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Nakajima K, Iwata H, Naito M, Hirai S, Yakura T, Hatayama N, Kume K, Tomita J, Gao T, Hashimoto S, Omachi C, Nagayoshi J, Mizoe J, Ogino H, Shibamoto Y. Fruit Fly Helps Elucidate the Biological Effects of Proton Therapy: In Vivo Model of Normal Tissue Response. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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152
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Iwata H, Shuto T, Kamei S, Omachi K, Moriuchi M, Omachi C, Toshito T, Nagayoshi J, Nakajima K, Hashimoto S, Ogino H, Mizoe J, Kai H, Shibamoto Y. Effects of Proton Beams and X Rays on the Cell Cycle of Fluorescent Ubiquitination-Based Cell Cycle Indicator (Fucci)-Expressing Cells. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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153
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Hashimoto S, Katsurada M, Muramatsu R, Asai K, Shimomura A, Ueki K, Kino H, Yoshida A, Tanaka K, Hayashi K, Kimura M, Kibe Y, Omachi C, Toshito T, Nakajima K, Hattori Y, Iwata H, Mizoe J, Ogino H, Shibamoto Y. Effect of a Device-Free Compressed Shell Fixation Method on Hepatic Respiratory Movement. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.1544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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154
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Halu A, Wang JG, Iwata H, Mojcher A, Abib AL, Singh SA, Aikawa M, Sharma A. Context-enriched interactome powered by proteomics helps the identification of novel regulators of macrophage activation. eLife 2018; 7:37059. [PMID: 30303482 PMCID: PMC6179386 DOI: 10.7554/elife.37059] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 08/30/2018] [Indexed: 02/06/2023] Open
Abstract
The role of pro-inflammatory macrophage activation in cardiovascular disease (CVD) is a complex one amenable to network approaches. While an indispensible tool for elucidating the molecular underpinnings of complex diseases including CVD, the interactome is limited in its utility as it is not specific to any cell type, experimental condition or disease state. We introduced context-specificity to the interactome by combining it with co-abundance networks derived from unbiased proteomics measurements from activated macrophage-like cells. Each macrophage phenotype contributed to certain regions of the interactome. Using a network proximity-based prioritization method on the combined network, we predicted potential regulators of macrophage activation. Prediction performance significantly increased with the addition of co-abundance edges, and the prioritized candidates captured inflammation, immunity and CVD signatures. Integrating the novel network topology with transcriptomics and proteomics revealed top candidate drivers of inflammation. In vitro loss-of-function experiments demonstrated the regulatory role of these proteins in pro-inflammatory signaling. When human cells or tissues are injured, the body triggers a response known as inflammation to repair the damage and protect itself from further harm. However, if the same issue keeps recurring, the tissues become inflamed for longer periods of time, which may ultimately lead to health problems. This is what could be happening in cardiovascular diseases, where long-term inflammation could damage the heart and blood vessels. Many different proteins interact with each other to control inflammation; gaining an insight into the nature of these interactions could help to pinpoint the role of each molecular actor. Researchers have used a combination of unbiased, large-scale experimental and computational approaches to develop the interactome, a map of the known interactions between all proteins in humans. However, interactions between proteins can change between cell types, or during disease. Here, Halu et al. aimed to refine the human interactome and identify new proteins involved in inflammation, especially in the context of cardiovascular disease. Cells called macrophages produce signals that trigger inflammation whey they detect damage in other cells or tissues. The experiments used a technique called proteomics to measure the amounts of all the proteins in human macrophages. Combining these data with the human interactome made it possible to predict new links between proteins known to have a role in inflammation and other proteins in the interactome. Further analysis using other sets of data from macrophages helped identify two new candidate proteins – GBP1 and WARS – that may promote inflammation. Halu et al. then used a genetic approach to deactivate the genes and decrease the levels of these two proteins in macrophages, which caused the signals that encourage inflammation to drop. These findings suggest that GBP1 and WARS regulate the activity of macrophages to promote inflammation. The two proteins could therefore be used as drug targets to treat cardiovascular diseases and other disorders linked to inflammation, but further studies will be needed to precisely dissect how GBP1 and WARS work in humans.
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Affiliation(s)
- Arda Halu
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States.,Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Jian-Guo Wang
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Hiroshi Iwata
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Alexander Mojcher
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Ana Luisa Abib
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Sasha A Singh
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Masanori Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
| | - Amitabh Sharma
- Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, United States
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155
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Sano Y, Iwata A, Wanaka H, Matsui M, Yamamoto S, Koyanagi J, Iwata H. An easy and safe training method for trunk function improves mobility in total knee arthroplasty patients: A quasi-randomized controlled trial. PLoS One 2018; 13:e0204884. [PMID: 30286130 PMCID: PMC6171877 DOI: 10.1371/journal.pone.0204884] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2017] [Accepted: 09/14/2018] [Indexed: 11/18/2022] Open
Abstract
Objective Total knee arthroplasty (TKA) is aimed mainly at reducing pain and restoring mobility. However, mobility deficits can persist even longer than 1 year. The trunk function and movement velocity of any region have been recently recognized to be critical for determining mobility in older people. Therefore, the main goal of this quasi-randomized trial is to clarify the effectiveness of a novel training method, the seated side tapping (SST) training, for improving mobility by focusing on movement velocity of trunk function in the short term after TKA. Methods SST training consists of side trunk movements repeated as quickly as possible in a seated position. All participants after TKA were randomly assigned to the SST training group (n = 37) or control training group (n = 38). The participants in the SST group performed SST training plus the standard rehabilitation program 5 days per week for 3 weeks after TKA, while the control group performed only the standard rehabilitation programs. The primary outcome was the effect of SST training on mobility, indicated by gait speed and the timed up and go test (TUG) time. Measurements were performed before and 1, 2, and 3 weeks after surgery. Results At all-time points, the patients in the SST group showed significantly better mobility, despite that knee function, represented by muscle strength, range of motion, and degree of pain at the knee joint, was similar in both groups. The difference in gait speed between the groups was >0.1 m/s at all time points, which is clinically significant. Conclusion SST training significantly improved patients’ mobility within 3 weeks after TKA, despite that no additional benefit was observed in knee function. The findings in this study indicate that SST training may be considered as a part of the rehabilitation program after TKA, although further evaluation of its long-term effectiveness is needed. Trial registration University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR; UMIN000027909).
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Affiliation(s)
- Yuki Sano
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Akira Iwata
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- * E-mail:
| | - Hideyuki Wanaka
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Mina Matsui
- Department of Rehabilitation, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Saki Yamamoto
- Department of Physical Therapy, Faculty of Comprehensive Rehabilitation, Osaka Prefecture University, Habikino, Osaka, Japan
| | - Junichiro Koyanagi
- Department of Orthopaedic Surgery, Osaka General Medical Center, Osaka, Osaka, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Bunkyo-ku, Tokyo, Japan
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156
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Iwata H, Masuda N, Yamamoto Y, Fujisawa T, Toyama T, Taira N, Kashiwaba M, Ohtani S, Sakai T, Hasegawa Y, Nakamura R, Akabane H, Shibahara Y, Sasano H, Yamaguchi T, Ohashi Y. Distant disease-free survival (DDFS) according to response category in neoadjuvant endocrine therapy (NET): 6-year analysis in phase III NEOS trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy270.182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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157
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Yoshinouchi Y, Hirano M, Nakata H, Nomyamai K, Tanabe S, Kim EY, Iwata H. Structure-activity relationships of Baikal seal estrogen receptors and environmental phenols. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.703] [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]
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158
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Schmid P, Adams S, Rugo H, Schneeweiss A, Barrios C, Iwata H, Dieras V, Hegg R, Im SA, Wright G, Henschel V, Molinero L, Chui S, Funke R, Husain A, Winer E, Loi S, Emens L. IMpassion130: Results from a global, randomised, double-blind, phase III study of atezolizumab (atezo) + nab-paclitaxel (nab-P) vs placebo + nab-P in treatment-naive, locally advanced or metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.008] [Citation(s) in RCA: 4] [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: 11/14/2022] Open
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159
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Yoshino T, Iwata H, Tamura K, Takahashi S, Redfern C, Modi S, Doi T, Kawakami H, Taniguchi H, Takashima A, Yamaguchi K, Fisher J, Li B, Saito K, Fujisaki Y, Sugihara M, Tsurutani J. Updated results of phase I study of trastuzumab deruxtecan (DS-8201a) in HER2-expressing advanced colorectal cancer. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.109] [Citation(s) in RCA: 4] [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: 11/14/2022] Open
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160
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Cristofanilli M, Slamon D, Ro J, Bondarenko I, Im SA, Masuda N, Colleoni M, DeMichele A, Loi S, Verma S, Iwata H, Harbeck N, Loibl S, André F, Puyana Theall K, Huang X, Giorgetti C, Huang Bartlett C, Turner N. Overall survival (OS) with palbociclib plus fulvestrant in women with hormone receptor-positive (HR+), human epidermal growth factor receptor 2-negative (HER2−) advanced breast cancer (ABC): Analyses from PALOMA-3. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.009] [Citation(s) in RCA: 6] [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] [Indexed: 11/13/2022] Open
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161
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Shimomura A, Tamura K, Mizutani T, Shibata T, Hara F, Fujisawa T, Niikura N, Hojo T, Kambayashi C, Saji S, Masuda N, Sawaki M, Yamamoto N, Nagashima F, Shien T, Iwata H. A phase III study comparing trastuzumab emtansine with trastuzumab, pertuzumab, and docetaxel in elderly patients with advanced stage HER2-positive breast cancer (JCOG1607 HERB TEA study). Ann Oncol 2018. [DOI: 10.1093/annonc/mdy272.349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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162
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Ochiai M, Kurihara N, Matsuda A, Nakagun S, Shiozaki A, Nakata A, Matsuishi T, Kunisue T, Iwata H. In vitro cytotoxicity assessments of persistent organic pollutants using cetacean fibroblasts. Toxicol Lett 2018. [DOI: 10.1016/j.toxlet.2018.06.654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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163
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André F, Ciruelos E, Rubovszky G, Campone M, Loibl S, Rugo H, Iwata H, Conte P, Mayer I, Kaufman B, Yamashita T, Lu YS, Inoue K, Takahashi M, Pápai Z, Longin AS, Mills D, Wilke C, Hirawat S, Juric D. Alpelisib (ALP) + fulvestrant (FUL) for advanced breast cancer (ABC): Results of the phase III SOLAR-1 trial. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy424.010] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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164
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Mai Y, Ujiie H, Higashi T, Yamagami J, Iwata H, Shimizu H. Autoantibodies undetectable by chemiluminescent enzyme immunoassay require extended antigen-antibody reaction time for detection. Br J Dermatol 2018; 180:215-216. [PMID: 30171687 DOI: 10.1111/bjd.17121] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y Mai
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - H Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - T Higashi
- Department of Cellular Pharmacology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - J Yamagami
- Department of Dermatology, Keio University School of Medicine, Shinjuku-ku, Tokyo, Japan
| | - H Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - H Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
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165
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Yoshimoto N, Ujiie H, Zheng M, Iwata H, Kosumi H, Hata H, Shimizu H. Bullous pemphigoid with the deposition of IgG2 but not IgG1, IgG3 nor IgG4 autoantibodies at the basement membrane zone. J Eur Acad Dermatol Venereol 2018; 32:e344-e346. [DOI: 10.1111/jdv.14920] [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: 11/29/2022]
Affiliation(s)
- N. Yoshimoto
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - H. Ujiie
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - M. Zheng
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - H. Iwata
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - H. Kosumi
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - H. Hata
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
| | - H. Shimizu
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Sapporo Japan
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166
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Mai Y, Nishie W, Izumi K, Yoshimoto N, Morita Y, Watanabe M, Toyonaga E, Ujiie H, Iwata H, Fujita Y, Nomura T, Sato-Matsumura KC, Shimizu S, Shimizu H. Detection of anti-BP180 NC16A autoantibodies after the onset of dipeptidyl peptidase-IV inhibitor-associated bullous pemphigoid: a report of three patients. Br J Dermatol 2018; 179:790-791. [PMID: 29624639 DOI: 10.1111/bjd.16656] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Y Mai
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - W Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - K Izumi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - N Yoshimoto
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Y Morita
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
- Department of Dermatology, JR Sapporo Hospital, Sapporo, Japan
| | - M Watanabe
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - E Toyonaga
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - H Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - H Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - Y Fujita
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - T Nomura
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - K C Sato-Matsumura
- Department of Dermatology, Japan Community Health Care Organization, Sapporo Hokushin Hospital, Sapporo, Japan
| | - S Shimizu
- Department of Dermatology, Sapporo City General Hospital, Sapporo, Japan
| | - H Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-ku, Sapporo, 060-8638, Japan
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167
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Dohi T, Kasai T, Endo H, Wada H, Yanagisawa N, Nojiri S, Funamizu T, Shitara J, Doi S, Kato Y, Okai I, Iwata H, Isoda K, Okazaki S, Miyauchi K, Daida H. CPAP effects on atherosclerotic plaques in patients with sleep-disordered breathing and coronary artery disease: The ENTERPRISE trial. J Cardiol 2018; 73:89-93. [PMID: 30177302 DOI: 10.1016/j.jjcc.2018.07.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Revised: 06/20/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Sleep-disordered breathing (SDB) is a novel cardiovascular risk factor. To date, the effects of continuous positive airway pressure (CPAP) on coronary plaque atheroma in SDB patients with coronary artery disease (CAD) have remained unclear. The CPAP Effects on Atherosclerotic Plaques in Patients with Sleep-Disordered Breathing and Coronary Artery Disease (ENTERPRISE) trial was designed to evaluate the effects of CPAP treatment in addition to optimal medical treatment on coronary plaque regression in SDB patients. METHODS This study is planned as a prospective, randomized, open-label, single-center study. The presence of SDB is defined as a 3% oxygen desaturation index (ODI) of ≥15 events/h as measured by nocturnal pulse oximetry. A total of 100 eligible SDB patients undergoing intravascular ultrasound (IVUS)-guided percutaneous coronary intervention will be randomly assigned to either CPAP as add-on therapy or no CPAP for SDB (1:1 ratio for CPAP vs. no CPAP). The intervention will consist of 12 months of CPAP treatment. The primary endpoint will be percentage changes in plaque atheroma volume of the non-culprit lesion segment as measured by IVUS. A specialist sleep cardiology team will carefully monitor patients receiving CPAP treatment in order to quickly detect and resolve problems, and to motivate patients to continue treatment. CONCLUSION This study will provide novel information on the effects of SDB and its treatment with CPAP on coronary plaque stability with regard to secondary prevention of CAD.
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Affiliation(s)
- Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan.
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hideki Wada
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Naotake Yanagisawa
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Shuko Nojiri
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan; Clinical Research and Trial Center, Juntendo University Hospital, Tokyo, Japan
| | - Takehiro Funamizu
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Yoshiteru Kato
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Iwao Okai
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, Tokyo, Japan
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168
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Wada H, Dohi T, Miyauchi K, Shitara J, Endo H, Doi S, Tsuboi S, Ogita M, Iwata H, Kasai T, Okazaki S, Isoda K, Suwa S, Daida H. Mean platelet volume and long-term cardiovascular outcomes in patients with stable coronary artery disease. Atherosclerosis 2018; 277:108-112. [PMID: 30195145 DOI: 10.1016/j.atherosclerosis.2018.08.048] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2018] [Revised: 07/31/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND AND AIMS Although an elevated mean platelet volume (MPV) has been associated with poor clinical outcomes after acute coronary syndrome (ACS), the association between MPV and long-term outcomes in patients with stable coronary artery disease (CAD) remains uncertain. We aimed to investigate the impact of pre-procedural MPV levels in patients following elective percutaneous coronary intervention (PCI). METHODS We studied 2872 stable CAD patients who underwent their first PCI and who had available data on pre-procedural MPV between 2002 and 2016. Patients were divided into quartiles based on their MPV. The incidences of major adverse cardiac events (MACE), including all-cause death and non-fatal myocardial infarction, were evaluated. RESULTS The median MPV was 10.4 fL (interquartile range: 9.8-11.0). During a median follow-up of 5.6 years, 498 (17.3%) MACE were identified, with a cumulative incidence significantly higher in the lowest MPV group than in other groups (p < 0.01). After adjustment for platelet count and the other cardiovascular risk factors, the lowest MPV group had a significantly higher risk of MACE compared with the highest MPV groups (hazard ratio: 1.43, 95% confidence interval 1.10-1.86, p = 0.009). Decreasing MPV as a continuous variable was associated with the incidence of MACE (hazard ratio: 1.16 per 1 fL decrease, 95% confidence interval 1.04-1.30, p = 0.007). CONCLUSIONS Contrary to previous studies on ACS patients, this study showed that a low MPV was associated with worse clinical outcomes among stable CAD patients.
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Affiliation(s)
- Hideki Wada
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan.
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Jun Shitara
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hirohisa Endo
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Doi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shuta Tsuboi
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Manabu Ogita
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Takatoshi Kasai
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinya Okazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kikuo Isoda
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Satoru Suwa
- Department of Cardiology, Juntendo University Shizuoka Hospital, Izunokuni, Shizuoka, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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169
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Endo H, Dohi T, Miyauchi K, Funamizu T, Shitara J, Wada H, Doi S, Iwata H, Kasai T, Okazaki S, Isoda K, Daida H. 6134Long-term predictive value of high sensitivity c-reactive protein for cancer mortality in patients undergoing percutaneous coronary intervention. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.6134] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- H Endo
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - T Dohi
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - K Miyauchi
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - T Funamizu
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - J Shitara
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - H Wada
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - S Doi
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - H Iwata
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - T Kasai
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - S Okazaki
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - K Isoda
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
| | - H Daida
- Juntendo University, Department of Cardiovasculer Medicine, Tokyo, Japan
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170
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Sugita Y, Miyazaki T, Shimizu M, Kunimoto M, Aikawa T, Ouchi S, Kadoguchi T, Kawaguchi Y, Shiozawa T, Takahashi S, Hiki M, Yokoyama M, Iwata H, Shimada K, Daida H. P6275Malnutrition and low omega 6 PUFA levels on admission were associated with the development of delirium in patients with acute cardiovascular disease admitted to coronary care unit. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6275] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Y Sugita
- Juntendo University, Tokyo, Japan
| | | | | | | | - T Aikawa
- Juntendo University, Tokyo, Japan
| | - S Ouchi
- Juntendo University, Tokyo, Japan
| | | | | | | | | | - M Hiki
- Juntendo University, Tokyo, Japan
| | | | - H Iwata
- Juntendo University, Tokyo, Japan
| | | | - H Daida
- Juntendo University, Tokyo, Japan
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171
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Zheng M, Ujiie H, Muramatsu K, Sato-Matsumura KC, Maeda T, Ujiie I, Iwata H, Izumi K, Nishie W, Shimizu H. A possible association between BP230-type bullous pemphigoid and dementia: a report of two cases in elderly patients. Br J Dermatol 2018; 178:1449-1450. [PMID: 29278417 DOI: 10.1111/bjd.16249] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- M Zheng
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Muramatsu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | | | - T Maeda
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - I Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - K Izumi
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - W Nishie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - H Shimizu
- Department of Dermatology, Hokkaido University Graduate School of Medicine, Sapporo, Japan
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172
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Miura T, Suemizu H, Goto M, Sakai N, Iwata H, Shimizu M, Yamazaki H. Human urinary concentrations of monoisononyl phthalate estimated using physiologically based pharmacokinetic modeling and experimental pharmacokinetics in humanized-liver mice orally administered with diisononyl phthalate. Xenobiotica 2018; 49:513-520. [DOI: 10.1080/00498254.2018.1471753] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
| | - Hiroshi Suemizu
- Central Institute for Experimental Animals, Kawasaki-ku, Japan
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173
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Taguchi I, Iimuro S, Iwata H, Takashima H, Abe M, Amiya E, Ogawa T, Ozaki Y, Sakuma I, Nakagawa Y, Hibi K, Hiro T, Fukumoto Y, Hokimoto S, Miyauchi K, Yamazaki T, Ito H, Otsuji Y, Kimura K, Takahashi J, Hirayama A, Yokoi H, Kitagawa K, Urabe T, Okada Y, Terayama Y, Toyoda K, Nagao T, Matsumoto M, Ohashi Y, Kaneko T, Fujita R, Ohtsu H, Ogawa H, Daida H, Shimokawa H, Saito Y, Kimura T, Inoue T, Matsuzaki M, Nagai R. High-Dose Versus Low-Dose Pitavastatin in Japanese Patients With Stable Coronary Artery Disease (REAL-CAD): A Randomized Superiority Trial. Circulation 2018; 137:1997-2009. [PMID: 29735587 PMCID: PMC5959207 DOI: 10.1161/circulationaha.117.032615] [Citation(s) in RCA: 144] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Accepted: 02/28/2018] [Indexed: 01/02/2023]
Abstract
BACKGROUND Current guidelines call for high-intensity statin therapy in patients with cardiovascular disease on the basis of several previous "more versus less statins" trials. However, no clear evidence for more versus less statins has been established in an Asian population. METHODS In this prospective, multicenter, randomized, open-label, blinded end point study, 13 054 Japanese patients with stable coronary artery disease who achieved low-density lipoprotein cholesterol (LDL-C) <120 mg/dL during a run-in period (pitavastatin 1 mg/d) were randomized in a 1-to-1 fashion to high-dose (pitavastatin 4 mg/d; n=6526) or low-dose (pitavastatin 1 mg/d; n=6528) statin therapy. The primary end point was a composite of cardiovascular death, nonfatal myocardial infarction, nonfatal ischemic stroke, or unstable angina requiring emergency hospitalization. The secondary composite end point was a composite of the primary end point and clinically indicated coronary revascularization excluding target-lesion revascularization at sites of prior percutaneous coronary intervention. RESULTS The mean age of the study population was 68 years, and 83% were male. The mean LDL-C level before enrollment was 93 mg/dL with 91% of patients taking statins. The baseline LDL-C level after the run-in period on pitavastatin 1 mg/d was 87.7 and 88.1 mg/dL in the high-dose and low-dose groups, respectively. During the entire course of follow-up, LDL-C in the high-dose group was lower by 14.7 mg/dL than in the low-dose group (P<0.001). With a median follow-up of 3.9 years, high-dose as compared with low-dose pitavastatin significantly reduced the risk of the primary end point (266 patients [4.3%] and 334 patients [5.4%]; hazard ratio, 0.81; 95% confidence interval, 0.69-0.95; P=0.01) and the risk of the secondary composite end point (489 patients [7.9%] and 600 patients [9.7%]; hazard ratio, 0.83; 95% confidence interval, 0.73-0.93; P=0.002). High-dose pitavastatin also significantly reduced the risks of several other secondary end points such as all-cause death, myocardial infarction, and clinically indicated coronary revascularization. The results for the primary and the secondary composite end points were consistent across several prespecified subgroups, including the low (<95 mg/dL) baseline LDL-C subgroup. Serious adverse event rates were low in both groups. CONCLUSIONS High-dose (4 mg/d) compared with low-dose (1 mg/d) pitavastatin therapy significantly reduced cardiovascular events in Japanese patients with stable coronary artery disease. CLINICAL TRIAL REGISTRATION URL: https://www.clinicaltrials.gov. Unique identifier: NCT01042730.
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Affiliation(s)
- Isao Taguchi
- Department of Cardiology, Dokkyo Medical University Koshigaya Hospital, Koshigaya, Japan (I.T.)
| | - Satoshi Iimuro
- Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (S.I., T. Kaneko)
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (H.I., K.M., H.D.)
| | - Hiroaki Takashima
- Department of Cardiology, Aichi Medical University, Nagakute, Japan (H.T.)
| | - Mitsuru Abe
- Department of Cardiology, National Hospital Organization Kyoto Medical Center, Japan (M.A.)
| | - Eisuke Amiya
- Department of Cardiovascular Medicine, Graduate School of Medicine, University of Tokyo, Japan (E.A.)
| | - Takanori Ogawa
- Department of Cardiovascular Medicine, Hokuto Social Medical Corp, Hokuto Hospital, Obihiro, Japan (T.O.)
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University School of Medicine, Toyoake, Japan (Y. Ozaki)
| | - Ichiro Sakuma
- Caress Sapporo Hokko Memorial Clinic, Sapporo, Japan (I.S.)
| | | | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center, Japan (K.H., K. Kimura)
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (T.H., A.H.)
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine, Japan (Y.F.)
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Kumamoto University Hospital, Japan (S.H.)
| | - Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (H.I., K.M., H.D.)
| | - Tsutomu Yamazaki
- Clinical Research Support Center, University of Tokyo Hospital, Japan (T.Y.)
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University, Graduate School of Medicine, Japan (H.I.)
| | - Yutaka Otsuji
- Second Department of Internal Medicine, University of Occupational and Environmental Health, School of Medicine, Kita-Kyushu, Japan (Y. Otsuji)
| | - Kazuo Kimura
- Division of Cardiology, Yokohama City University Medical Center, Japan (K.H., K. Kimura)
| | - Jun Takahashi
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (J.T., H.S.)
| | - Atsushi Hirayama
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine, Tokyo, Japan (T.H., A.H.)
| | | | - Kazuo Kitagawa
- Department of Neurology, Tokyo Women's Medical University, Japan (K. Kitagawa)
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Japan (T.U.)
| | - Yasushi Okada
- Clinical Research Institute and Department of Cerebrovascular Medicine and Neurology, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan (Y.O.)
| | - Yasuo Terayama
- Division of Neurology and Gerontology, Department of Internal Medicine, School of Medicine, Iwate Medical University, Morioka, Japan (Y.T.)
| | - Kazunori Toyoda
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Suita, Japan (K.T.)
| | - Takehiko Nagao
- Department of Neurology, Nippon Medical School Tama-Nagayama Hospital, Tama, Japan (T.N.)
| | - Masayasu Matsumoto
- Japan Community Healthcare Organization, Hoshigaoka Medical Center, Hirakata, Japan (M. Matsumoto)
| | - Yasuo Ohashi
- Department of Integrated Science and Technology for Sustainable Society, Chuo University, Tokyo, Japan (Y. Ohashi)
| | - Tetsuji Kaneko
- Teikyo Academic Research Center, Teikyo University, Tokyo, Japan (S.I., T. Kaneko)
| | - Retsu Fujita
- Department of Clinical Research Medicine, School of Medicine, Teikyo University, Tokyo, Japan (R.F.)
| | - Hiroshi Ohtsu
- National Center for Global Health and Medicine, Center for Clinical Sciences, Tokyo, Japan (H. Ohtsu)
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Suita, Japan (H. Ogawa)
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan (H.I., K.M., H.D.)
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine, Sendai, Japan (J.T., H.S.)
| | | | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Japan (T. Kimura).
| | - Teruo Inoue
- Department of Cardiovascular Medicine, Dokkyo Medical University, Mibu, Japan (T.I.).
| | | | - Ryozo Nagai
- Jichi Medical University, Shimotsuke, Japan (R.N.)
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174
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Miyazawa H, Fujita Y, Iwata H, Ishikawa Y, Nishio S, Ishijima K, Shinmei Y, Takeichi T, Goto K, Oi R, Akiyama M, Shimizu H. Two cases of generalized pustular psoriasis complicated by IgG4-related disease. Br J Dermatol 2018; 179:537-539. [PMID: 29709076 DOI: 10.1111/bjd.16712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- H Miyazawa
- Department of Dermatology, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Y Fujita
- Department of Dermatology, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - H Iwata
- Department of Dermatology, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Y Ishikawa
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - S Nishio
- Department of Rheumatology, Endocrinology and Nephrology, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - K Ishijima
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - Y Shinmei
- Department of Ophthalmology, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
| | - T Takeichi
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - K Goto
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - R Oi
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - M Akiyama
- Department of Dermatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - H Shimizu
- Department of Dermatology, Hokkaido University, N15 W7, Kita-ku, Sapporo, 060-8638, Japan
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Muramatsu K, Ujiie H, Kobayashi I, Nishie W, Natsuga K, Iwata H, Shimizu H. 012 Treg dysfunction induces autoantibodies to type XVII collagen and BP230 in mice and humans. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.016] [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: 10/17/2022]
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176
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Ujiie H, Sasaoka T, Nishie W, Iwata H, Ishikawa M, Higashino H, Natsuga K, Shimizu H. 011 Intravenous immunoglobulin reduces pathogenic antibodies, serum IL-6 levels and disease severity in experimental bullous pemphigoid. J Invest Dermatol 2018. [DOI: 10.1016/j.jid.2018.03.015] [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: 11/17/2022]
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177
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Nakatani T, Takano H, Noda H, Taenaka Y, Umezu M, Kinoshita M, Fukuda S, Matsuda T, Iwata H, Takatani S, Tatsumi E, Yagura A, Sekii Y, Akutsu T. Prerequisites to Salvage Profound Biventricular Failure Patients with Ventricular Assist Devices. Int J Artif Organs 2018. [DOI: 10.1177/039139888901200406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We conducted chronic experiments to determine how to treat profound biventricular failure systematically with ventricular assist devices (VADs) and to analyze the factors that affect prognoses for this condition. Anoxic arrest was induced in ten goats by aortic cross-clamping under normothermic conditions (38.5° C) for 30 (n= 3), 45 (n= 1), and 60 (n= 6) minutes. A left ventricular assist device (LVAD) was implanted in eight animals, and a biventricular assist device (BVAD) was used in two. Three goats — two of which had undergone anoxic arrest for 30 minutes and one for 60 minutes — whose right atrial pressure (RAP) was approximately 18 mm Hg during the acute stage, recovered in two to three weeks, and the pumps were successfully removed. Pathological findings in these animals showed scattered areas of surviving myocardium, with connective tissue replacing the degenerated myocardium. The remaining five LVAD goats required higher RAPs to maintain circulation and died from various causes. Maintaining circulation without volume loading, even in the presence of arrhythmias, was easier with the BVAD. One BVAD animal that underwent 45 minutes of anoxic arrest recovered from right ventricular failure, and the right pump was removed. The second goat (anoxic arrest, 60 min) on the BVAD failed to recover. Autopsy of the myocardium revealed a thin ventricular wall. Our studies show that the use of VADs allows time for a failing heart to recover, but the potential for healing is affected by the severity of myocardial damage prior to VAD application. We believe that although LVADs can maintain circulation with high RAPs, the use of BVADs might be more beneficial for maintaining systemic organ function in cases of persistent biventricular failure.
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Affiliation(s)
- T. Nakatani
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - H. Takano
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - H. Noda
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - Y. Taenaka
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - M. Umezu
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - M. Kinoshita
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - S. Fukuda
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - T. Matsuda
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - H. Iwata
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - S. Takatani
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - E. Tatsumi
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - A. Yagura
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - Y. Sekii
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
| | - T. Akutsu
- Department of Artificial Organs, National Cardiovascular Center, Research Institute, Osaka - Japan
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178
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Ohtani S, Yasuaki S, Takada M, Ohi Y, Kurozumi S, Inoue K, Kosaka Y, Hattori M, Yamashita T, Takao S, Sato N, Iwata H, Kurosumi M, Toi M. Effectiveness of Neo-Adjuvant Systemic Therapy for Basal HER2 type Breast Cancer – Results from Retrospective Cohort Study of Japan Breast Cancer Research Group (JBCRG) – C03. Eur J Cancer 2018. [DOI: 10.1016/s0959-8049(18)30506-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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179
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Miyauchi K, Kimura T, Shimokawa H, Daida H, Iimuro S, Iwata H, Ozaki Y, Sakuma I, Nakagawa Y, Hibi K, Hiro T, Fukumoto Y, Hokimoto S, Ohashi Y, Ohtsu H, Saito Y, Matsuzaki M, Nagai R. Rationale and Design of Randomized Evaluation of Aggressive or Moderate Lipid Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) Trial. Int Heart J 2018; 59:315-320. [PMID: 29503404 DOI: 10.1536/ihj.17-557] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Large-scale clinical trials in patients in Western countries with coronary artery disease (CAD) have found that aggressive lipid-lowering therapy using high-dose statins reduces cardiovascular (CV) events further than low-dose statins. However, such evidence has not yet been fully established in Asian populations, including in Japan. The Randomized Evaluation of Aggressive or Moderate Lipid-Lowering Therapy with Pitavastatin in Coronary Artery Disease (REAL-CAD) study addresses whether intensification of statin therapy improves clinical outcomes in Japanese patients with CAD.REAL-CAD is a prospective, multicenter, randomized, open-label, blinded-endpoint, physician-initiated phase 4 trial in Japan. The study will recruit up to 12,600 patients with stable CAD. Patients are assigned to receive either pitavastatin 1 mg/day or pitavastatin 4 mg/day. LDL-C levels are expected to reach approximate mean values of 100 mg/dL in the low-dose pitavastatin group and 80 mg/dL in the high-dose group. The primary endpoint is the time to occurrence of a major CV event, including CV death, non-fatal myocardial infarction, non-fatal ischemic stroke, and unstable angina requiring emergency hospitalization during an average of 5 years. The large number of patients and the long follow-up period in the REAL-CAD study should ensure that there is adequate power to definitively determine if reducing LDL-C levels to approximately 80 mg/dL by high-dose statin can provide additional clinical benefit.After the study is completed, we will have categorical evidence on the optimal statin dose and target LDL-C level for secondary prevention in Japanese patients.
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Affiliation(s)
- Katsumi Miyauchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Takeshi Kimura
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hiroaki Shimokawa
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | | | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine
| | - Yukio Ozaki
- Department of Cardiology, Fujita Health University Hospital, Fujita Health University School of Medicine
| | | | | | - Kiyoshi Hibi
- Division of Cardiology, Yokohama City University Medical Center
| | - Takafumi Hiro
- Division of Cardiology, Department of Medicine, Nihon University School of Medicine
| | - Yoshihiro Fukumoto
- Division of Cardiovascular Medicine, Department of Internal Medicine, Kurume University School of Medicine
| | - Seiji Hokimoto
- Department of Cardiovascular Medicine, Kumamoto University Hospital
| | - Yasuo Ohashi
- Department of Integrated Science and Technology for Sustainable Society, Chuo University
| | - Hiroshi Ohtsu
- National Center for Global Health and Medicine, Center for Clinical Sciences
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180
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Hiki M, Iwata H, Kawaguchi Y, Takamura K, Hiki M, Miyazaki T, Fujimoto S, Amano A, Daida H. Chest X-Ray Revealed a Slowly Progressive Giant Right Coronary Artery Aneurysm in an Asymptomatic Patient. Cardiology 2018; 139:231-233. [PMID: 29544225 DOI: 10.1159/000486950] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 01/17/2018] [Indexed: 11/19/2022]
Abstract
A giant right coronary artery aneurysm (60 × 70 mm in size) was incidentally found by chest X-ray as an abnormal right atrial enlargement, and it needed surgical resection. Although the majority of giant coronary artery aneurysms present with symptoms of coronary ischemia, this case presented without any specific symptom. This study indicates that when chest X-ray shows abnormal atrial enlargement, a differential diagnosis of giant coronary artery aneurysm may need to be considered.
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Affiliation(s)
- Masaru Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroshi Iwata
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Yuko Kawaguchi
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Kazuhisa Takamura
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Makoto Hiki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Tetsuro Miyazaki
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Shinichiro Fujimoto
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Daida
- Department of Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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Sawada M, Hida T, Ujiie H, Iwata H, Uhara H. A case of subepidermal autoimmune bullous disease with autoantibodies against 200 and 290-kDa antigens. J Eur Acad Dermatol Venereol 2018. [PMID: 29524251 DOI: 10.1111/jdv.14927] [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: 12/01/2022]
Affiliation(s)
- M Sawada
- Department of Dermatology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - T Hida
- Department of Dermatology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan
| | - H Ujiie
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - H Iwata
- Department of Dermatology, Hokkaido University Graduate School of Medicine, North 15, West 7, Kita-ku, Sapporo, 060-8638, Japan
| | - H Uhara
- Department of Dermatology, Sapporo Medical University School of Medicine, South 1, West 16, Chuo-ku, Sapporo, 060-8543, Japan
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Kosumi H, Iwata H, Miyazawa H, Tsujiwaki M, Mai Y, Ando S, Ito T, Yamano K, Shimizu H. Dermoscopic features of tungiasis. J Eur Acad Dermatol Venereol 2018; 32:e313-e314. [PMID: 29430724 DOI: 10.1111/jdv.14863] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- H. Kosumi
- Department of Dermatology; Hokkaido University Graduate School of Medicine; North 15 West 7, Kita-ku Sapporo 060-8638 Japan
| | - H. Iwata
- Department of Dermatology; Hokkaido University Graduate School of Medicine; North 15 West 7, Kita-ku Sapporo 060-8638 Japan
| | - H. Miyazawa
- Department of Dermatology; Hokkaido University Graduate School of Medicine; North 15 West 7, Kita-ku Sapporo 060-8638 Japan
| | - M. Tsujiwaki
- Department of Dermatology; Hokkaido University Graduate School of Medicine; North 15 West 7, Kita-ku Sapporo 060-8638 Japan
| | - Y. Mai
- Department of Dermatology; Hokkaido University Graduate School of Medicine; North 15 West 7, Kita-ku Sapporo 060-8638 Japan
| | - S. Ando
- Japan Community Health Care Organization Sapporo Hokushin Hospital; 2-6-2-1 Chuo Atsubetsu Atsubetsu-ku Sapporo 004-8618 Japan
| | - T. Ito
- Hokkaido Institute of Public Health; North 19 West 12, Kita-ku Sapporo 060-0819 Japan
| | - K. Yamano
- Hokkaido Institute of Public Health; North 19 West 12, Kita-ku Sapporo 060-0819 Japan
| | - H. Shimizu
- Department of Dermatology; Hokkaido University Graduate School of Medicine; North 15 West 7, Kita-ku Sapporo 060-8638 Japan
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Hiki M, Iwata H, Takasu K, Ishikawa G, Chikata Y, Kasai T, Miyazaki T, Inoue K, Fujiwara Y, Sumiyoshi M, Daida H. LOW HEART RATE IN COMBINATION WITH LOW BLOOD PRESSURE IN PATIENTS WITH ACUTE DECOMPENSATED HEART FAILURE ASSOCIATES WITH INCREASED RISK OF CARDIOVASCULAR MORTALITY. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)31379-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Doi S, Iwata H, Wada H, Shitara J, Endo H, Naito R, Konishi H, Tsuboi S, Ogita M, Dohi T, Kasai T, Okazaki S, Isoda K, Miyauchi K, Daida H. A NOVEL NUTRITIONAL INDEX BY SIMPLY MULTIPLYING SERUM LEVELS OF TRIGLYCERIDES AND TOTAL CHOLESTEROL, AND BODY WEIGHT SERVES AS A USEFUL INDICATOR FOR ALL-CAUSE, CARDIOVASCULAR AND CANCER MORTALITY IN PATIENTS UNDERWENT PERCUTANEOUS CORONARY INTERVENTION. J Am Coll Cardiol 2018. [DOI: 10.1016/s0735-1097(18)32323-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Iwata H, Masuda N, Fujisawa T, Toyama T, Ohtani S, Yamamoto Y, Kashiwaba M, Taira N, Sakai T, Hasegawa Y, Nakamura R, Akabane H, Shibahara Y, Sasano H, Yamaguchi T, Ohashi Y. Abstract P3-13-03: NEOS: A randomized, open label, phase 3 trial of adjuvant chemotherapy for postmenopausal breast cancer patients who responded to neoadjuvant letrozole: First report of long-term outcome and prognostic value of response to neoadjuvant endocrine therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-13-03] [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: Whether adjuvant chemotherapy is required for patients (pts) with intermediate-risk endocrine-responsive postmenopausal breast cancer (BC) remains unknown. Sufficient data have not been available about the long-term prognosis of patients with neoadjuvant endocrine therapy (ET). NEOS is a randomized phase III study that assessed the long-term prognosis of estrogen receptor positive (ER+) primary breast cancer (PBC) pts who received neoadjuvant ET with/without adjuvant chemotherapy.
Methods: Postmenopausal BC pts with ER +/HER2 negative, T1c-2, clinically node negative, under 76 years old were enrolled at primary registration. Pts were treated by leterozole (LET) in weeks 24-28 after primary enrollment. Pts experienced progression (PD) during neoadjuvant phase were excluded at randomization and received any systemic therapy driven by investigators before or after surgery. The long-term prognosis was followed in all registered pts including PD pts. Response to neoadjuvant ET was evaluated as complete response (CR), partial response (PR) or stable disease (SD) using calipers, ultrasound and MRI (or CT) at the baseline and end of treatment before surgery. Pts who met eligibility criteria were randomized 1:1 to LET for 4.5-5 years after chemotherapy or LET alone for 4.5-5 years without chemotherapy after surgery. Pts excluded at second registration were treated any systemic therapies driven by investigators. The primary endpoint was disease-free survival (DFS) and secondary endpoints included overall survival (OS), clinical response rate in neoadjuvant phase, pathological response, and breast-conserving surgery rate. The randomization code have been blinded to the investigators.
Results: Between May 2008 and June 2013, 904 patients were enrolled at primary registration from 100 institutions in Japan (median follow-up: 4.0 years) and 24 pts were withdrawn during neoadjuvant phase. The median age was 63 years, T1c:37%, T2:63%, and PgR+:78%. Clinical response rates (CR, PR, SD and PD) were2% (16pts), 48% (421pts), 45% (400pts) and 5% (43pts), respectively and, in each response category, 0% (0/16), 5.5% (23/421), 7.8% (31/400), and 20.9% (9/43) experienced DFS events. DFS in PD pts to neoadjuvant ET were statistically significantly worse than CR, PR, SD pts (p<0.0001, hazard ratio 4.7 (95% CI:2.3-9.5). The prognosis after surgery in 669 randomized pts was good regardless with/without chemotherapy, forty four pts (6.6%) experienced DFS events after surgery. The predictive markers of PD for neoadjuvant ET were yet unclear among evaluated clinical factors.
Conclusion: This is the first report of DFS in the largest neoadjuvant ET trial (NEOS). The DFS of postmenopausal, ER+/HER2-, PBC pts excluding PD pts to neoadjuvant ET is highly good regardless with/without chemotherapy. Neoadjuvant ET with utilization of PD response as a prognostic marker can be considered as a standard treatment option for these patients. Clinical trial information: UMIN000001090.
Citation Format: Iwata H, Masuda N, Fujisawa T, Toyama T, Ohtani S, Yamamoto Y, Kashiwaba M, Taira N, Sakai T, Hasegawa Y, Nakamura R, Akabane H, Shibahara Y, Sasano H, Yamaguchi T, Ohashi Y. NEOS: A randomized, open label, phase 3 trial of adjuvant chemotherapy for postmenopausal breast cancer patients who responded to neoadjuvant letrozole: First report of long-term outcome and prognostic value of response to neoadjuvant endocrine therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-13-03.
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Affiliation(s)
- H Iwata
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - N Masuda
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - T Fujisawa
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - T Toyama
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - S Ohtani
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - Y Yamamoto
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - M Kashiwaba
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - N Taira
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - T Sakai
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - Y Hasegawa
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - R Nakamura
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - H Akabane
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - Y Shibahara
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - H Sasano
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - T Yamaguchi
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
| | - Y Ohashi
- Aichi Cancer Center Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Kumamoto University, Kumamoato, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Chuo University, Tokyo, Japan
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Ejlertsen B, Chan A, Gnant M, von Minckwitz G, Delaloge S, Buyse M, O'Shaughnessy J, Mansi J, Moy B, Iwata H, Wong A, Ye Y, Means-Powell J, Hui R, Ruiz-Borrego M, Ruiz Simon A, Shen ZZ, Holmes FA, Lesniewski-Kmak K, Martin M. Abstract P1-13-05: Timing of initiation of neratinib after completion of trastuzumab-based adjuvant therapy in early-stage HER2+ breast cancer: Exploratory analyses from the phase III ExteNET trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The international, randomized, placebo-controlled phase III ExteNET trial showed that 1 year of neratinib after trastuzumab-based adjuvant therapy significantly improved 2-year invasive disease-free survival (iDFS) in early-stage HER2+ breast cancer (HR 0.67; 95% CI 0.50–0.91; p=0.009) [Chan et al. Lancet Oncol 2016]. The significant iDFS benefit with neratinib was maintained after a median of 5 years' follow-up (HR 0.73; 95% CI 0.57-0.92; p=0.008) [Martin et al. ESMO 2017]. We present exploratory analyses from the ExteNET trial examining the effects of the interval between completion of trastuzumab and randomization to commence neratinib on iDFS.
Methods: Women with early-stage HER2+ breast cancer were randomly assigned to oral neratinib 240 mg/day or placebo for 1 year after standard primary therapy and trastuzumab-based adjuvant therapy. Under the original study protocol, (neo)adjuvant trastuzumab was to be completed ≤24 months before randomization; this was revised to ≤12 months before randomization after the NCCTG-N9831/NSABP B-31 4-year analysis showed that the risk of relapse is greatest during the first 12 months after completing trastuzumab. Disease recurrences were collected prospectively during 1 and 2 years post-randomization, and from medical records during 3–5 years post-randomization. Patients randomized ≤12 months after completion of adjuvant trastuzumab were further separated to look at those who initiated neratinib ≤6 months of completing adjuvant trastuzumab. Primary endpoint: iDFS. HR (95% CI) estimated using Cox proportional-hazards models. Data cut-off: March 1, 2017. Clinicaltrials.gov: NCT00878709.
Results:The intention-to-treat population comprised 2840 patients (neratinib, n=1420; placebo, n=1420). Median time from last trastuzumab dose to randomization was 4.4 and 4.6 months in the neratinib and placebo groups, respectively. 81% of patients were randomized ≤12 months of completing trastuzumab. The effects of the interval between the last dose of trastuzumab and randomization/initiation of neratinib on iDFS after a median follow-up of 5.2 years are shown in the table.
Estimated 5-year iDFS rate, % P-valueInterval from last dose of trastuzumab to randomizationnNeratinibPlaceboHR (95% CI)a(2-sided)≤6 months164190.085.40.62 (0.46–0.84)0.002≤12 monthsb229789.786.50.70 (0.54–0.90)0.006>12 monthsb54392.392.61.00 (0.51–1.94)0.992a. Neratinib vs placebo; b. Protocol-defined subgroups
Conclusions: In ExteNET, patients who initiated neratinib within 12 months of completing trastuzumab-based adjuvant therapy appeared to derive greater benefit from treatment than those who started neratinib later. Further, exploratory analyses suggest that the magnitude of benefit with neratinib is greater if initiated sooner (i.e. within 6 months of completing trastuzumab). Given the benefits of neratinib overall in those initiating treatment ≤12 months from the end of adjuvant trastuzumab, extended adjuvant treatment with neratinib should be initiated early following completion of trastuzumab.
Citation Format: Ejlertsen B, Chan A, Gnant M, von Minckwitz G, Delaloge S, Buyse M, O'Shaughnessy J, Mansi J, Moy B, Iwata H, Wong A, Ye Y, Means-Powell J, Hui R, Ruiz-Borrego M, Ruiz Simon A, Shen Z-Z, Holmes FA, Lesniewski-Kmak K, Martin M. Timing of initiation of neratinib after completion of trastuzumab-based adjuvant therapy in early-stage HER2+ breast cancer: Exploratory analyses from the phase III ExteNET trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-05.
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Affiliation(s)
- B Ejlertsen
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - A Chan
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - M Gnant
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - G von Minckwitz
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - S Delaloge
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - M Buyse
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - J O'Shaughnessy
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - J Mansi
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - B Moy
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - H Iwata
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - A Wong
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - Y Ye
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - J Means-Powell
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - R Hui
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - M Ruiz-Borrego
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - A Ruiz Simon
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - Z-Z Shen
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - FA Holmes
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - K Lesniewski-Kmak
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
| | - M Martin
- Rigshospitalet, Copenhagen, Denmark; Breast Cancer Research Centre-Western Australia and Curtin University; Comprehensive Cancer Centre, Medical University of Vienna; German Breast Group; Institut Gustave Roussy; International Drug Development Institute; Texas Oncology-Baylor Charles A. Sammons Cancer Center; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; Puma Biotechnology Inc; Vanderbilt-Ingram Cancer Center; Westmead Hospital and the University of Sydney, Sydney, NSW, Australia; Hospital Universitario Virgen del Rocio; Instituto Valenciano de Oncología; Shanghai Cancer Center; Texas Oncology; Szpital Morski im. PCK Oddiział Onkologii Klinicznej, Gdyńskie Centrum Onkologii; Hospital General Universitario Gregorio Marañón
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Hattori M, Nakanishi H, Yoshimura A, Adachi Y, Iwase M, Gondo N, Kotani H, Sawaki M, Yatabe Y, Iwata H. Abstract P2-01-09: Circulating tumor cells (CTCs) in the venous drainage of the breast in patients with primary breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-01-09] [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:
CTCs are shed from tumors and circulate in the peripheral blood after passing through the drainage vein. Axillary lymph node dissection (ALND) provides access to the lateral thoracic vein which flows directly into the axillary vein. In this preliminary study, we evaluated the feasibility of detecting CTCs in the peripheral blood and in the lateral thoracic venous blood for breast cancer patients who underwent ALND.
Methods:
From June 2016 to March 2017, breast cancer patients who underwent ALND in our institute were eligible for this study. A peripheral blood sample,10ml, was drawn just before the surgery or one day before the surgery. A lateral thoracic venous blood sample was taken from the resected breast just after resection. A blood sample of 0.2ml or more was necessary for CTC isolation. The CTCs in the peripheral blood before surgery (periCTC) and in the blood from the lateral thoracic vein of the resected breast (ltvCTC) were quantitatively examined by using a size-selective CTC isolation platform.
Results:
A total of 21 patients with median age 51 years (37-75) were enrolled to the study. Of the 21 patients, 38% were premenopausal, 52% had neoadjuvant chemotherapy. Fifty-seven percent were ER and/or PgR positive, 24% were HER2 positive. Fifty-seven percent were stage II disease and 43% were stage III. In 3 patients, we couldn't obtain sufficient blood samples from the lateral thoracic vein. Of the remaining 18 patients, we were able to obtain the median 0.5ml (0.2-2.0) blood samples from the lateral thoracic vein. CTCs were detected in peripheral blood in 15 patients (71%) and median periCTC count was 1 CTC/10ml (0-39). In lateral thoracic venous blood, CTCs were detected in all patients who had sufficient blood samples and the median ltv CTC count was 35.5 CTC/ml (2.5-370). In 5 of 6 patients whom CTCs in peripheral blood samples were not detected, CTCs could be detected in the blood samples from lateral thoracic vein.
Conclusion:
CTCs can be detected in the peripheral blood and in the blood from lateral thoracic vein in patients with localized breast cancer, and can be detected at a higher rate and at a higher concentration in the blood from lateral thoracic vein than in peripheral blood.
Citation Format: Hattori M, Nakanishi H, Yoshimura A, Adachi Y, Iwase M, Gondo N, Kotani H, Sawaki M, Yatabe Y, Iwata H. Circulating tumor cells (CTCs) in the venous drainage of the breast in patients with primary breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P2-01-09.
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Affiliation(s)
- M Hattori
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
| | - H Nakanishi
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
| | - A Yoshimura
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
| | - Y Adachi
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
| | - M Iwase
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
| | - N Gondo
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
| | - H Kotani
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
| | - M Sawaki
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
| | - Y Yatabe
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
| | - H Iwata
- Aichi Cancer Center, Nagoya, Aichi, Japan; Aichi Cancer Center Aichi Hospital, Okazaki, Aichi, Japan
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188
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Kotani H, Terada M, Mori M, Horisawa N, Sugino K, Iwase M, Oonishi S, Kataoka A, Adachi Y, Gondou N, Yoshimura A, Hattori M, Sawaki M, Iwata H. Abstract P2-12-13: Withdrawn. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-12-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
This abstract was withdrawn by the authors.
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Affiliation(s)
- H Kotani
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - M Terada
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - M Mori
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - N Horisawa
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - K Sugino
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - M Iwase
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - S Oonishi
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - A Kataoka
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - Y Adachi
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - N Gondou
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - A Yoshimura
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - M Hattori
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - M Sawaki
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
| | - H Iwata
- Aichi Cancer Ctr. Hosp., Nagoya, Aichi, Japan
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189
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Iwata H, Masuda N, Kim SB, Inoue K, Rai Y, Fujita T, Shen ZZ, Chiu JW, Ohtani S, Takahashi M, Yamamoto N, Miyaki T, Sun Q, Yen-Shen L, Xu B, Yap YS, Bustam AZ, Lee JR, Zhang B, Bryce R, Chan A. Abstract P1-13-11: Neratinib in the extended adjuvant treatment of patients from Asia with early-stage HER2+ breast cancer after trastuzumab-based therapy: Exploratory analyses from the phase III ExteNET trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-11] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Current breast cancer knowledge is based largely on studies conducted in western populations. Their findings may not be generalizable to Asian women because of ethnic, genetic and lifestyle differences. Neratinib (N) is an irreversible tyrosine kinase inhibitor of HER1, 2 and 4. The international, randomized, placebo (P)-controlled phase III ExteNET trial showed that 1 year (yr) of N after trastuzumab (T)-based adjuvant therapy significantly improved 2-yr invasive disease-free survival (iDFS) in patients (pts) with early-stage HER2+ breast cancer (HR 0.67; 95% CI 0.50–0.91; p=0.009) [Chan et al. Lancet Oncol 2016]. The significant iDFS benefit with N was shown to be durable after 5 yrs' follow-up (HR 0.73; 95% CI 0.57-0.92; p=0.008) [Martin et al. ESMO 2017]. We report efficacy and safety findings from pts enrolled from Asian centers (China, Hong Kong, Japan, Korea, Malaysia, Singapore, and Taiwan) on the ExteNET trial to better characterize the effects of N in Asian women.
Methods: Pts with early-stage HER2+ breast cancer were randomly assigned to oral N 240 mg/day or P for 1 yr after standard primary therapy and T-based adjuvant therapy. Antidiarrheal prophylaxis was not required by protocol. Data concerning disease recurrences were collected prospectively during yr 1-2 post-randomization, and from medical records during yr 3–5 post-randomization. Primary endpoint: iDFS. HR (95% CI) estimated using Cox proportional-hazards models stratified by nodal status, hormone-receptor status and prior T regimen. Data cut-off: 2-yr analysis, July 2014; 5-yr analysis, March 2017. Clinicaltrials.gov:NCT00878709.
Results: Of 2840 randomized pts (N, n=1420; P, n=1420), 341 (12%) were enrolled from Asian centers (N, n=165; P, n=176). Baseline characteristics: median age 53 yr; hormone receptor-positive 48%. Median treatment duration was similar in both groups (N, 351 days; P, 352 days). iDFS events in Asian vs ITT populations are shown in the Table.
Primary 2-yr analysisa5-yr analysis NPNPAsian population, n165176165176iDFS events, n10151222HR (95% CI)b0.71 (0.31-1.57)0.54 (0.26-1.08)P-value (2-sided)0.4040.085ITT population, n1420142014201420iDFS events, n67106116163HR (95% CI)b0.66 (0.49-0.90)0.73 (0.57-0.92)P-value (2-sided)0.0080.008a. Primary study endpoint; b. Neratinib vs placebo
The incidence of grade 3/4 diarrhea with N was slightly higher in Asian pts (46.1% vs ITT, 39.8%). All other grade 3/4 adverse events with N were rare among Asian pts (elevated ALT, mucosal inflammation, 2 pts each; other events, 1 pt each). Compliance with N in Asian pts was also improved (71% vs ITT, 61%).
Conclusions: In Asian pts enrolled into ExteNET, compliance with N was better and the magnitude of N effect was similar or greater that that observed in the ITT population. Although N-related grade 3/4 diarrhea was more common in Asian pts than in the ITT population, all other grade 3/4 events were rare. Despite small pt numbers, our analyses suggest that the findings from ExteNET are applicable to Asian pts, and support the conclusion that N reduces disease recurrences in Asian pts with early-stage HER2+ breast cancer after T-based adjuvant therapy.
Citation Format: Iwata H, Masuda N, Kim S-B, Inoue K, Rai Y, Fujita T, Shen Z-Z, Chiu JW, Ohtani S, Takahashi M, Yamamoto N, Miyaki T, Sun Q, Yen-Shen L, Xu B, Yap YS, Bustam AZ, Lee JR, Zhang B, Bryce R, Chan A. Neratinib in the extended adjuvant treatment of patients from Asia with early-stage HER2+ breast cancer after trastuzumab-based therapy: Exploratory analyses from the phase III ExteNET trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-11.
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Affiliation(s)
- H Iwata
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - N Masuda
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S-B Kim
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - K Inoue
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Y Rai
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - T Fujita
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Z-Z Shen
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - JW Chiu
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S Ohtani
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - M Takahashi
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - N Yamamoto
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - T Miyaki
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Q Sun
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - L Yen-Shen
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Xu
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - YS Yap
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - AZ Bustam
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - JR Lee
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Zhang
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - R Bryce
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
| | - A Chan
- Aichi Cancer Center, Nagoya, Japan; Osaka National Hospital, Osaka, Japan; Asan Medical Centre; Saitama Cancer Center; Hakuaikai Sagara Hospital, Japan; Jichi Medical University Hospital, Japan; Shanghai Cancer Center; Queen Mary Hospital, Hong Kong; Hiroshima City Hiroshima Citizens Hospital, Japan; Hokkaido Cancer Center, Japan; Chiba Cancer Center, Japan; Peking Union Medical College Hospital, China; National Taiwan University Hospital, Taiwan; Chinese Academy of Medical Sciences and Peking Union Medical College, China; National Cancer Centre Singapore, Singapore; University Malaya Medical Centre, Malaysia; Puma Biotechnology Inc; Breast Cancer Research Centre-Western Australia and Curtin University
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Chia SKL, Martin M, Iwata H, Moy B, Lalani AS, Holmes FA, Mansi J, von Minckwitz G, Buyse M, Delaloge S, Ejlertsen B, Yao B, Murias Rosales A, Hellerstedt B, Cold S, Inoue K, Shen ZZ, Galeano T, Barrios CH, Chan A. Abstract P1-13-03: Effects of neratinib after trastuzumab-based adjuvant therapy in hormone receptor-positive HER2+ early-stage breast cancer: Exploratory analyses from the phase III ExteNET trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-03] [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: The international, randomized, placebo-controlled phase III ExteNET trial showed that a 1-year course of neratinib after trastuzumab-based adjuvant therapy significantly improved 2-year invasive disease-free survival (iDFS) in patients with early-stage HER2+ breast cancer (BC) (hazard ratio 0.67; 95% CI 0.50–0.91; p=0.009) [Chan et al. Lancet Oncol 2016]. The significant iDFS benefit with neratinib was maintained after a median 5 years' follow-up (hazard ratio 0.73; 95% CI 0.57-0.92; p=0.008) [Martin et al. ESMO 2017]. At both time-points, marked benefit with neratinib was evident in patients with hormone receptor (HR)+ tumors, whereas in patients with HR– disease, initial improvements with neratinib diminished after completing treatment. We report exploratory analyses from the ExteNET trial done to better characterize the effects of neratinib in the HR+ subgroup.
Methods: Patients with early-stage HER2+ BC were randomly assigned to oral neratinib 240 mg/day or placebo for 1 year after standard primary therapy and trastuzumab-based adjuvant therapy. Randomization was stratified by HR status (locally assessed), nodal status, and trastuzumab regimen. Adjuvant endocrine therapy was recommended for patients with HR+ disease. Data concerning disease recurrences were collected prospectively during year 1-2 post-randomization, and from medical records during year 3–5 post-randomization. Primary endpoint: iDFS. Secondary endpoints: DFS including ductal carcinoma in situ (DFS-DCIS); time to distant recurrence (TTDR); distant DFS (DDFS); cumulative incidence of central nervous system (CNS) recurrences; overall survival (OS). Hazard ratios (95% CI) were estimated using Cox proportional-hazards models. Data cut-off: March 2017. Clinicaltrials.gov: NCT00878709.
Results: 2840 patients were randomized (neratinib, n=1420; placebo, n=1420); 1631 (57%) patients had HR+ tumors (neratinib, n=816; placebo, n=815). 93% and 94% of HR+ patients in the neratinib and placebo groups, respectively, were receiving adjuvant endocrine therapy at baseline. Efficacy outcomes in the HR+ cohort after a median follow-up of 5.2 years are shown in the table. In subgroup analyses of the HR+ cohort, hazard ratios for iDFS were 0.49 in centrally confirmed HER2+ patients (n=951), and 0.58 in patients who had completed prior trastuzumab ≤12 months before randomization (n=1334). CNS recurrence and OS data are not yet mature.
Updated 2-year analysis5-year analysis Hazard ratiobP-value Hazard ratiobP-value Δ, %a(95% CI)(2 sided)Δ, %a(95% CI)(2 sided)iDFS4.10.49 (0.31–0.75)0.0014.40.60 (0.43–0.83)0.002DFS-DCIS4.80.45 (0.29–0.69)<0.0015.10.57 (0.42–0.79)<0.001DDFS3.10.52 (0.32–0.84)0.0084.00.60 (0.42–0.85)0.004TTDR2.90.52 (0.31–0.85)0.013.80.61 (0.42–0.86)0.006a. Difference in event rates between neratinib vs placebo; b. Neratinib vs placebo
Conclusions: Neratinib was associated with an absolute iDFS benefit of 4.4% in patients with HR+/HER2+ BC after 5 years' follow-up. HR/HER2 receptor cross-talk may underpin the notable effect of neratinib in patients with HR+ tumors when given in combination with endocrine therapy.
Citation Format: Chia SKL, Martin M, Iwata H, Moy B, Lalani AS, Holmes FA, Mansi J, von Minckwitz G, Buyse M, Delaloge S, Ejlertsen B, Yao B, Murias Rosales A, Hellerstedt B, Cold S, Inoue K, Shen Z-Z, Galeano T, Barrios CH, Chan A. Effects of neratinib after trastuzumab-based adjuvant therapy in hormone receptor-positive HER2+ early-stage breast cancer: Exploratory analyses from the phase III ExteNET trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P1-13-03.
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Affiliation(s)
- SKL Chia
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - M Martin
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - H Iwata
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Moy
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - AS Lalani
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - FA Holmes
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - J Mansi
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - G von Minckwitz
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - M Buyse
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S Delaloge
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Ejlertsen
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Yao
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - A Murias Rosales
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Hellerstedt
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S Cold
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - K Inoue
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Z-Z Shen
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - T Galeano
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - CH Barrios
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
| | - A Chan
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Aichi Cancer Center Hospital; Massachusetts General Hospital Cancer Center; Puma Biotechnology Inc.; Texas Oncology; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; German Breast Group; International Drug Development Institute; Institut Gustave Roussy; Rigshospitalet; Compejo Hospitalario Materno Insular de Las Palmas; Texas Oncology, P.A; Odense University Hospital; Saitama Cancer Center; Shanghai Cancer Center; Magna Graecia University; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Breast Cancer Research Centre-Western Australia and Curtin University
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Im SA, Xu B, Li W, Robson M, Ouyang Q, Yeh DC, Iwata H, Park YH, Sohn JH, Tseng LM, Goessl C, Wu W, Runswick S, Masuda N. Abstract P5-21-13: Olaparib monotherapy versus chemotherapy for patients with HER2-negative metastatic breast cancer and a germline BRCA mutation: Asian subgroup analysis from the phase III OlympiAD trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-21-13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
In the Phase III OlympiAD trial (NCT02000622, D0819C00003), olaparib (Lynparza™) showed a significant progression-free survival (PFS) improvement compared with chemotherapy treatment of physician's choice (TPC) in patients (pts) with metastatic breast cancer (mBC) and a germline BRCA mutation (gBRCAm) (Robson et al. NEJM 2017). Here, we present data from a subgroup analysis of Asian pts. It is not yet known whether Asian pts, in comparison with the global patient population, may experience instances of differential toxicity with olaparib therapy.
Methods
OlympiAD, an open-label, multicenter, Phase III trial, randomized (2:1) pts with HER2-negative mBC and a gBRCAm to olaparib tablets (300 mg twice daily) or single-agent TPC (21-day cycles of capecitabine, eribulin or vinorelbine). Pts must have received ≤2 lines of chemotherapy for mBC and prior anthracycline and taxane in the adjuvant, neo-adjuvant or metastatic setting. Primary endpoint was PFS by blinded independent central review (BICR). Region (Asia, Europe, North America, South America) was a pre-defined subgroup for PFS.
Results
The Asian subgroup analysis included pts randomized at centers in China, Japan, Korea and Taiwan. Of 87 Asian pts randomized (median age 46 years), 86 received study treatment (n=59, olaparib; n=27, TPC). In the olaparib group, 29/59 (49%) had estrogen receptor positive (ER+) and/or progesterone receptor positive (PR+) tumors, and 30/59 (51%) had triple negative breast cancer (TNBC). In the TPC group, 13/28 (46%) had ER+/PR+ tumors and 15/28 (54%) had TNBC. The primary endpoint, PFS by BICR, favored olaparib with a hazard ratio (HR) of 0.53 (95% confidence interval [CI] 0.29–0.97; median 5.7 vs 4.2 months; 77% maturity), and was supported by investigator-assessed PFS (HR 0.29, 95% CI 0.16–0.55). In the overall OlympiAD study population (N=302), the PFS by BICR favored olaparib with a HR of 0.58 (95% CI 0.43–0.80; P=0.0009). Within the Asian subgroup, objective response rate (ORR) (RECIST) was 64% for olaparib versus 38% for the TPC group. Time to second progression, PFS2, was longer for pts receiving olaparib versus TPC (HR 0.43, 95% CI 0.22–0.84; 57% maturity). Grade ≥3 adverse events (AEs) occurred in 46% and 59% of pts receiving olaparib and TPC, respectively. The most common grade ≥3 AE was anemia (olaparib, 20%; TPC, 15%). In both treatment groups, 7% of pts discontinued study treatment due to AEs (n=4, olaparib; n=2, TPC). The tolerability profile of olaparib between the subgroup of Asian pts and the overall OlympiAD population will be examined in our data presentation.
Conclusion
Olaparib demonstrated an efficacy benefit compared with TPC in pts with HER2-negative mBC and a gBRCAm in this subgroup analysis of Asian pts from the Phase III OlympiAD trial. Discontinuation rates due to toxicity were low, highlighting that olaparib was generally well-tolerated. The efficacy of olaparib within the subgroup of Asian pts was consistent with that shown for the full OlympiAD dataset; consistent hazard ratios were shown in favor of olaparib using the primary endpoint of PFS by BICR, and for the key secondary endpoints of PFS by investigator assessment, PFS2, and ORR.
Citation Format: Im S-A, Xu B, Li W, Robson M, Ouyang Q, Yeh D-C, Iwata H, Park Y-H, Sohn JH, Tseng L-M, Goessl C, Wu W, Runswick S, Masuda N. Olaparib monotherapy versus chemotherapy for patients with HER2-negative metastatic breast cancer and a germline BRCA mutation: Asian subgroup analysis from the phase III OlympiAD trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-21-13.
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Affiliation(s)
- S-A Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - B Xu
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - W Li
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - M Robson
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Q Ouyang
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - D-C Yeh
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - H Iwata
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - Y-H Park
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - JH Sohn
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - L-M Tseng
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - C Goessl
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - W Wu
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - S Runswick
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | - N Masuda
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea; National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China; The First Hospital of Jilin University, Changchun, China; Memorial Sloan Kettering Cancer Center, New York; Medical Oncology Center, Hunan Tumor Hospital, Changsha, China; Taichung Tzu-Chi Hospital, Taichung City, Taiwan; Aichi Cancer Center Hospital, Aichi, Japan; Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea; Yonsei University College of Medicine, Seoul, Korea; Taipei Veterans General Hospital, Taipei, Taiwan; Astrazeneca, Gaithersburg; AstraZeneca, Macclesfield, United Kingdom; National Hospital Organization, Osaka National Hospital, Osaka, Japan
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Shimomura A, Masuda N, Tamura K, Yasojima H, Sawaki M, Nishimura Y, Saji S, Iwata H. Abstract P3-11-06: A phase 1 study of KHK2375 (entinostat) as monotherapy and in combination with exemestane in Japanese patients with hormone receptor-positive, HER2-negative, advanced or recurrent breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p3-11-06] [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: Patients (pts) with hormone receptor-positive (HR+) and non-life threatening advanced or metastatic breast cancer (BC) are usually treated with sequential endocrine therapies. Endocrine therapies are continued until tumor cells acquire resistance to them, following which pts are switched to cytotoxic chemotherapy. Entinostat (ENT) is an oral inhibitor of class I histone deacetylases (HDACs) and is expected to be used for endocrine therapy-resistant pts. The efficacy of ENT in combination with an aromatase inhibitor (AI) for HR+ BC was demonstrated in a previous randomized phase 2 study. Because of the lack of data on safety and pharmacokinetics (PK) in Japanese HR+ BC pts, we performed this dose escalation phase 1 study to investigate the safety of ENT monotherapy and combination therapy with exemestane (EXE) in postmenopausal women with advanced or recurrent HR+ BC. Secondary objectives were to assess PK and efficacy.
Methods: This study was based on a 3+3 dose escalation design. Postmenopausal women with advanced or recurrent HR+ HER2- BC previously treated with nonsteroidal AIs and with ECOG PS 0-1 were enrolled. The dose limiting toxicities (DLT) of ENT monotherapy (3 mg/qw, 5 mg/qw, or 10 mg/q2w) in Cohort 1-3 and those of ENT (5 mg/qw or 3 mg/qw) in combination with EXE 25 mg/qd in Cohort 4-5 were assessed for 7 and 28 days, respectively. Pts continued ENT (3 mg or 5 mg) in combination with EXE even after the DLT observation period until disease progression or discontinuation for other reasons. Adverse events (AEs) were graded per NCI-CTCAE version 4.03. Tumor response was evaluated by RECIST version 1.1 every 8 weeks. ENT concentration was measured intensively. Samples of peripheral blood mononuclear cells (PBMC) were collected to measure protein lysine hyperacetylation and for immune subset analysis. Optional tumor biopsies for biomarker assessment were collected before and during treatment.
Results: Twelve pts were enrolled and three each were assigned to Cohort 1-4 between Nov 2015 and Sept 2016. Neither DLT nor grade 3-5 AE occurred. As no DLT occurred in Cohort 4, Cohort 5 was omitted as originally planned. The drug-related AEs observed in ≥2 pts during the DLT observation period were grade 1-2 hypophosphatemia (1 pt each in Cohort 2, 3, and 4), grade 1 nausea (1 pt in Cohort 3 and 2 pts in Cohort 4), and grade 1-2 platelet count decreased (2 pts in Cohort 4). AUC0-168 increased in a dose proportional manner. As of May 2017, 4 pts continue to receive study treatment, including one treated for more than 18 months. Biomarker data including protein lysine hyperacetylation and immune subset in PBMC and results of paired biopsy samples will be reported.
Conclusions: This study showed the tolerability of the combination therapy of ENT 5 mg with EXE 25 mg in Japanese pts. There were no new safety concerns as compared to those reported previously. Following this result, a randomized phase 2 study for Japanese pts is planned.
Clinical trial information : NCT02623751.
Citation Format: Shimomura A, Masuda N, Tamura K, Yasojima H, Sawaki M, Nishimura Y, Saji S, Iwata H. A phase 1 study of KHK2375 (entinostat) as monotherapy and in combination with exemestane in Japanese patients with hormone receptor-positive, HER2-negative, advanced or recurrent breast cancer [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P3-11-06.
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Affiliation(s)
- A Shimomura
- National Cancer Center Hospital, Tokyo, Japan; National Hospital Organization Osaka National Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan; Fukushima Medical University, Fukushima, Japan
| | - N Masuda
- National Cancer Center Hospital, Tokyo, Japan; National Hospital Organization Osaka National Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan; Fukushima Medical University, Fukushima, Japan
| | - K Tamura
- National Cancer Center Hospital, Tokyo, Japan; National Hospital Organization Osaka National Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan; Fukushima Medical University, Fukushima, Japan
| | - H Yasojima
- National Cancer Center Hospital, Tokyo, Japan; National Hospital Organization Osaka National Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan; Fukushima Medical University, Fukushima, Japan
| | - M Sawaki
- National Cancer Center Hospital, Tokyo, Japan; National Hospital Organization Osaka National Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan; Fukushima Medical University, Fukushima, Japan
| | - Y Nishimura
- National Cancer Center Hospital, Tokyo, Japan; National Hospital Organization Osaka National Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan; Fukushima Medical University, Fukushima, Japan
| | - S Saji
- National Cancer Center Hospital, Tokyo, Japan; National Hospital Organization Osaka National Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan; Fukushima Medical University, Fukushima, Japan
| | - H Iwata
- National Cancer Center Hospital, Tokyo, Japan; National Hospital Organization Osaka National Hospital, Osaka, Japan; Aichi Cancer Center Hospital, Nagoya, Japan; Kyowa Hakko Kirin Co., Ltd., Tokyo, Japan; Fukushima Medical University, Fukushima, Japan
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Yamamoto Y, Iwata H, Masuda N, Fujisawa T, Toyama T, Kashiwaba M, Ohtani S, Taira N, Sakai T, Hasegawa Y, Nakamura R, Akabane H, Shibahara Y, Sasano H, Yamaguchi T, Sakamaki K, Chao C, McCullough D, Sugiyama N, Ohashi Y. Abstract PD5-03: TransNEOS: Validation of the oncotype DX recurrence score (RS) testing core needle biopsy samples from NEOS as predictor of clinical response to neoadjuvant endocrine therapy for postmenopausal estrogen receptor positive (ER+), HER2 negative (HER2-) breast cancer patients. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd5-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Neoadjuvant therapy for locally advanced breast cancer has the potential to improve surgical therapeutic outcomes without sacrificing the survival advantages of adjuvant therapy. However, determining whether ER+ patients (pts) will respond to neoadjuvant (NA) chemotherapy (CT) or hormone therapy (HT) can be difficult. Not all ER+ pts respond to NACT, while response to NAHT can vary across ER+ pts. Thus, the ability to select pts more likely to benefit from NAHT would represent progress in clinical management of breast cancer. NEOS is a randomized phase III study assessinglong-term prognosis of ER+ primary breast cancer with/without adjuvant CT following NAHT (UMIN 000001090, http://www.umin.ac.jp/). We used archived core biopsy tumor samples from the NEOS study to validate the RS result as a predictor of clinical response and its association with successful breast conserving surgery (BCS) in pts treated with 6 months of NAHT.
Methods: NEOS enrolled 904 postmenopausal pts with ER+, HER2-, clinically node negative (cN0) breast cancer to evaluate whether adjuvant CT was necessary for pts who responded to NAHT. In this current study, we enrolled pts with tumors ≥2cm from the NEOS study. Biopsy samples of 333 pts were assessed for the Oncotype DX assay. Response to NAHT was recorded as complete/partial response (CR/PR), or stable/progressive disease (SD/PD).
Primary endpoint of this study was to evaluate clinical response (CR/PR) to NA letrozole between pts with low (<18) and high (≥31) RS result. Secondary endpoints include evaluating the relationships between clinical response and continuous RS results, and other covariates including age, tumor size, grade, Ki67 by IHC, ER and PR single gene scores, and ER and proliferation gene group scores by RT-PCR.
Results: The analysis included 294 pts with median age of 63 yrs, median tumor size of 25mm, and 66% were nuclear grade 1. 156 (53.0%), 83 (28.6%) and 54(18.4%) cases were low, intermediate, and high RS groups by Oncotype DX, respectively. Six (2%), 126 (42.8%), 149 (50.3%), 13 (4.4%) cases experienced CR, PR, SD, PD as clinical response, respectively, similar to that of all NEOS pts. Clinical response rate was 54%, 42% and 22% in low, intermediate, and high RS groups, respectively. The proportion of pts with clinical response was significantly higher in the low RS group vs the high RS group (p<0.001). In univariate analyses, continuous RS was significantly associated with clinical response (p<0.001), along with ER (p=.02), PR (p<0.001), and ER gene group score (p<0.001). Other covariates were not associated with clinical response.
Conclusion: The Oncotype DX RS test in core biopsy samples is validated as a predictive assay for clinical response of NAHT in postmenopausal, ER+/HER2-, cN0, primary early breast cancer pts. Further results on the association of RS results with BCS outcomes following NAHT will be presented. These results when combined with previously published data on RS in NACT studies help guide pts with ER+, HER2- breast cancer with NAHT vs NACT treatment options to maximize clinical response.
Citation Format: Yamamoto Y, Iwata H, Masuda N, Fujisawa T, Toyama T, Kashiwaba M, Ohtani S, Taira N, Sakai T, Hasegawa Y, Nakamura R, Akabane H, Shibahara Y, Sasano H, Yamaguchi T, Sakamaki K, Chao C, McCullough D, Sugiyama N, Ohashi Y. TransNEOS: Validation of the oncotype DX recurrence score (RS) testing core needle biopsy samples from NEOS as predictor of clinical response to neoadjuvant endocrine therapy for postmenopausal estrogen receptor positive (ER+), HER2 negative (HER2-) breast cancer patients [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD5-03.
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Affiliation(s)
- Y Yamamoto
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - H Iwata
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - N Masuda
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - T Fujisawa
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - T Toyama
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - M Kashiwaba
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - S Ohtani
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - N Taira
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - T Sakai
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - Y Hasegawa
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - R Nakamura
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - H Akabane
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - Y Shibahara
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - H Sasano
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - T Yamaguchi
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - K Sakamaki
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - C Chao
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - D McCullough
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - N Sugiyama
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
| | - Y Ohashi
- Kumamoto University, Kumamoto, Japan; Aichi Cancer Ceter Hospital, Nagoya, Japan; NHO Osaka National Hospital, Osaka, Japan; Gunma Prefectural Cancer Center, Maebashi, Japan; Nagoya City University Graduate School of Medical Science, Nagoya, Japan; Breastopia Miyazaki Hospital, Miyazaki, Japan; Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan; Okayama University Hospital, Okayama, Japan; Cancer Institute Hospital of Japanese Foundation for Cancer Research, Tokyo, Japan; Hirosaki Municipal Hospital, Hirosaki, Japan; Chiba Cancer Center, Chiba, Japan; Hokkaido P.W.F.A.C. Asahikawa-Kosei General Hospital, Asahikawa, Japan; Tohoku University Graduate School of Medicine, Sendai, Japan; Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Genomic Health, Inc.; Chuo University, Tokyo, Japan
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Chia SKL, Martin M, Holmes FA, Ejlertsen B, Delaloge S, Moy B, Iwata H, von Minckwitz G, Mansi J, Barrios CH, Gnant M, Tomašević Z, Denduluri N, Šeparović R, Kim SB, Hugger Jakobsen E, Harvey V, Robert N, Smith J, Harker G, Lalani AS, Zhang B, Eli LD, Buyse M, Chan A. Abstract PD3-12: PIK3CA alterations and benefit with neratinib after trastuzumab-based adjuvant therapy in early-stage HER2+ breast cancer: Correlative analyses of the phase III ExteNET trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd3-12] [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: Neratinib is a pan-HER tyrosine kinase inhibitor that blocks the PI3K/Akt and MAPK signaling pathways downstream from HER2. The international, randomized, placebo-controlled phase III ExteNET trial showed that a 1-year course of neratinib after trastuzumab-based adjuvant therapy significantly improved 2-year invasive disease-free survival (iDFS) in early-stage HER2+ breast cancer (HR 0.67; 95% CI 0.50–0.91; p=0.0091) [Chan et al. Lancet Oncol 2016]. Furthermore, the effects of neratinib on iDFS were shown to be durable at 5 years' follow-up (HR 0.73; 95% CI 0.57–0.92; p=0.008) [Martin et al. ESMO 2017]. PIK3CA alterations are common in HER2+ breast cancers, and in general are associated with a worse prognosis. We sought to assess the prognostic and predictive significance of PIK3CA alterations in an exploratory substudy of the ExteNET trial.
Methods: ExteNET is an international, multi-center, randomized, double-blind, placebo-controlled phase III trial (Clinicaltrials.gov: NCT00878709). Patients received oral neratinib 240 mg/day or placebo for 1 year. Of the intent-to-treat (ITT) population (n=2840), primary formalin-fixed paraffin-embedded (FFPE) tumor specimens were available from 991 patients for PIK3CA mutation testing by RT-PCR for two hot-spot mutations in exon 9 (E542K, E545K/D) and one hot-spot mutation in exon 20 (H1047R). 702 FFPE tumor slides underwent FISH analysis for PIK3CA amplification with a ratio of ≥2.2 considered as amplified. Primary endpoint: iDFS. iDFS events were tested by 2-sided log-rank tests, and HR (95% CI) were estimated using Cox proportional-hazards models. Data cut-off: March 2017.
Results: Baseline demographics and disease characteristics between treatment arms of the correlative cohort (n=1201) were balanced. Overall, 21.2% (n=210) of primary tumors harbored one of the specified PIK3CA mutations, and 8.7% (n=61) were PIK3CA FISH-amplified. Patients with PIK3CA-altered tumors (i.e. PIK3CA mutations or FISH-amplified) had fewer iDFS events with neratinib compared with placebo (HR 0.41; 95% CI 0.17-0.90, p=0.028). The interaction test was not significant (p=0.1842). Results of the various correlative analyses within treatment arms are shown in the table.
NeratinibPlacebo iDFS iDFS 2-sidedPopulationnevents, nnevents, nHR (95% CI)P valueaITT142011614201630.73 (0.57–0.92)b0.008bCorrelative cohort59345608700.67 (0.45–0.96)0.0317PIK3CA-mutation positive1047106170.43 (0.17–1.01)0.056PIK3CA-mutation negative38527396420.66 (0.40-1.06)0.089PIK3CA-amplified3312840.20 (0.01-1.33)0.106PIK3CA-non-amplified31629325360.85 (0.52-1.39)0.521PIK3CA-altered1308132200.41 (0.17-0.90)0.028a. Log-rank test; b. Stratified analysis
Conclusions: One year of neratinib treatment after trastuzumab-based adjuvant therapy significantly improves iDFS after 5 years in patients with early-stage HER2+ breast cancer. From this modest-sized exploratory cohort, it appears that PIK3CA may be a biomarker for differential sensitivity to neratinib after 1 year of trastuzumab in the adjuvant setting.These exploratory results should be validated in a larger subset.
Citation Format: Chia SKL, Martin M, Holmes FA, Ejlertsen B, Delaloge S, Moy B, Iwata H, von Minckwitz G, Mansi J, Barrios CH, Gnant M, Tomašević Z, Denduluri N, Šeparović R, Kim S-B, Hugger Jakobsen E, Harvey V, Robert N, Smith II J, Harker G, Lalani AS, Zhang B, Eli LD, Buyse M, Chan A. PIK3CA alterations and benefit with neratinib after trastuzumab-based adjuvant therapy in early-stage HER2+ breast cancer: Correlative analyses of the phase III ExteNET trial [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD3-12.
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Affiliation(s)
- SKL Chia
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - M Martin
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - FA Holmes
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Ejlertsen
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S Delaloge
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Moy
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - H Iwata
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - G von Minckwitz
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - J Mansi
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - CH Barrios
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - M Gnant
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - Z Tomašević
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - N Denduluri
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - R Šeparović
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - S-B Kim
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - E Hugger Jakobsen
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - V Harvey
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - N Robert
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - J Smith
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - G Harker
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - AS Lalani
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - B Zhang
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - LD Eli
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - M Buyse
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
| | - A Chan
- British Columbia Cancer Agency, Vancouver, BC, Canada; Hospital General Universitario Gregorio Marañón; Texas Oncology; Rigshospitalet; Institut Gustave Roussy; Massachusetts General Hospital Cancer Center; Aichi Cancer Center Hospital; German Breast Group; Guy's and St Thomas' NHS Foundation Trust and Biomedical Research Centre, King's College London; Pontifical Catholic University of Rio Grande do Sul School of Medicine; Comprehensive Cancer Centre, Medical University of Vienna; Institute for Oncology and Radiology of Serbia, Belgrade, Serbia; US Oncology Research; Sestre Milosrdnice University Hospital Center; University Hospital for Tumors; Asan Medical Centre; Sygehus Lillebaelt; Auckland Hospital; Virginia Cancer Specialists; Compass Oncology, US Oncology, Portland, OR; Utah Cancer Specialists; Puma Biotechnology Inc.; International Drug Development Institute; Breast Cancer Research Centre-Western Australia and Curtin University
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Yee D, Sablin MP, Iwata H, Johnston EL, Bogenrieder T, Serra J, Hua H, Lo Russo P, Prat A. Abstract OT3-06-02: A phase Ib trial of xentuzumab and abemaciclib in patients with locally advanced or metastatic solid tumors, including hormone receptor-positive, HER2-negative breast cancer (plus endocrine therapy). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-ot3-06-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Resistance to endocrine therapy remains an important clinical problem in hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer (BC), necessitating alternative treatment options. The insulin-like growth factor (IGF) axis and cyclin D-cyclin-dependent kinase (CDK) 4/6-retinoblastoma pathway have been implicated in the pathogenesis and resistance mechanisms of a variety of cancers, including BC. Binding of IGF-I and -II to the IGF receptor results in upregulation of cyclin D1, and subsequent progression through the cell cycle, thus providing rationale for the simultaneous inhibition of IGF-I and -II and CDK4/6. This Phase Ib trial assesses the maximum-tolerated dose (MTD)/recommended phase II dose (RP2D), safety and preliminary efficacy of the IGF-ligand-neutralizing antibody, xentuzumab, in combination with abemaciclib, a selective, small-molecule inhibitor of both CDK4 and 6, in patients (pts) with solid tumors. The trial includes four dose finding cohorts followed by two expansion cohorts. Only those cohorts that will include pts with postmenopausal HR+, HER2- BC will be presented here.
Trial design: In this phase Ib multicenter, non-randomized, open-label, dose escalation trial (BI 1280.18 [NCT03099174]), the key aims in the BC cohorts (Cohorts B–D, F) are to define the MTD or recommended phase 2 dose (RP2D), and to evaluate the preliminary efficacy, safety and tolerability of xentuzumab plus abemaciclib in combination with endocrine therapies. Eligible pts include adults ≥18 yrs (≥20 for Japan), with measurable or evaluable disease, adequate organ function, ECOG PS ≤1, and postmenopausal locally advanced or metastatic HR+, HER2- BC (Cohorts B–D, F). CDK4/6 inhibitor-naïve pts (Cohorts B–D) and pts who have received prior CDK4/6 inhibitors (palbociclib or ribociclib) plus aromatase inhibitors (Cohort F) are included. The MTD/RP2D of xentuzumab plus abemaciclib to be used in Cohorts B–D will be established in pts with solid tumors (Cohort A) who will receive xentuzumab (starting dose 1000mg weekly iv) plus abemaciclib (starting dose 150mg every 12 hours). CDK4/6 inhibitor-naïve pts with BC will receive xentuzumab plus abemaciclib at the RP2D determined in Cohort A in combination with letrozole (2.5mg/day; Cohort B), anastrozole (1mg/day; Cohort C), or fulvestrant (500mg/month; Cohort D). CDK4/6 inhibitor pre-treated pts with BC (Cohort F) will receive xentuzumab plus abemaciclib and fulvestrant at the RP2D determined in Cohort D. Primary endpoints in the BC cohorts are the MTD and/or RP2D of xentuzumab plus abemaciclib in combination with endocrine therapies, and the objective response (OR) in CDK4/6 inhibitor pre-treated pts with advanced BC (Cohort F); disease control (DC), duration of DC, time to OR, duration of OR, and progression-free survival (PFS) in Cohort F are secondary endpoints. Additionally, PK outcomes, safety and tolerability will be assessed in all cohorts. This study will be conducted in the US, Europe and Japan. Pt screening started in May 2017. Target enrolment is ˜88 pts, including ˜56 pts with advanced HR+, HER2- BC, of whom ˜20 had previously been treated with CDK 4/6 inhibitors.
Citation Format: Yee D, Sablin MP, Iwata H, Johnston EL, Bogenrieder T, Serra J, Hua H, Lo Russo P, Prat A. A phase Ib trial of xentuzumab and abemaciclib in patients with locally advanced or metastatic solid tumors, including hormone receptor-positive, HER2-negative breast cancer (plus endocrine therapy) [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr OT3-06-02.
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Affiliation(s)
- D Yee
- Masonic Cancer Center, Minnesota, MN; Institut Curie, Paris, France; Aichi Cancer Center Hospital, Nagoya, Japan; Eli Lilly and Company, Indianapolis, IN; Boehringer Ingelheim RCV, Vienna, Austria; Boehringer Ingelheim España S.A., Barcelona, Spain; Boegringer Ingelheim (China) Investment Co., Ltd, Shanghai, China; Yale Cancer Center, Connecticut, CT; Hospital Clínic, Barcelona, Spain
| | - MP Sablin
- Masonic Cancer Center, Minnesota, MN; Institut Curie, Paris, France; Aichi Cancer Center Hospital, Nagoya, Japan; Eli Lilly and Company, Indianapolis, IN; Boehringer Ingelheim RCV, Vienna, Austria; Boehringer Ingelheim España S.A., Barcelona, Spain; Boegringer Ingelheim (China) Investment Co., Ltd, Shanghai, China; Yale Cancer Center, Connecticut, CT; Hospital Clínic, Barcelona, Spain
| | - H Iwata
- Masonic Cancer Center, Minnesota, MN; Institut Curie, Paris, France; Aichi Cancer Center Hospital, Nagoya, Japan; Eli Lilly and Company, Indianapolis, IN; Boehringer Ingelheim RCV, Vienna, Austria; Boehringer Ingelheim España S.A., Barcelona, Spain; Boegringer Ingelheim (China) Investment Co., Ltd, Shanghai, China; Yale Cancer Center, Connecticut, CT; Hospital Clínic, Barcelona, Spain
| | - EL Johnston
- Masonic Cancer Center, Minnesota, MN; Institut Curie, Paris, France; Aichi Cancer Center Hospital, Nagoya, Japan; Eli Lilly and Company, Indianapolis, IN; Boehringer Ingelheim RCV, Vienna, Austria; Boehringer Ingelheim España S.A., Barcelona, Spain; Boegringer Ingelheim (China) Investment Co., Ltd, Shanghai, China; Yale Cancer Center, Connecticut, CT; Hospital Clínic, Barcelona, Spain
| | - T Bogenrieder
- Masonic Cancer Center, Minnesota, MN; Institut Curie, Paris, France; Aichi Cancer Center Hospital, Nagoya, Japan; Eli Lilly and Company, Indianapolis, IN; Boehringer Ingelheim RCV, Vienna, Austria; Boehringer Ingelheim España S.A., Barcelona, Spain; Boegringer Ingelheim (China) Investment Co., Ltd, Shanghai, China; Yale Cancer Center, Connecticut, CT; Hospital Clínic, Barcelona, Spain
| | - J Serra
- Masonic Cancer Center, Minnesota, MN; Institut Curie, Paris, France; Aichi Cancer Center Hospital, Nagoya, Japan; Eli Lilly and Company, Indianapolis, IN; Boehringer Ingelheim RCV, Vienna, Austria; Boehringer Ingelheim España S.A., Barcelona, Spain; Boegringer Ingelheim (China) Investment Co., Ltd, Shanghai, China; Yale Cancer Center, Connecticut, CT; Hospital Clínic, Barcelona, Spain
| | - H Hua
- Masonic Cancer Center, Minnesota, MN; Institut Curie, Paris, France; Aichi Cancer Center Hospital, Nagoya, Japan; Eli Lilly and Company, Indianapolis, IN; Boehringer Ingelheim RCV, Vienna, Austria; Boehringer Ingelheim España S.A., Barcelona, Spain; Boegringer Ingelheim (China) Investment Co., Ltd, Shanghai, China; Yale Cancer Center, Connecticut, CT; Hospital Clínic, Barcelona, Spain
| | - P Lo Russo
- Masonic Cancer Center, Minnesota, MN; Institut Curie, Paris, France; Aichi Cancer Center Hospital, Nagoya, Japan; Eli Lilly and Company, Indianapolis, IN; Boehringer Ingelheim RCV, Vienna, Austria; Boehringer Ingelheim España S.A., Barcelona, Spain; Boegringer Ingelheim (China) Investment Co., Ltd, Shanghai, China; Yale Cancer Center, Connecticut, CT; Hospital Clínic, Barcelona, Spain
| | - A Prat
- Masonic Cancer Center, Minnesota, MN; Institut Curie, Paris, France; Aichi Cancer Center Hospital, Nagoya, Japan; Eli Lilly and Company, Indianapolis, IN; Boehringer Ingelheim RCV, Vienna, Austria; Boehringer Ingelheim España S.A., Barcelona, Spain; Boegringer Ingelheim (China) Investment Co., Ltd, Shanghai, China; Yale Cancer Center, Connecticut, CT; Hospital Clínic, Barcelona, Spain
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Masuda N, Toi M, Yamamoto N, Iwata H, Kuroi K, Bando H, Ohtani S, Takano T, Inoue K, Yanagita Y, Kasai H, Morita S, Sakurai T, Ohno S. Efficacy and safety of trastuzumab, lapatinib, and paclitaxel neoadjuvant treatment with or without prolonged exposure to anti-HER2 therapy, and with or without hormone therapy for HER2-positive primary breast cancer: a randomised, five-arm, multicentre, open-label phase II trial. Breast Cancer 2018; 25:407-415. [PMID: 29445928 PMCID: PMC5996004 DOI: 10.1007/s12282-018-0839-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 01/21/2018] [Indexed: 12/26/2022]
Abstract
Background Dual blockade of HER2 promises increased pathological complete response (pCR) rate compared with single blockade in the presence of chemotherapy for HER2-positive (+) primary breast cancer. Many questions remain regarding optimal duration of treatment and combination impact of endocrine therapy for luminal HER2 disease. Methods We designed a randomised phase II, five-arm study to evaluate the efficacy and safety of lapatinib and trastuzumab (6 weeks) followed by lapatinib and trastuzumab plus weekly paclitaxel (12 weeks) with/without prolongation of anti-HER2 therapy prior to chemotherapy (18 vs. 6 weeks), and with/without endocrine therapy in patients with HER2+ and/or oestrogen receptor (ER)+ disease. The primary endpoint was comprehensive pCR (CpCR) rate. Among the secondary endpoints, pCR (yT0-isyN0) rate, safety, and clinical response were evaluated. Results In total, 215 patients were enrolled; 212 were included in the full analysis set (median age 53.0 years; tumour size = T2, 65%; and tumour spread = N0, 55%). CpCR was achieved in 101 (47.9%) patients and was significantly higher in ER− patients than in ER+ patients (ER− 63.0%, ER+ 36.1%; P = 0.0034). pCR with pN0 was achieved in 42.2% of patients (ER− 57.6%, ER+ 30.3%). No significant difference was observed in pCR rate between prolonged exposure groups and standard groups. Better clinical response outcomes were obtained in the prolongation phase of the anti-HER2 therapy. No surplus was detected in pCR rate by adding endocrine treatment. No major safety concern was recognised by prolonging the anti-HER2 treatment or adding endocrine therapy. Conclusions This study confirmed the therapeutic impact of lapatinib, trastuzumab, and paclitaxel therapy for each ER− and ER+ subgroup of HER2+ patients. Development of further strategies and tools is required, particularly for luminal HER2 disease. Electronic supplementary material The online version of this article (10.1007/s12282-018-0839-7) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- N Masuda
- Department of Surgery, Breast Oncology, NHO Osaka National Hospital, Osaka, Japan
| | - M Toi
- Department of Surgery (Breast Surgery), Kyoto University Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - N Yamamoto
- Division of Breast Surgery, Chiba Cancer Center, Chiba, Japan
| | - H Iwata
- Department of Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - K Kuroi
- Department of Breast Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, Tokyo, Japan
| | - H Bando
- Breast and Endocrine Surgery, Faculty of Medicine, University of Tsukuba, Ibaraki, Japan
| | - S Ohtani
- Department of Breast Surgery, Hiroshima City Hiroshima Citizens Hospital, Hiroshima, Japan
| | - T Takano
- Department of Medical Oncology, Toranomon Hospital, Tokyo, Japan
| | - K Inoue
- Division of Breast Oncology, Saitama Cancer Center, Saitama, Japan
| | - Y Yanagita
- Department of Breast Oncology, Gunma Prefectural Cancer Center, Gunma, Japan
| | - H Kasai
- Institute for Advancement of Clinical and Translational Science, Kyoto University Hospital, Kyoto, Japan
| | - S Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - T Sakurai
- Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan
| | - S Ohno
- Clinical Research Institute, NHO Kyushu Cancer Center, Fukuoka, Japan
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Kamaguchi M, Iwata H, Ujiie H, Izumi K, Natsuga K, Nishie W, Asaka T, Kitagawa Y, Shimizu H. Oral mucosa is a useful substrate for detecting autoantibodies of mucous membrane pemphigoid. Br J Dermatol 2018; 178:e119-e121. [DOI: 10.1111/bjd.15925] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Affiliation(s)
- M. Kamaguchi
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
- Department of Oral Diagnosis and Medicine; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - H. Iwata
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - H. Ujiie
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - K. Izumi
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - K. Natsuga
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - W. Nishie
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - T. Asaka
- Department of Oral Diagnosis and Medicine; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - Y. Kitagawa
- Department of Oral Diagnosis and Medicine; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
| | - H. Shimizu
- Department of Dermatology; Hokkaido University Graduate School of Medicine; Kita-ku Sapporo Japan
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Sugita Y, Miyazaki T, Shimada K, Shimizu M, Kunimoto M, Aikawa T, Ouchi S, Kadoguchi T, Kawaguchi Y, Shiozawa T, Hiki M, Takahashi S, Yokoyama M, Iwata H, Daida H. Omega-6 Polyunsaturated Fatty Acid Levels and Delirium in Patients With Acute Cardiovascular Disease. Eur Cardiol 2018. [DOI: 10.15420/ecr.2018.13.2.po14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hayashi T, Ueda S, Mori M, Baba T, Abe T, Iwata H. Influence of resveratrol pretreatment on thawed bovine embryo quality and mitochondrial DNA copy number. Theriogenology 2018; 106:271-278. [DOI: 10.1016/j.theriogenology.2017.10.022] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Revised: 10/09/2017] [Accepted: 10/15/2017] [Indexed: 01/23/2023]
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Yamaguchi Y, Shinkuma S, Ishii N, Takashima S, Natsuga K, Ujiie H, Iwata H, Nomura T, Fujita Y, Hamasaka A, Hamasaka K, Hashimoto T, Shimizu H. Appearance of antidesmocollin 1 autoantibodies leading to a vegetative lesion in a patient with pemphigus vulgaris. Br J Dermatol 2017; 178:294-295. [DOI: 10.1111/bjd.15834] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y. Yamaguchi
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - S. Shinkuma
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - N. Ishii
- Department of Dermatology Kurume University School of Medicine Kurume Fukuoka Japan
- Kurume University Institute of Cutaneous Cell Biology Kurume Fukuoka Japan
| | - S. Takashima
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - K. Natsuga
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - H. Ujiie
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - H. Iwata
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - T. Nomura
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | - Y. Fujita
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
| | | | | | - T. Hashimoto
- Department of Dermatology Kurume University School of Medicine Kurume Fukuoka Japan
- Kurume University Institute of Cutaneous Cell Biology Kurume Fukuoka Japan
| | - H. Shimizu
- Department of Dermatology Hokkaido University Graduate School of Medicine Kita‐ku Sapporo Japan
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