Cancer Comprehensive Center, National Cancer Institute, Cairo University, Cairo, Egypt
| | - I-Chun Chen
- Department of Oncology, National Taiwan University Cancer Center, Taipei, Taiwan
- Department of Oncology, National Taiwan University Hospital, Taipei, Taiwan
| | - Veronica Bautista
- Department of Pathology, Breast Cancer Center FUCAM, Mexico City, Mexico
| | | | - Bernardo L Rapoport
- The Medical Oncology Centre of Rosebank, Johannesburg, South Africa
- Department of Immunology, Faculty of Health Sciences, University of Pretoria, corner Doctor Savage Road and Bophelo Road, Pretoria, 0002, South Africa
| | - Carlos Castaneda
- Department of Medical Oncology, Instituto Nacional de Enfermedades Neoplásicas, Lima, 15038, Peru
- Faculty of Health Sciences, Universidad Cientifica del Sur, Lima, Peru
| | - Eunice Spengler
- Departmento de Patologia, Hospital Universitario Austral, Pilar, Argentina
| | - Gabriela Acosta-Haab
- Department of Pathology, Hospital de Oncología Maria Curie, Buenos Aires, Argentina
| | - Isabel Frahm
- Department of Pathology, Sanatorio Mater Dei, Buenos Aires, Argentina
| | - Joselyn Sanchez
- Department of Research, Instituto Nacional de Enfermedades Neoplasicas, Lima, 15038, Peru
| | - Miluska Castillo
- Department of Research, Instituto Nacional de Enfermedades Neoplasicas, Lima, 15038, Peru
| | - Najat Bouchmaa
- Institute of Biological Sciences, Mohammed VI Polytechnic University (UM6P), 43 150, Ben-Guerir, Morocco
| | - Reena R Md Zin
- Department of Pathology, Faculty of Medicine, UKM Medical Centre, Kuala Lumpur, Malaysia
| | - Ruohong Shui
- Department of Pathology, Fudan University Cancer Center, Shanghai, China
| | | | - Wentao Yang
- Department of Pathology, Fudan University Cancer Center, Shanghai, China
| | | | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - An Coosemans
- Laboratory of Tumour Immunology and Immunotherapy, Department of Oncology, KU Leuven, Leuven, Belgium
| | - Edith A Perez
- Department of Hematology/Oncology, Mayo Clinic, Jacksonville, FL, USA
| | - Elena Provenzano
- Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Paula Gonzalez Ericsson
- Breast Cancer Program, Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Eduardo Richardet
- Clinical Oncology Unit, Instituto Oncológico Córdoba, Córdoba, Argentina
| | - Ravi Mehrotra
- India Cancer Research Consortium-ICMR, Department of Health Research, New Delhi, India
| | - Sandra Sarancone
- Department of Pathology, Laboratorio QUANTUM, Rosario, Argentina
| | - Anna Ehinger
- Department of Clinical Genetics and Pathology, Skåne University Hospital, Lund University, Lund, Sweden
| | - David L Rimm
- Department of Pathology, Yale School of Medicine, New Haven, CT, USA
| | - John M S Bartlett
- Diagnostic Development, Ontario Institute for Cancer Research, Toronto, Canada
- Cancer Research UK Edinburgh Centre, Institute of Genetics and Cancer, The University of Edinburgh, Edinburgh, UK
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Canada
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia IRCCS, and University of Milan, Milan, Italy
| | - Carsten Denkert
- Institute of Pathology, Universitätsklinikum Gießen und Marburg GmbH, Standort Marburg and Philipps-Universität Marburg, Marburg, Germany
| | - Akira I Hida
- Department of Pathology, Matsuyama Shimin Hospital, Matsuyama, Japan
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Stephen M Hewitt
- Laboratory of Pathology, National Cancer Institute, NIH, Bethesda, MD, USA
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - William Fraser Symmans
- Department of Pathology, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Rim S Kim
- National Surgical Adjuvant Breast and Bowel Project (NSABP)/NRG Oncology, Pittsburgh, PA, USA
| | - Giancarlo Pruneri
- Department of Pathology, RCCS Fondazione Istituto Nazionale Tumori and University of Milan, School of Medicine, Milan, Italy
| | - Shom Goel
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
| | - Prudence A Francis
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
- Medical Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Rin Yamaguchi
- Department of Pathology and Laboratory Medicine, Kurume University Medical Center, Kurume, Fukuoka, Japan
| | - Hernan Garcia-Rivello
- Servicio de Anatomía Patológica, Hospital Italiano de Buenos Aires, Buenos Aires, Argentina
| | - Hugo Horlings
- Division of Pathology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Said Afqir
- Department of Medical Oncology, Mohammed VI University Hospital, Faculty of Medicine and Pharmacy, Mohammed Ist University, Oujda, Morocco
| | - Roberto Salgado
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Pathology, GZA-ZNA Hospitals, Antwerp, Belgium
| | - Sylvia Adams
- Perlmutter Cancer Center, New York University Medical School, New York, NY, USA
| | - Marleen Kok
- Divisions of Medical Oncology, Molecular Oncology & Immunology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova, Italy
- Medical Oncology 2, Istituto Oncologico Veneto IOV-IRCCS, Padova, Italy
| | - Stefan Michiels
- Service de Biostatistique et d'Epidémiologie, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
| | - Sandra Demaria
- Department of Radiation Oncology, Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Sherene Loi
- Division of Research, Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, VIC, Australia
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Gennari A, André F, Barrios CH, Cortés J, de Azambuja E, DeMichele A, Dent R, Fenlon D, Gligorov J, Hurvitz SA, Im SA, Krug D, Kunz WG, Loi S, Penault-Llorca F, Ricke J, Robson M, Rugo HS, Saura C, Schmid P, Singer CF, Spanic T, Tolaney SM, Turner NC, Curigliano G, Loibl S, Paluch-Shimon S, Harbeck N. ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol 2021; 32:1475-1495. [PMID: 34678411 DOI: 10.1016/j.annonc.2021.09.019] [Citation(s) in RCA: 403] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- A Gennari
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif, France
| | - C H Barrios
- Oncology Research Center, Grupo Oncoclínicas, Porto Alegre, Brazil
| | - J Cortés
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona, Spain; Scientific Department, Medica Scientia Innovation Research, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - E de Azambuja
- Medical Oncology Department, Institute Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A DeMichele
- Hematology/Oncology Department, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - R Dent
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - D Fenlon
- College of Human and Health Sciences, Swansea University-Singleton Park Campus, Swansea, UK
| | - J Gligorov
- Départment d' Oncologie Médicale, Institut Universitaire de Cancérologie AP-HP, Sorbonne Université, Hôpital Tenon, Paris, France
| | - S A Hurvitz
- Department of Medicine/Division of Hematology Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA; Jonsson Comprehensive Cancer Center, Los Angeles, USA
| | - S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein-Campus Kiel, Kiely, Germany
| | - W G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - S Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F Penault-Llorca
- Centre de Lutte Contre le Cancer Jean Perrin, Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, UMR INSERM-UCA, Clermont Ferrand, France
| | - J Ricke
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif, France; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - M Robson
- Medicine Department, Memorial Sloan Kettering Cancer Center, New York, USA
| | - H S Rugo
- Department of Medicine, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - C Saura
- Breast Cancer Program, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Schmid
- Centre of Experimental Cancer Medicine, Cancer Research UK Barts Centre, Barts and The London School of Medicine and Dentistry, London, UK
| | - C F Singer
- Center for Breast Health and Department of Obstetrics & Gynecology, Medical University of Vienna, Vienna, Austria
| | - T Spanic
- Europa Donna Slovenia, Slovenia, USA
| | | | - N C Turner
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS and University of Milano, Milan, Italy
| | - S Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - N Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
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Rugo HS, Loi S, Adams S, Schmid P, Schneeweiss A, Barrios CH, Iwata H, Diéras V, Winer EP, Kockx MM, Peeters D, Chui SY, Lin JC, Nguyen-Duc A, Viale G, Molinero L, Emens LA. PD-L1 Immunohistochemistry Assay Comparison in Atezolizumab Plus nab-Paclitaxel-Treated Advanced Triple-Negative Breast Cancer. J Natl Cancer Inst 2021; 113:1733-1743. [PMID: 34097070 PMCID: PMC8634452 DOI: 10.1093/jnci/djab108] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 01/07/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the phase III IMpassion130 study, atezolizumab plus nab-paclitaxel (A+nP) showed clinical benefit in advanced or metastatic triple-negative breast cancer patients who were programmed death-ligand 1 (PD-L1)+ (tumor-infiltrating immune cells [IC] ≥1%) using the SP142 immunohistochemistry assay. Here we evaluate 2 other PD-L1 assays for analytical concordance with SP142 and patient-associated clinical outcomes. METHODS Samples from 614 patients (68.1% of intention-to-treat population) were centrally evaluated by immunohistochemistry for PD-L1 status on IC (VENTANA SP142, SP263, Dako 22C3) or as a combined positive score (CPS; 22C3). RESULTS Using SP142, SP263, and 22C3 assays, PD-L1 IC ≥1% prevalence was 46.4% (95% confidence interval [CI] = 42.5% to 50.4%), 74.9% (95% CI = 71.5% to 78.3%), and 73.1% (95% CI = 69.6% to 76.6%), respectively; 80.9% were 22C3 CPS ≥1. At IC ≥1% (+), the analytical concordance between SP142 and SP263 and 22C3 was 69.2% and 68.7%, respectively. Almost all SP142+ cases were captured by other assays (double positive), but several SP263+ (29.6%) or 22C3+ (29.0%) cases were SP142- (single positive). A+nP clinical activity vs placebo+nP in SP263+ and 22C3+ patients (progression-free survival [PFS] hazard ratios [HRs] = 0.64 to 0.68; overall survival [OS] HRs = 0.75 to 0.79) was driven by double-positive cases (PFS HRs = 0.60 to 0.61; OS HRs = 0.71 to 0.75) rather than single-positive cases (PFS HRs = 0.68 to 0.81; OS HRs = 0.87 to 0.95). Concordance for harmonized cutoffs for SP263 (IC ≥4%) and 22C3 (CPS ≥10) to SP142 (IC ≥1%) was subpar (approximately 75%). CONCLUSIONS 22C3 and SP263 assays identified more patients as PD-L1+ (IC ≥1%) than SP142. No inter-assay analytical equivalency was observed. Consistent improved A+nP efficacy was captured by the SP142 PD-L1 IC ≥1% subgroup nested within 22C3 and SP263 PD-L1+ (IC ≥1%) populations.
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Affiliation(s)
- Hope S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sherene Loi
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - Sylvia Adams
- New York University Langone Health, Perlmutter Cancer Center, New York, NY, USA
| | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Carlos H Barrios
- Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Véronique Diéras
- Department of Medical Oncology, Institut Curie, Paris, and Centre Eugène Marquis, Rennes, France
| | | | | | | | | | | | | | - Giuseppe Viale
- Post-graduate Medical School in Pathology, University of Milan, Milan, Italy
- Division of Pathology and Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Leisha A Emens
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
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96
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Emens LA, Adams S, Barrios CH, Diéras V, Iwata H, Loi S, Rugo HS, Schneeweiss A, Winer EP, Patel S, Henschel V, Swat A, Kaul M, Molinero L, Patel S, Chui SY, Schmid P. Corrigendum to 'First-line atezolizumab plus nab-paclitaxel for unresectable, locally advanced, or metastatic triple-negative breast cancer: IMpassion130 final overall survival analysis': Annals of Oncology 2021; 32: 983-993. Ann Oncol 2021; 32:1650. [PMID: 34740469 DOI: 10.1016/j.annonc.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- L A Emens
- University of Pittsburgh Medical Center Hillman Cancer Center and Department of Medicine, Pittsburgh, USA.
| | - S Adams
- Breast Cancer Center, and Department of Medicine, New York University Langone Health, Perlmutter Cancer Center, New York, USA
| | - C H Barrios
- Oncology Clinics Group, Centro de Pesquisa Clínica, HSL, PUCRS, Porto Alegre, Brazil
| | - V Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - H Iwata
- Breast Cancer Oncology Department, Aichi Cancer Center Hospital, Nagoya, Japan
| | - S Loi
- Translational Breast Cancer Genomics and Therapeutics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H S Rugo
- Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco, USA
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - E P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - S Patel
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - V Henschel
- Product Development Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - A Swat
- Product Development Oncology, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - M Kaul
- Product Development Safety, Genentech, Inc., South San Francisco, USA
| | - L Molinero
- Oncology Biomarker Development, Genentech, Inc., South San Francisco, USA
| | - S Patel
- Product Development Data Sciences, Genentech, Inc., South San Francisco, USA
| | - S Y Chui
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - P Schmid
- Department of Cancer Medicine, Barts Cancer Institute, Queen Mary University London, London, UK
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97
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Aftimos P, Oliveira M, Irrthum A, Fumagalli D, Sotiriou C, Gal-Yam EN, Robson ME, Ndozeng J, Di Leo A, Ciruelos EM, de Azambuja E, Viale G, Scheepers ED, Curigliano G, Bliss JM, Reis-Filho JS, Colleoni M, Balic M, Cardoso F, Albanell J, Duhem C, Marreaud S, Romagnoli D, Rojas B, Gombos A, Wildiers H, Guerrero-Zotano A, Hall P, Bonetti A, Larsson KF, Degiorgis M, Khodaverdi S, Greil R, Sverrisdóttir Á, Paoli M, Seyll E, Loibl S, Linderholm B, Zoppoli G, Davidson NE, Johannsson OT, Bedard PL, Loi S, Knox S, Cameron DA, Harbeck N, Montoya ML, Brandão M, Vingiani A, Caballero C, Hilbers FS, Yates LR, Benelli M, Venet D, Piccart MJ. Genomic and Transcriptomic Analyses of Breast Cancer Primaries and Matched Metastases in AURORA, the Breast International Group (BIG) Molecular Screening Initiative. Cancer Discov 2021; 11:2796-2811. [PMID: 34183353 PMCID: PMC9414283 DOI: 10.1158/2159-8290.cd-20-1647] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/05/2021] [Accepted: 06/11/2021] [Indexed: 02/01/2023]
Abstract
AURORA aims to study the processes of relapse in metastatic breast cancer (MBC) by performing multi-omics profiling on paired primary tumors and early-course metastases. Among 381 patients (primary tumor and metastasis pairs: 252 targeted gene sequencing, 152 RNA sequencing, 67 single nucleotide polymorphism arrays), we found a driver role for GATA1 and MEN1 somatic mutations. Metastases were enriched in ESR1, PTEN, CDH1, PIK3CA, and RB1 mutations; MDM4 and MYC amplifications; and ARID1A deletions. An increase in clonality was observed in driver genes such as ERBB2 and RB1. Intrinsic subtype switching occurred in 36% of cases. Luminal A/B to HER2-enriched switching was associated with TP53 and/or PIK3CA mutations. Metastases had lower immune score and increased immune-permissive cells. High tumor mutational burden correlated to shorter time to relapse in HR+/HER2- cancers. ESCAT tier I/II alterations were detected in 51% of patients and matched therapy was used in 7%. Integration of multi-omics analyses in clinical practice could affect treatment strategies in MBC. SIGNIFICANCE: The AURORA program, through the genomic and transcriptomic analyses of matched primary and metastatic samples from 381 patients with breast cancer, coupled with prospectively collected clinical data, identified genomic alterations enriched in metastases and prognostic biomarkers. ESCAT tier I/II alterations were detected in more than half of the patients.This article is highlighted in the In This Issue feature, p. 2659.
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Affiliation(s)
- Philippe Aftimos
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Mafalda Oliveira
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Christos Sotiriou
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | | | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Justin Ndozeng
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | - Giuseppe Viale
- IEO, Istituto Europeo di Oncologia, IRCCS, and University of Milan, Milan, Italy
| | | | - Giuseppe Curigliano
- IEO, Istituto Europeo di Oncologia, IRCCS, and University of Milan, Milan, Italy
| | - Judith M Bliss
- The Institute of Cancer Research, London, United Kingdom
| | | | - Marco Colleoni
- IEO, Istituto Europeo di Oncologia, IRCCS, and University of Milan, Milan, Italy
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Joan Albanell
- Hospital del Mar - CIBERONC; IMIM, Barcelona; Pompeu Fabra University, Barcelona, Spain
| | - Caroline Duhem
- Centre Hospitalier Luxembourg, Luxembourg City, Luxembourg
| | | | | | - Beatriz Rojas
- CIOCC (Centro Integral Oncologico "Clara Campal"), Madrid, Spain
| | - Andrea Gombos
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Peter Hall
- University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Andrea Bonetti
- Department of Oncology AZIENDA ULSS 9 Verona, Verona, Italy
| | | | | | - Silvia Khodaverdi
- Sana Klinikum Offenbach, Klinik für Gynaekologie und Geburtshilfe, Offenbach, Germany
| | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute-CCCIT and Cancer Cluster Salzburg, Salzburg, Austria
| | | | | | - Ethel Seyll
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Gabriele Zoppoli
- Università degli Studi di Genova and IRCCS Ospedale Policlinico San Martino, San Martino, Italy
| | - Nancy E Davidson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington
| | | | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Susan Knox
- Europa Donna- The European Breast Cancer Coalition, Milan, Italy
| | - David A Cameron
- University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Nadia Harbeck
- Breast Center, LMU University Hospital, Munich, Germany, and West German Study Group, Moenchengladbach, Germany
| | | | - Mariana Brandão
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Andrea Vingiani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Lucy R Yates
- Wellcome Trust Sanger Institute, London, United Kingdom
| | | | - David Venet
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Martine J Piccart
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium.
- Breast International Group, Brussels, Belgium
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Carey L, Pierga JY, Kümmel S, Jerusalem G, De Laurentiis M, Miller M, Li Z, Kaper M, Su F, Loi S. 275P A phase II study of LAG525 in combination with spartalizumab (PDR001), PDR001 and carboplatin (Carbo), or Carbo, as first- or second-line therapy in patients (Pts) with advanced (Adv) triple-negative breast cancer (tnbc). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.558] [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: 10/20/2022] Open
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99
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Klempner S, Beeram M, Sabanathan D, Chan A, Hamilton E, Loi S, Oh DY, Emens L, Patnaik A, Kim J, Park Y, Odegard V, Hamke S, Jang G, Jacquemont C, Hunder N, Piha-Paul S. 209P Interim results of a phase I/Ib study of SBT6050 monotherapy and pembrolizumab combination in patients with advanced HER2-expressing or amplified solid tumors. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.491] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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100
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Rugo H, Im SA, Joy A, Yaroslav S, Walshe J, Sleckman B, Loi S, Puyana Theall K, Kim S, Huang X, Bananis E, Mahtani R, Finn R, Diéras V. 234P Effect of palbociclib (PAL) + endocrine therapy (ET) on time to chemotherapy (TTC) across subgroups of patients (pts) with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) advanced breast cancer (ABC): Post hoc analyses from PALOMA-2 (P2) and PALOMA-3 (P3). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.08.517] [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: 11/28/2022] Open
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