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Ferraro E, Viale G, Achutti Duso B, Belli C, Criscitiello C, Mazzarella L, Esposito A, Morganti S, Trapani D, Tarantino P, D'Amico P, Busacca C, Massaro M, Curigliano G. Safety of immunotherapy in elderly patients: A retrospective analysis of a phase I unit. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy288.106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol 2018; 29:2153. [PMID: 29733336 DOI: 10.1093/annonc/mdx806] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [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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Conforti F, Pala L, Bagnardi V, De Pas T, Martinetti M, Viale G, Gelber R, Goldhirsch A. Reply to Jeffrey Graham, Omar Abdel-Rahman, Toni K. Choueiri, and Daniel Y.C. Heng's Letter to the Editor re: Fabio Conforti, Laura Pala, Vincenzo Bagnardi, et al. Cancer Immunotherapy Efficacy and Patients' Sex: A Systematic Review and Meta-analysis. Lancet Oncol 2018;19:737-46: Outcomes of Metastatic Renal Cell Carcinoma by Gender: Contrasting Results from the International mRCC Database Consortium. Eur Urol 2018; 75:e34-e35. [PMID: 30224196 DOI: 10.1016/j.eururo.2018.08.034] [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] [Received: 08/14/2018] [Accepted: 08/27/2018] [Indexed: 11/29/2022]
Affiliation(s)
- Fabio Conforti
- Division of Medical Oncology for Melanoma & Sarcoma, European Institute of Oncology, Milan, Italy.
| | - Laura Pala
- Division of Medical Oncology for Melanoma & Sarcoma, European Institute of Oncology, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Tommaso De Pas
- Division of Medical Oncology for Melanoma & Sarcoma, European Institute of Oncology, Milan, Italy
| | - Marco Martinetti
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology, Milan, Italy
| | - Richard Gelber
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Aron Goldhirsch
- Division of Medical Oncology for Melanoma & Sarcoma, European Institute of Oncology, Milan, Italy
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Galimberti V, Cole BF, Viale G, Veronesi P, Vicini E, Intra M, Mazzarol G, Massarut S, Zgajnar J, Taffurelli M, Littlejohn D, Knauer M, Tondini C, Di Leo A, Colleoni M, Regan MM, Coates AS, Gelber RD, Goldhirsch A. Axillary dissection versus no axillary dissection in patients with breast cancer and sentinel-node micrometastases (IBCSG 23-01): 10-year follow-up of a randomised, controlled phase 3 trial. Lancet Oncol 2018; 19:1385-1393. [PMID: 30196031 DOI: 10.1016/s1470-2045(18)30380-2] [Citation(s) in RCA: 284] [Impact Index Per Article: 47.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 05/16/2018] [Accepted: 05/16/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND We previously reported the 5-year results of the phase 3 IBCSG 23-01 trial comparing disease-free survival in patients with breast cancer with one or more micrometastatic (≤2 mm) sentinel nodes randomly assigned to either axillary dissection or no axillary dissection. The results showed no difference in disease-free survival between the groups and showed non-inferiority of no axillary dissection relative to axillary dissection. The current analysis presents the results of the study after a median follow-up of 9·7 years (IQR 7·8-12·7). METHODS In this multicentre, randomised, controlled, open-label, non-inferiority, phase 3 trial, participants were recruited from 27 hospitals and cancer centres in nine countries. Eligible women could be of any age with clinical, mammographic, ultrasonographic, or pathological diagnosis of breast cancer with largest lesion diameter of 5 cm or smaller, and one or more metastatic sentinel nodes, all of which were 2 mm or smaller and with no extracapsular extension. Patients were randomly assigned (1:1) before surgery (mastectomy or breast-conserving surgery) to no axillary dissection or axillary dissection using permuted blocks generated by a web-based congruence algorithm, with stratification by centre and menopausal status. The protocol-specified primary endpoint was disease-free survival, analysed in the intention-to-treat population (as randomly assigned). Safety was assessed in all randomly assigned patients who received their allocated treatment (as treated). We did a one-sided test for non-inferiority of no axillary dissection by comparing the observed hazard ratios (HRs) for disease-free survival with a margin of 1·25. This 10-year follow-up analysis was not prespecified in the trial's protocol and thus was not adjusted for multiple, sequential testing. This trial is registered with ClinicalTrials.gov, number NCT00072293. FINDINGS Between April 1, 2001, and Feb 8, 2010, 6681 patients were screened and 934 randomly assigned to no axillary dissection (n=469) or axillary dissection (n=465). Three patients were ineligible and were excluded from the trial after randomisation. Disease-free survival at 10 years was 76·8% (95% CI 72·5-81·0) in the no axillary dissection group, compared with 74·9% (70·5-79·3) in the axillary dissection group (HR 0·85, 95% CI 0·65-1·11; log-rank p=0·24; p=0·0024 for non-inferiority). Long-term surgical complications included lymphoedema of any grade in 16 (4%) of 453 patients in the no axillary dissection group and 60 (13%) of 447 in the axillary dissection group, sensory neuropathy of any grade in 57 (13%) in the no axillary dissection group versus 85 (19%) in the axillary dissection group, and motor neuropathy of any grade (14 [3%] in the no axillary dissection group vs 40 [9%] in the axillary dissection group). One serious adverse event (postoperative infection and inflamed axilla requiring hospital admission) was attributed to axillary dissection; the event resolved without sequelae. INTERPRETATION The findings of the IBCSG 23-01 trial after a median follow-up of 9·7 years (IQR 7·8-12·7) corroborate those obtained at 5 years and are consistent with those of the 10-year follow-up analysis of the Z0011 trial. Together, these findings support the current practice of not doing an axillary dissection when the tumour burden in the sentinel nodes is minimal or moderate in patients with early breast cancer. FUNDING International Breast Cancer Study Group.
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Affiliation(s)
- Viviana Galimberti
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy.
| | - Bernard F Cole
- IBCSG Statistical Center and Department of Mathematics and Statistics, University of Vermont, Burlington, VT, USA
| | - Giuseppe Viale
- International Breast Cancer Study Group (IBCSG) Central Pathology Office, Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy; University of Milan, Milan, Italy
| | - Paolo Veronesi
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy; University of Milan, Milan, Italy
| | - Elisa Vicini
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Mattia Intra
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Giovanni Mazzarol
- International Breast Cancer Study Group (IBCSG) Central Pathology Office, Division of Pathology and Laboratory Medicine, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Janez Zgajnar
- Department of Surgical Oncology, Institute of Oncology, Ljubljana, Slovenia
| | | | | | - Michael Knauer
- Breast Center St Gallen, Kantonsspital, St Gallen, Switzerland
| | - Carlo Tondini
- Department of Medical Oncology, Ospedale Papa Giovanni XXIII, Bergamo, Italy
| | - Angelo Di Leo
- Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, Prato, Italy
| | - Marco Colleoni
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Meredith M Regan
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA
| | - Alan S Coates
- IBCSG and University of Sydney, Sydney, NSW, Australia
| | - Richard D Gelber
- IBCSG Statistical Center, Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, USA; Harvard T H Chan School of Public Health, Boston, MA, USA; Frontier Science and Technology Research Foundation, Boston, MA, USA
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Van Asten K, Slembrouck L, Olbrecht S, Jongen L, Brouckaert O, Wildiers H, Floris G, Van Limbergen E, Weltens C, Smeets A, Paridaens R, Giobbie-Hurder A, Regan MM, Viale G, Thürlimann B, Vergote I, Christodoulou E, Van Calster B, Neven P. Prognostic Value of the Progesterone Receptor by Subtype in Patients with Estrogen Receptor-Positive, HER-2 Negative Breast Cancer. Oncologist 2018; 24:165-171. [PMID: 30171067 DOI: 10.1634/theoncologist.2018-0176] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 06/28/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND In estrogen receptor-positive (ER+), human epidermal growth factor receptor 2 (HER-2) negative breast cancers, the progesterone receptor (PR) is an independent prognostic marker. Little is known about the prognostic value of PR by tumor grade. We assessed this in two independent datasets. PATIENTS AND METHODS Women with primary operable, invasive ER+ HER-2 negative breast cancer diagnosed between 2000 and 2012, treated at University Hospitals Leuven, were included. We assessed the association of PR status and subtype (grade 1-2 vs. grade 3) with distant recurrence-free interval (DRFI) and breast cancer-specific survival. The interaction between PR status and subtype was investigated, and associations of PR status by subtype were calculated. The BIG 1-98 data set was used for validation. RESULTS In total, 4,228 patients from Leuven and 5,419 from BIG 1-98 were analyzed. In the Leuven cohort, the adjusted hazard ratio (HR) of PR-positive versus PR-negative tumors for DRFI was 0.66 (95% confidence interval [CI], 0.50-0.89). For the interaction with subtype (p = .34), the HR of PR status was 0.79 (95% CI, 0.61-1.01) in luminal A-like and 0.59 (95% CI, 0.46-0.76) in luminal B-like tumors. In luminal A-like tumors, observed 5-year cumulative incidences of distant recurrence were 4.1% for PR-negative and 2.8% for PR-positive tumors, and in luminal B-like 18.7% and 9.2%, respectively. In the BIG 1-98 cohort, similar results were observed; for the interaction with subtype (p = .12), the adjusted HR of PR status for DRFI was 0.88 (95% CI, 0.57-1.35) in luminal A-like and 0.58 (95% CI, 0.43-0.77) in luminal B-like tumors. Observed 5-year cumulative incidences were similar. CONCLUSION PR positivity may be more protective against metastatic relapse in luminal B-like versus luminal A-like breast cancer, but no strong conclusions can be made. In absolute risk, results suggest an absent PR is clinically more important in high compared with low proliferative ER+ HER-2 negative tumors. IMPLICATIONS FOR PRACTICE An absent progesterone receptor (PR) predicts a worse outcome in women treated for an estrogen receptor-positive, human epidermal growth factor receptor 2 negative breast cancer. As low proliferative tumors lacking PR are now also classified high risk, the prognostic value of PR across risk groups was studied. Despite a negative test for interaction of the prognostic value of PR by tumor grade, the magnitude of an absent PR on breast cancer relapse is much larger in high than in low proliferative breast cancers.
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Affiliation(s)
- Kathleen Van Asten
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | | | - Siel Olbrecht
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Lynn Jongen
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
| | - Olivier Brouckaert
- Department of Gynecology and Obstetrics, Senology, Jan Yperman Hospital, Ypres, Belgium
| | - Hans Wildiers
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Giuseppe Floris
- Laboratory of Translational Cell & Tissue Research, Department of Imaging and Pathology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Pathology, University Hospitals Leuven, Leuven, Belgium
| | - Erik Van Limbergen
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Radiotherapy Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Caroline Weltens
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Radiotherapy Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Ann Smeets
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Surgical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Robert Paridaens
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of General Medical Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Anita Giobbie-Hurder
- Department of Biostatistics and Computational Biology, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Meredith M Regan
- Department of Biostatistics and Computational Biology, International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Boston, Massachusetts, USA
| | - Giuseppe Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan, Milan, Italy
| | - Beat Thürlimann
- Breast Center St. Gallen, Cantonal Hospital, St. Gallen, Switzerland
- International Breast Cancer Study Group, Bern, Switzerland
- Swiss Group for Clinical Cancer Research, Bern, Switzerland
| | - Ignace Vergote
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
| | - Evangelia Christodoulou
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Ben Van Calster
- Department of Development and Regeneration, KU Leuven - University of Leuven, Leuven, Belgium
| | - Patrick Neven
- Department of Oncology, KU Leuven - University of Leuven, Leuven, Belgium
- Department of Gynecology and Obstetrics, University Hospitals Leuven, Leuven, Belgium
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Conforti F, Pala L, Bagnardi V, De Pas T, Marco M, Viale G, Gelber R, Goldhirsch A. Sex as a predictor of response to cancer immunotherapy – Authors' reply. Lancet Oncol 2018; 19:e380-e381. [DOI: 10.1016/s1470-2045(18)30535-7] [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] [Received: 07/10/2018] [Revised: 07/13/2018] [Accepted: 07/13/2018] [Indexed: 11/16/2022]
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Wolff AC, Hammond MEH, Allison KH, Harvey BE, Mangu PB, Bartlett JMS, Bilous M, Ellis IO, Fitzgibbons P, Hanna W, Jenkins RB, Press MF, Spears PA, Vance GH, Viale G, McShane LM, Dowsett M. Human Epidermal Growth Factor Receptor 2 Testing in Breast Cancer: American Society of Clinical Oncology/College of American Pathologists Clinical Practice Guideline Focused Update. J Clin Oncol 2018; 36:2105-2122. [PMID: 29846122 DOI: 10.1200/jco.2018.77.8738] [Citation(s) in RCA: 1165] [Impact Index Per Article: 194.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Purpose To update key recommendations of the American Society of Clinical Oncology/College of American Pathologists human epidermal growth factor receptor 2 (HER2) testing in breast cancer guideline. Methods Based on the signals approach, an Expert Panel reviewed published literature and research survey results on the observed frequency of less common in situ hybridization (ISH) patterns to update the recommendations. Recommendations Two recommendations addressed via correspondence in 2015 are included. First, immunohistochemistry (IHC) 2+ is defined as invasive breast cancer with weak to moderate complete membrane staining observed in > 10% of tumor cells. Second, if the initial HER2 test result in a core needle biopsy specimen of a primary breast cancer is negative, a new HER2 test may (not "must") be ordered on the excision specimen based on specific clinical criteria. The HER2 testing algorithm for breast cancer is updated to address the recommended work-up for less common clinical scenarios (approximately 5% of cases) observed when using a dual-probe ISH assay. These scenarios are described as ISH group 2 ( HER2/chromosome enumeration probe 17 [CEP17] ratio ≥ 2.0; average HER2 copy number < 4.0 signals per cell), ISH group 3 ( HER2/CEP17 ratio < 2.0; average HER2 copy number ≥ 6.0 signals per cell), and ISH group 4 ( HER2/CEP17 ratio < 2.0; average HER2 copy number ≥ 4.0 and < 6.0 signals per cell). The diagnostic approach includes more rigorous interpretation criteria for ISH and requires concomitant IHC review for dual-probe ISH groups 2 to 4 to arrive at the most accurate HER2 status designation (positive or negative) based on combined interpretation of the ISH and IHC assays. The Expert Panel recommends that laboratories using single-probe ISH assays include concomitant IHC review as part of the interpretation of all single-probe ISH assay results. Find additional information at www.asco.org/breast-cancer-guidelines .
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Affiliation(s)
- Antonio C Wolff
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - M Elizabeth Hale Hammond
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Kimberly H Allison
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Brittany E Harvey
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Pamela B Mangu
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - John M S Bartlett
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Michael Bilous
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Ian O Ellis
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Patrick Fitzgibbons
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Wedad Hanna
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Robert B Jenkins
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Michael F Press
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Patricia A Spears
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Gail H Vance
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Giuseppe Viale
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Lisa M McShane
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
| | - Mitchell Dowsett
- Antonio C. Wolff, Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore; Lisa M. McShane, National Cancer Institute, Bethesda, MD; M. Elizabeth Hale Hammond, Intermountain Healthcare and University of Utah School of Medicine, Salt Lake City, UT; Kimberly H. Allison, Stanford University School of Medicine, Stanford; Patrick Fitzgibbons, St Jude Medical Center, Fullerton; Michael F. Press, University of Southern California, Los Angeles, CA; Brittany E. Harvey and Pamela B. Mangu, American Society of Clinical Oncology, Alexandria, VA; John M.S. Bartlett, Ontario Institute for Cancer Research; Wedad Hanna, Sunnybrook Health Sciences Centre and Women's College Hospital, Toronto, Ontario, Canada; Michael Bilous, Western Sydney University and Australian Clinical Laboratories, Sydney, New South Wales, Australia; Ian O. Ellis, The University of Nottingham, Nottingham; Mitchell Dowsett, The Royal Marsden NHS Foundation Trust, London, United Kingdom; Robert B. Jenkins, Mayo Clinic, Rochester, MN; Patricia A. Spears, Cancer Information and Support Network, Raleigh, NC; Gail H. Vance, Indiana University School of Medicine, Indianapolis, IN; and Giuseppe Viale, University of Milan and Istituto Europeo di Oncologia, Milan, Italy
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Dowsett M, Sestak I, Regan MM, Dodson A, Viale G, Thürlimann B, Colleoni M, Cuzick J. Integration of Clinical Variables for the Prediction of Late Distant Recurrence in Patients With Estrogen Receptor-Positive Breast Cancer Treated With 5 Years of Endocrine Therapy: CTS5. J Clin Oncol 2018; 36:1941-1948. [PMID: 29676944 PMCID: PMC6049399 DOI: 10.1200/jco.2017.76.4258] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Purpose Estimating risk of late distant recurrence (DR) is an important goal for managing women with hormone receptor-positive breast cancer after 5 years of endocrine treatment without recurrence. We developed and validated a simple clinicopathologic tool (Clinical Treatment Score post-5 years [CTS5]) to estimate residual risk of DR after 5 years of endocrine treatment. Patients and Methods The ATAC (Arimidex, Tamoxifen, Alone or in Combination) data set (N = 4,735) was used to create a prognostic score for post-5-year risk of DR. Validity of CTS5 (ATAC) was tested in the BIG 1-98 data set (N = 6,711). Time to late DR, 5 years after finishing scheduled endocrine therapy, was the primary end point. Cox regression models estimated the prognostic performance of CTS5 (ATAC). Results CTS5 (ATAC) was significantly prognostic for late DR in the ATAC cohort (hazard ratio, 2.47; 95% CI, 2.24 to 2.73; P < .001) and BIG 1-98 validation cohort (hazard ratio, 2.07; 95% CI, 1.88 to 2.28; P < .001). CTS5 (ATAC) risk stratification defined in the training cohort as low (< 5% DR risk, years 5 to 10), intermediate (5% to 10%), or high (> 10%) identified 43% of the validation cohort as low risk, with an observed DR rate of 3.6% (95% CI, 2.7% to 4.9%) during years 5 to 10. From years 5 to 10, 63% of node-negative patients were low risk, with a DR rate of 3.9% (95% CI, 2.9% to 5.3%), and 24% with one to three positive nodes were low risk, with a DR rate of 1.5% (95% CI, 0.5% to 3.8%). A final CTS5 for future use was derived from pooled data from ATAC and BIG 1-98. Conclusion CTS5 is a simple tool based on information that is readily available to all clinicians. CTS5 was validated as highly prognostic for late DR in the independent BIG 1-98 study. The final CTS5 algorithm identified 42% of women with < 1% per-year risk of DR who could be advised of the limited potential value of extended endocrine therapy.
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Affiliation(s)
- Mitch Dowsett
- Mitch Dowsett and Andrew Dodson, Royal Marsden Hospital; Mitch Dowsett, Institute of Cancer Research; Ivana Sestak and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Meredith M. Regan, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA; Giuseppe Viale, University of Milan; Guiseppe Viale and Marco Colleoni, European Institute of Oncology, Milan, Italy; Beat Thürlimann, Kantonsspital St Gallen, St Gallen, and International Breast Cancer Study Group and Swiss Group for Clinical Cancer Research, Berne, Switzerland
| | - Ivana Sestak
- Mitch Dowsett and Andrew Dodson, Royal Marsden Hospital; Mitch Dowsett, Institute of Cancer Research; Ivana Sestak and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Meredith M. Regan, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA; Giuseppe Viale, University of Milan; Guiseppe Viale and Marco Colleoni, European Institute of Oncology, Milan, Italy; Beat Thürlimann, Kantonsspital St Gallen, St Gallen, and International Breast Cancer Study Group and Swiss Group for Clinical Cancer Research, Berne, Switzerland
| | - Meredith M. Regan
- Mitch Dowsett and Andrew Dodson, Royal Marsden Hospital; Mitch Dowsett, Institute of Cancer Research; Ivana Sestak and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Meredith M. Regan, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA; Giuseppe Viale, University of Milan; Guiseppe Viale and Marco Colleoni, European Institute of Oncology, Milan, Italy; Beat Thürlimann, Kantonsspital St Gallen, St Gallen, and International Breast Cancer Study Group and Swiss Group for Clinical Cancer Research, Berne, Switzerland
| | - Andrew Dodson
- Mitch Dowsett and Andrew Dodson, Royal Marsden Hospital; Mitch Dowsett, Institute of Cancer Research; Ivana Sestak and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Meredith M. Regan, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA; Giuseppe Viale, University of Milan; Guiseppe Viale and Marco Colleoni, European Institute of Oncology, Milan, Italy; Beat Thürlimann, Kantonsspital St Gallen, St Gallen, and International Breast Cancer Study Group and Swiss Group for Clinical Cancer Research, Berne, Switzerland
| | - Giuseppe Viale
- Mitch Dowsett and Andrew Dodson, Royal Marsden Hospital; Mitch Dowsett, Institute of Cancer Research; Ivana Sestak and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Meredith M. Regan, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA; Giuseppe Viale, University of Milan; Guiseppe Viale and Marco Colleoni, European Institute of Oncology, Milan, Italy; Beat Thürlimann, Kantonsspital St Gallen, St Gallen, and International Breast Cancer Study Group and Swiss Group for Clinical Cancer Research, Berne, Switzerland
| | - Beat Thürlimann
- Mitch Dowsett and Andrew Dodson, Royal Marsden Hospital; Mitch Dowsett, Institute of Cancer Research; Ivana Sestak and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Meredith M. Regan, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA; Giuseppe Viale, University of Milan; Guiseppe Viale and Marco Colleoni, European Institute of Oncology, Milan, Italy; Beat Thürlimann, Kantonsspital St Gallen, St Gallen, and International Breast Cancer Study Group and Swiss Group for Clinical Cancer Research, Berne, Switzerland
| | - Marco Colleoni
- Mitch Dowsett and Andrew Dodson, Royal Marsden Hospital; Mitch Dowsett, Institute of Cancer Research; Ivana Sestak and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Meredith M. Regan, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA; Giuseppe Viale, University of Milan; Guiseppe Viale and Marco Colleoni, European Institute of Oncology, Milan, Italy; Beat Thürlimann, Kantonsspital St Gallen, St Gallen, and International Breast Cancer Study Group and Swiss Group for Clinical Cancer Research, Berne, Switzerland
| | - Jack Cuzick
- Mitch Dowsett and Andrew Dodson, Royal Marsden Hospital; Mitch Dowsett, Institute of Cancer Research; Ivana Sestak and Jack Cuzick, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom; Meredith M. Regan, Dana Farber Cancer Institute and Harvard Medical School, Boston, MA; Giuseppe Viale, University of Milan; Guiseppe Viale and Marco Colleoni, European Institute of Oncology, Milan, Italy; Beat Thürlimann, Kantonsspital St Gallen, St Gallen, and International Breast Cancer Study Group and Swiss Group for Clinical Cancer Research, Berne, Switzerland
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Kensler KH, Regan MM, Heng YJ, Pyle ME, Schnitt SJ, Thürlimann B, Viale G, Colleoni M, Brown M, Tamimi RM. Abstract 4207: Androgen receptor expression and ER+ breast cancer prognosis in the BIG 1-98 trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.am2018-4207] [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 androgen receptor (AR) is emerging as a potential biomarker of breast cancer prognosis and therapeutic target. AR is expressed in 60-80% of breast cancers, with higher prevalence among estrogen receptor (ER) positive tumors. Treatment with dihydrotestosterone has been found to inhibit ER signaling in ER+/AR+ breast cancer cell lines, and epidemiologic studies have shown AR expression to be associated with improved survival among women with ER+ breast cancer. However, it is unknown if AR expression modifies the efficacy of selective ER modulators or aromatase inhibitors in patients with ER+ cancers.
Methods We evaluated AR expression among 3,103 postmenopausal patients with ER+ breast cancer in the Breast International Group (BIG) 1-98 trial (NCT00004205). The BIG 1-98 study was a four-armed randomized double-blind phase III clinical trial that compared 5 years of tamoxifen or letrozole monotherapy, or sequences of 2 years and 3 years treatment with one drug and then the other. Tissue microarrays were constructed from tumor tissue from trial participants. AR expression was measured by immunohistochemistry and the percentage of AR positive nuclei was digitally quantified. The association between AR expression and prognosis was evaluated through use of Cox proportional hazards models, adjusting for patient, tumor, and treatment factors. Continuous AR-by-treatment interactions were assessed by use of Subpopulation Treatment Effect Pattern Plots (STEPP).
Results In the univariate Kaplan-Meier analysis, AR expression (≥1% vs. <1%) was associated with longer breast cancer-free interval (247 events) over a median 8.2 years (IQR: 7.3-9.1) of follow-up (p=0.029 from log-rank test). Patients with AR+ cancers were more likely to have smaller, lower-grade tumors, as well as tumors with greater ER and PR expression and lower Ki67 expression. However, upon adjustment for patient, tumor, and treatment factors, AR expression (≥1% vs. <1%) was not associated with breast cancer-free interval (HR=1.06, 95% CI 0.82-1.36). A 10% increase in AR expression similarly did not predict breast cancer-free interval (HR=1.02, 95% CI 0.96-1.07). The letrozole vs. tamoxifen treatment effect was non-significantly stronger among AR- tumors (HR=0.42, 95% CI 0.24-0.74) than among AR+ tumors (HR=0.65, 95% CI 0.48-0.87). STEPP analysis also suggested no heterogeneity of treatment effect across the continuum of AR expression (p=0.280). Findings were likewise null when evaluating the secondary endpoints of distant recurrence free interval, disease free survival, and overall survival.
Conclusions After adjustment for tumor characteristics, AR expression did not predict prognosis among postmenopausal patients with ER+ breast cancer, nor did it modify the effect of tamoxifen or letrozole treatment. These findings suggest that AR expression may not be an informative biomarker for the treatment of postmenopausal ER+ breast cancers.
Citation Format: Kevin H. Kensler, Meredith M. Regan, Yujing J. Heng, Michael E. Pyle, Stuart J. Schnitt, Beat Thürlimann, Giuseppe Viale, Marco Colleoni, Myles Brown, Rulla M. Tamimi. Androgen receptor expression and ER+ breast cancer prognosis in the BIG 1-98 trial [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4207.
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Affiliation(s)
| | - Meredith M. Regan
- 2Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | | | | | | | | | - Giuseppe Viale
- 6European Institute of Oncology, University of Milan, Milan, Italy
| | - Marco Colleoni
- 6European Institute of Oncology, University of Milan, Milan, Italy
| | - Myles Brown
- 2Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Rulla M. Tamimi
- 7Brigham and Women's Hospital and Harvard Medical School, Boston, MA
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Affiliation(s)
- Vivianne Tjan-Heijnen
- From the Department of Medical Oncology, School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands (V.T.-H.); and the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.)
| | - Giuseppe Viale
- From the Department of Medical Oncology, School of Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, the Netherlands (V.T.-H.); and the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.)
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Baselga J, Petersen JA, Clark E, Barton C, Restuccia E, Procter MJ, Sonnenblick A, Fumagalli D, Parlier D, Arahmani A, Viale G, Reaby LL, Frank E, Gelber RD, Piccart-Gebhart MJ, Bines J, Minckwitz GV, Gasper SM. Patient (pt)-reported function and symptoms in APHINITY: A randomized comparison of chemotherapy (C) + trastuzumab (H) + placebo (Pla) versus C + H + pertuzumab (P) as adjuvant therapy in pts with HER2-positive early breast cancer (EBC). J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.521] [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: 11/20/2022] Open
Affiliation(s)
- Jose Baselga
- Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Emma Clark
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Claire Barton
- Roche Products Limited, Welwyn Garden City, United Kingdom
| | | | | | - Amir Sonnenblick
- Breast European Adjuvant Study Team (BrEAST) Data Center, Institut Jules Bordet, Brussels, Belgium, Institute of Oncology, Sourasky Medical Center, and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Damian Parlier
- Breast European Adjuvant Study Team (BrEAST) Data Center, Institut Jules Bordet, Brussels, Belgium
| | | | - Giuseppe Viale
- European Institute of Oncology, University of Milan, Milan, Italy
| | | | | | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston, MA
| | | | - Jose Bines
- Instituto Nacional de Câncer, Rio De Janeiro, Brazil
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Regan MM, Francis PA, Pagani O, Fleming GF, Walley B, Viale G, Colleoni M, Lang I, Gomez HL, Tondini CA, Pinotti G, Di Leo A, Coates AS, Goldhirsch A, Gelber RD. Absolute improvements in freedom from distant recurrence with adjuvant endocrine therapies for premenopausal women with hormone receptor-positive (HR+) HER2-negative breast cancer (BC): Results from TEXT and SOFT. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.503] [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: 11/20/2022] Open
Affiliation(s)
| | | | - Olivia Pagani
- Institute of Oncology of Southern Switzerland, Lugano Viganello, Switzerland
| | | | | | - Giuseppe Viale
- European Institute of Oncology, University of Milan, Milan, Italy
| | | | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | | | | | | | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | | | - Richard D. Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston, MA
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Guerini Rocco E, Gray KP, Munzone E, Fumagalli C, Reforgiato MR, Leone I, Kammler R, Viale G, Neven P, Hitre E, Jerusalem GHM, Simoncini E, Gombos A, Deleu I, Di Leo A, Goldhirsch A, Barberis M, Regan MM, Colleoni M. Molecular alterations and late recurrence in postmenopausal women with hormone receptor-positive node-positive breast cancer (BC): Results from the “SOLE” trial. J Clin Oncol 2018. [DOI: 10.1200/jco.2018.36.15_suppl.517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | - Marta Rita Reforgiato
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Isabella Leone
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Rosita Kammler
- European Thoracic Oncology Platform (ETOP), Bern, Switzerland
| | - Giuseppe Viale
- European Institute of Oncology, University of Milan, Milan, Italy
| | | | - Erika Hitre
- Orszagos Onkologiai Intezet, Budapest, Hungary
| | | | | | - Andrea Gombos
- Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Ines Deleu
- Oncology Centre, AZ Nikolaas, Sint-Niklaas, Belgium
| | - Angelo Di Leo
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Massimo Barberis
- Department of Pathology, European Institute of Oncology, Milan, Italy
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Conforti F, Pala L, Bagnardi V, De Pas T, Martinetti M, Viale G, Gelber RD, Goldhirsch A. Cancer immunotherapy efficacy and patients' sex: a systematic review and meta-analysis. Lancet Oncol 2018; 19:737-746. [PMID: 29778737 DOI: 10.1016/s1470-2045(18)30261-4] [Citation(s) in RCA: 556] [Impact Index Per Article: 92.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/27/2018] [Accepted: 03/28/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Despite the acknowledged sex-related dimorphism in immune system response, little is known about the effect of patients' sex on the efficacy of immune checkpoint inhibitors as cancer treatments. We did a systematic review and meta-analysis to assess the heterogeneity of immune checkpoint inhibitor efficacy between men and women. METHODS We systematically searched PubMed, MEDLINE, Embase, and Scopus, from database inception to Nov 30, 2017, for randomised controlled trials of immune checkpoint inhibitors (inhibitors of PD-1, CTLA-4, or both) that had available hazard ratios (HRs) for death according to patients' sex. We also reviewed abstracts and presentations from all major conference proceedings. We excluded non-randomised trials and considered only papers published in English. The primary endpoint was to assess the difference in efficacy of immune checkpoint inhibitors between men and women, measured in terms of the difference in overall survival log(HR) reported in male and female study participants. We calculated the pooled overall survival HR and 95% CI in men and women using a random-effects model, and assessed the heterogeneity between the two estimates using an interaction test. FINDINGS Of 7133 studies identified in our search, there were 20 eligible randomised controlled trials of immune checkpoint inhibitors (ipilimumab, tremelimumab, nivolumab, or pembrolizumab) that reported overall survival according to patients' sex. Overall, 11 351 patients with advanced or metastatic cancers (7646 [67%] men and 3705 [33%] women) were included in the analysis; the most common types of cancer were melanoma (3632 [32%]) and non-small-cell lung cancer (3482 [31%]). The pooled overall survival HR was 0·72 (95% CI 0·65-0·79) in male patients treated with immune checkpoint inhibitors, compared with men treated in control groups. In women treated with immune checkpoint inhibitors, the pooled overall survival HR compared with control groups was 0·86 (95% CI 0·79-0·93). The difference in efficacy between men and women treated with immune checkpoint inhibitors was significant (p=0·0019). INTERPRETATION Immune checkpoint inhibitors can improve overall survival for patients with advanced cancers such as melanoma and non-small-cell lung cancer, but the magnitude of benefit is sex-dependent. Future research should guarantee greater inclusion of women in trials and focus on improving the effectiveness of immunotherapies in women, perhaps exploring different immunotherapeutic approaches in men and women. FUNDING None.
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Affiliation(s)
- Fabio Conforti
- Division of Medical Oncology for Melanoma & Sarcoma, European Institute of Oncology, Milan, Italy.
| | - Laura Pala
- Division of Medical Oncology for Melanoma & Sarcoma, European Institute of Oncology, Milan, Italy
| | - Vincenzo Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Tommaso De Pas
- Division of Medical Oncology for Melanoma & Sarcoma, European Institute of Oncology, Milan, Italy
| | - Marco Martinetti
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology & State University of Milan, Milan, Italy
| | - Richard D Gelber
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Harvard T.H. Chan School of Public Health, Boston, MA, USA; Frontier Science & Technology Research Foundation, Boston, MA, USA
| | - Aron Goldhirsch
- Division of Medical Oncology for Melanoma & Sarcoma, European Institute of Oncology, Milan, Italy
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Abstract
Aims and background Adenomyoepithelioma is a rare lesion that can involve the breast tissue. The diagnostic appearance of the lesion can give raise to a difficult differential diagnosis with breast carcinoma. Patients and methods We report our experience with a case of adenomyoepithelioma whose differential diagnosis with a breast carcinoma was particularly difficult, leading to surgery for definitive histology. Discussion Few papers are available with evidence about adenomyoepithelioma. The difficult differential diagnosis and the potentiality of malignant evolution of this lesion could in principle justify a conservative surgical approach for final histology.
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Affiliation(s)
- Giovanna Gatti
- Senology Division, European Oncology Institute, Milan, Italy.
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216
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Abstract
A case of gangliocytic paraganglioma of the second portion of the duodenal loop is presented. The tumor was polypoid and, histologically, composed of mature ganglion cells, spindle cells and epithelial-like cells. Immunocytochemical examination demonstrated the presence of neurofilament 200 K and S-100 protein only in the first two types of cells; all the cells were positive for neuron-specific enolase. The reaction for cytokeratin was negative in all neoplastic components. According to morphologic and immunocytochemical findings, we suggest a hamartomatous nature of this entity.
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Affiliation(s)
- S Dante
- Istituto di Anatomia e Istologia Patologica I, Università di Padova, Italia
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217
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Abstract
A case of plasma cell granuloma (PCG) of the lung in a 54-year old man is reported. PCG is a rare benign lesion that usually presents as a solitary nodule in the lung (coin lesion) at routine X-ray examination. Microscopically it consists of a granulomatous tissue where the major components are mature plasma cells. The immunohistochemical demonstration of poly-clonality of plasma cells, excluding the diagnosis of plasmacytoma, confirms the inflammatory pseudotumoral nature of this lesion, although the etiology remains obscure. The presence of lymphocytes, histiocytes, macrophages, blood vessels with prominent endothelial cells and peripheral sclero-hyalinized connective tissue may pose problems in the differential diagnosis, with sclerosing hemangioma, pseudolymphoma, nodular amyloidosis, pulmonary hyalinizing granuloma, chronic abscess and neoplasms of true histiocytic origin. The term inflammatory pseudotumor is preferable in describing this type of lesion.
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218
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De Cicco C, Mariani L, Vedruccio C, Ricci C, Balma M, Rotmensz N, Ferrari ME, Autino E, Trifirò G, Sacchini V, Viale G, Paganelli G. Clinical Application of Spectral Electromagnetic Interaction in Breast Cancer: Diagnostic Results of a Pilot Study. Tumori 2018; 92:207-12. [PMID: 16869237 DOI: 10.1177/030089160609200304] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background There is a need for a cost-effective method to safely reduce the number of diagnostic procedures women undergo for breast cancer. We tested a new procedure for breast cancer diagnosis based on breast tissue response to low level electromagnetic incident waves. Methods We tested 101 patients with suspicious palpable breast lesions detected by mammography or ultrasonography, who were scheduled to undergo an open biopsy. Using an electromagnetic field generator (tissue resonance interaction method probe [TRIMprobTM]), we passed the TRIMprobTM over the breast area and recorded the signal variation of one or more spectral lines (dB1, dB2, dB3). The results were compared with those of a control group as well as with pathology data obtained from excisional biopsy. Results No adverse effects of the test were observed. Pathology revealed 86 malignant breast cancers (72 invasive, 14 in situ) and 15 benign conditions. We achieved the best discrimination between normal breasts and lesions using dB1 (dB1 AUC-ROC = 0.8; dB2 AUC-ROC = 0.61; dB3 AUC-ROC = 0.76). With a specificity of 75% to 95%, the sensitivity ranged from 49% to 84%. Tumor or patient variables did not influence the results. Conclusions The TRIMprobTM test was able to provide some degree of discrimination between normal breast tissue and lesions but not between benign and malignant lesions. The lack of influence of patient age and tumor size on test results might be advantageous in terms of early diagnosis in young women. These preliminary results need to be verified and extended in a preclinical-stage disease setting before clinical applicability can be envisaged.
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Affiliation(s)
- Concetta De Cicco
- Division of Nuclear Medicine, European Institute of Oncology, Milan, Italy.
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219
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Munzone E, Gray KP, Fumagalli C, Guerini-Rocco E, Láng I, Ruhstaller T, Gianni L, Kammler R, Viale G, Di Leo A, Coates AS, Gelber RD, Regan MM, Goldhirsch A, Barberis M, Colleoni M. Mutational analysis of triple-negative breast cancers within the International Breast Cancer Study Group (IBCSG) Trial 22-00. Breast Cancer Res Treat 2018; 170:351-360. [PMID: 29589138 DOI: 10.1007/s10549-018-4767-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Accepted: 03/21/2018] [Indexed: 01/26/2023]
Abstract
PURPOSE We investigated the occurrence and the prognostic and predictive relationship of a selected number of somatic mutations in triple-negative breast cancer (TNBC) patients having known clinical outcomes treated within the IBCSG Trial 22-00. METHODS A matched case-control sampling selected patients enrolled in the IBCSG Trial 22-00 who had TNBC tumors, based on local assessment. Cases had invasive breast cancer recurrence (at local, regional, or distant site) according to the protocol definition. Matched controls had not recurred. Mutational analysis was performed with OncoCarta panel v1.0 using Mass Array System. The panel includes 19 genes belonging to different functional pathways as PI3K pathway, receptor tyrosine kinase, and cell cycle-metabolic group. Conditional logistic regression assessed the association of mutation status with breast cancer recurrence. RESULTS Mutation assessment was successful for 135 patients (49 cases, 86 controls). A total of 37 (27.4%) of the 135 patients had at least one mutation in the selected genes. PIK3CA was the most common mutated gene (18/135; 13.3%), followed by BRAF, KIT and PDGFRA (each 4/135, 3.0%) and AKT1 (3/135; 2.2%). TNBC patients with at least one mutation had increased odds of recurrence compared with those with wild-type tumors (odds ratio (OR) 2.28; 95% CI 0.88-5.92), though this difference was not statistically significant (p = 0.09). We found no evidence that these mutations were predictive for the value of maintenance metronomic chemotherapy. CONCLUSIONS Mutations in the tested oncogenes were not associated with breast cancer recurrence in this TNBC subset of patients. The question of whether any of these mutated genes (e.g., PIK3CA) may represent a useful therapeutic target in TNBC may be answered by ongoing clinical trials and/or larger dataset analysis.
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Affiliation(s)
- Elisabetta Munzone
- Division of Medical Senology, European Institute of Oncology, Milan, Italy.
| | - Kathryn P Gray
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, and Harvard T.H Chan School of Public Health, Boston, MA, USA
| | - Caterina Fumagalli
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Elena Guerini-Rocco
- Division of Pathology and Laboratory Medicine, Department of Oncology and Hemato-oncology, European Institute of Oncology and University of Milan, Milan, Italy
| | - István Láng
- National Institute of Oncology, Budapest, Hungary
| | - Thomas Ruhstaller
- Breast Center St. Gallen, Switzerland, Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Lorenzo Gianni
- Divisione di Oncologia, Ospedale degli Infermi, Rimini, Dipartimento di Oncologia ed Ematologia, AUSL della Romagna, Rimini, Italy
| | - Roswitha Kammler
- Translational Research Coordination and Central Pathology Office, International Breast Cancer Study Group Coordinating Center, Bern, Switzerland
| | - Giuseppe Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, University of Milan and International Breast Cancer Study Group Central Pathology Office, Milan, Italy
| | - Angelo Di Leo
- Hospital of Prato-AUSL Toscana Centro, Istituto Toscano Tumori, and International Breast Cancer Study Group, Prato, Italy
| | - Alan S Coates
- International Breast Cancer Study Group and University of Sydney, Sydney, Australia
| | - Richard D Gelber
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute, Harvard T.H. Chan School of Public Health, Harvard Medical School and Frontier Science & Technology Research Foundation, Boston, MA, USA
| | - Meredith M Regan
- International Breast Cancer Study Group Statistical Center, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Aron Goldhirsch
- Scientific & Clinical Evaluation Board, European Institute of Oncology and International Breast Cancer Study Group, Milan, Italy
| | - Massimo Barberis
- Division of Pathology and Laboratory Medicine, European Institute of Oncology and University of Milan, Milan, Italy
| | - Marco Colleoni
- Division of Medical Senology, European Institute of Oncology, and International Breast Cancer Study Group, Milan, Italy
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220
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Fumagalli C, Vacirca D, Rappa A, Passaro A, Guarize J, Rafaniello Raviele P, de Marinis F, Spaggiari L, Casadio C, Viale G, Barberis M, Guerini-Rocco E. The long tail of molecular alterations in non-small cell lung cancer: a single-institution experience of next-generation sequencing in clinical molecular diagnostics. J Clin Pathol 2018. [PMID: 29535211 DOI: 10.1136/jclinpath-2018-205032] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Molecular profiling of advanced non-small cell lung cancers (NSCLC) is essential to identify patients who may benefit from targeted treatments. In the last years, the number of potentially actionable molecular alterations has rapidly increased. Next-generation sequencing allows for the analysis of multiple genes simultaneously. AIMS To evaluate the feasibility and the throughput of next-generation sequencing in clinical molecular diagnostics of advanced NSCLC. METHODS A single-institution cohort of 535 non-squamous NSCLC was profiled using a next-generation sequencing panel targeting 22 actionable and cancer-related genes. RESULTS 441 non-squamous NSCLC (82.4%) harboured at least one gene alteration, including 340 cases (63.6%) with clinically relevant molecular aberrations. Mutations have been detected in all but one gene (FGFR1) of the panel. Recurrent alterations were observed in KRAS, TP53, EGFR, STK11 and MET genes, whereas the remaining genes were mutated in <5% of the cases. Concurrent mutations were detected in 183 tumours (34.2%), mostly impairing KRAS or EGFR in association with TP53 alterations. CONCLUSIONS The study highlights the feasibility of targeted next-generation sequencing in clinical setting. The majority of NSCLC harboured mutations in clinically relevant genes, thus identifying patients who might benefit from different targeted therapies.
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Affiliation(s)
- Caterina Fumagalli
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Davide Vacirca
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Alessandra Rappa
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Juliana Guarize
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | | | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Lorenzo Spaggiari
- Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Chiara Casadio
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Giuseppe Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Massimo Barberis
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Elena Guerini-Rocco
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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221
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Filipits M, Dafni U, Gnant M, Polydoropoulou V, Hills M, Kiermaier A, de Azambuja E, Larsimont D, Rojo F, Viale G, Toi M, Harbeck N, Prichard KI, Gelber RD, Dinh P, Zardavas D, Leyland-Jones B, Piccart-Gebhart MJ, Dowsett M. Association of p27 and Cyclin D1 Expression and Benefit from Adjuvant Trastuzumab Treatment in HER2-Positive Early Breast Cancer: A TransHERA Study. Clin Cancer Res 2018. [PMID: 29530933 DOI: 10.1158/1078-0432.ccr-17-3473] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose: To assess the prognostic and predictive value of selected biomarkers involved in cell-cycle regulation or proliferation in patients with HER2-positive early breast cancer.Experimental Design: Protein expression of TOP2A, Ki67, cyclin D1, and p27 was immunohistochemically determined in tissue microarrays of surgical specimens from 862 patients randomized to trastuzumab (1 or 2 years; N = 561) and observation (N = 301) arms of the HERA trial. The primary analysis endpoint was disease-free survival (DFS). Biomarkers were examined as continuous or categorical variables (predefined cutoffs). Interaction terms between biomarkers and treatment were assessed in multivariate Cox models adjusted for variables of clinical interest.Results: A significant interaction was detected between p27 and treatment (adjusted P = 0.0049). Trastuzumab effect was significant in the p27-low subgroup (≤70% p27-positive tumor cells; N = 318). HR Comb Trast vs. Obs 0.44, 95% CI, 0.29-0.65 (P < 0.001). No trastuzumab effect was observed in the p27-high subgroup N = 435; HR Comb Trast vs. Obs 0.97, 95% CI, 0.66-1.44, P = 0.89), indicating that these patients derived little or no benefit from trastuzumab treatment. A prognostic effect of p27 on DFS was observed, with p27-high patients experiencing half the hazard of a DFS event compared with low ones (HR p27 High vs. Low 0.49, 95% CI, 0.32-0.75). TOP2A, Ki67, and cyclin D1, as categorical variables were not predictive, whereas cyclin D1 as continuous variable was predictive of trastuzumab benefit.Conclusions: In TransHERA, patients with HER2-positive early breast cancer with low p27 expression in their tumors benefited from trastuzumab treatment, whereas patients with high p27 expression did not. Clin Cancer Res; 24(13); 3079-86. ©2018 AACR.
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Affiliation(s)
- Martin Filipits
- Institute of Cancer Research, Department of Medicine I, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria.
| | - Urania Dafni
- Frontier Science Foundation-Hellas, Zografou, and National and Kapodistrian University of Athens, Athens, Greece
| | - Michael Gnant
- Department of Surgery, Medical University of Vienna, Comprehensive Cancer Center, Vienna, Austria
| | - Varvara Polydoropoulou
- Frontier Science Foundation-Hellas, Zografou, and National and Kapodistrian University of Athens, Athens, Greece
| | | | | | - Evandro de Azambuja
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Denis Larsimont
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Federico Rojo
- Pathology Department, University Hospital "Fundacion Jimenez Diaz," Madrid, Spain
| | - Giuseppe Viale
- University of Milan, European Institute of Oncology, Milan, Italy
| | - Masakazu Toi
- Department of Surgery, Kyoto University, Kyoto, Japan
| | - Nadia Harbeck
- Breast Center, University of Munich (LMU), Munich, Germany
| | - Kathleen I Prichard
- Sunnybrook Odette Cancer Centre, Toronto Sunnybrook Regional Cancer Centre, Toronto, Canada
| | - Richard D Gelber
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health and Frontier Science and Technology Research Foundation, Boston, Massachusetts
| | - Phuong Dinh
- Westmead Hospital, University of Sydney, Sydney, Australia
| | | | | | - Martine J Piccart-Gebhart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Breast International Group (BIG), Brussels, Belgium
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222
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Swain SM, Ewer MS, Viale G, Delaloge S, Ferrero JM, Verrill M, Colomer R, Vieira C, Werner TL, Douthwaite H, Bradley D, Waldron-Lynch M, Kiermaier A, Eng-Wong J, Dang C. Pertuzumab, trastuzumab, and standard anthracycline- and taxane-based chemotherapy for the neoadjuvant treatment of patients with HER2-positive localized breast cancer (BERENICE): a phase II, open-label, multicenter, multinational cardiac safety study. Ann Oncol 2018; 29:646-653. [PMID: 29253081 PMCID: PMC5888999 DOI: 10.1093/annonc/mdx773] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Anti-HER2 therapies are associated with a risk of increased cardiac toxicity, particularly when part of anthracycline-containing regimens. We report cardiac safety of pertuzumab, trastuzumab, and chemotherapy in the neoadjuvant treatment of HER2-positive early breast cancer. Patients and methods BERENICE (NCT02132949) is a nonrandomized, phase II, open-label, multicenter, multinational study in patients with normal cardiac function. In the neoadjuvant period, cohort A patients received four cycles of dose-dense doxorubicin and cyclophosphamide, then 12 doses of standard paclitaxel plus four standard trastuzumab and pertuzumab cycles. Cohort B patients received four standard fluorouracil/epirubicin/cyclophosphamide cycles, then four docetaxel cycles with four standard trastuzumab and pertuzumab cycles. The primary end point was cardiac safety during neoadjuvant treatment, assessed by the incidence of New York Heart Association class III/IV heart failure and of left ventricular ejection fraction declines (≥10 percentage-points from baseline and to a value of <50%). The main efficacy end point was pathologic complete response (pCR, ypT0/is ypN0). Results are descriptive. Results Safety populations were 199 and 198 patients in cohorts A and B, respectively. Three patients [1.5%; 95% confidence interval (CI) 0.31% to 4.34%] in cohort A experienced four New York Heart Association class III/IV heart failure events. Thirteen patients (6.5%; 95% CI 3.5% to 10.9%) in cohort A and four (2.0%; 95% CI 0.6% to 5.1%) in cohort B experienced at least one left ventricular ejection fraction decline. No new safety signals were identified. pCR rates were 61.8% and 60.7% in cohorts A and B, respectively. The highest pCR rates were in the HER2-enriched PAM50 subtype (75.0% and 73.7%, respectively). Conclusion Treatment with pertuzumab, trastuzumab, and common anthracycline-containing regimens for the neoadjuvant treatment of early breast cancer resulted in cardiac and general safety profiles, and pCR rates, consistent with prior studies with pertuzumab. Clinical Trial Information NCT02132949.
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Affiliation(s)
- S M Swain
- Georgetown University Medical Center, Lombardi Comprehensive Cancer Center, Washington, USA.
| | - M S Ewer
- Department of Cardiology, The University of Texas MD Anderson Cancer Center, Houston, USA
| | - G Viale
- Department of Pathology, European Institute of Oncology, University of Milan, Milan, Italy
| | - S Delaloge
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif
| | - J-M Ferrero
- Clinical Research Department, Centre Antoine Lacassagne, Nice, France
| | - M Verrill
- Medical Oncology Department, Northern Centre for Cancer Care, Newcastle upon Tyne, UK
| | - R Colomer
- Medical Oncology Department, Hospital Universitario La Princesa, Madrid, Spain
| | - C Vieira
- Medical Oncology, Instituto Português de Oncologia Francisco Gentil (IPOFG) Porto, Porto, Portugal
| | - T L Werner
- Huntsman Cancer Institute, University of Utah, Salt Lake City, USA
| | - H Douthwaite
- Biostatistics, Product Development, Roche Products Ltd, Welwyn Garden City, UK
| | - D Bradley
- Clinical Science, Global Product Development, Roche Products Ltd, Welwyn Garden City, UK
| | - M Waldron-Lynch
- Clinical Science, Global Product Development, Roche Products Ltd, Welwyn Garden City, UK
| | - A Kiermaier
- Oncology Biomarker Development (OBD), F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - J Eng-Wong
- Product Development - Oncology, Genentech, Inc., South San Francisco
| | - C Dang
- Department of Medicine, Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York, USA
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223
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Colleoni M, Gray K, Munzone E, Dellapasqua S, Zamagni C, Gianni L, Johansson H, Viale G, Kammler R, Maibach R, Rabaglio-Poretti M, Di Leo A, Coates AS, Gelber RD, Regan MM, Goldhirsch A. Abstract P1-10-06: A randomized phase II trial evaluating the endocrine activity and efficacy of neoadjuvant degarelix versus triptorelin in premenopausal patients receiving letrozole for primary endocrine responsive breast cancer (TREND; IBCSG 41-13). Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-10-06] [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: Neoadjuvant endocrine therapy (NET) with gonadotropin-releasing hormone (GnRH) agonist and aromatase inhibitors is effective in selected premenopausal patients (pts). Degarelix, an antagonist of GnRH, has immediate onset of action through binding to GnRH receptors in the pituitary gland and thereby suppressing the production of LH and FSH. Its suppressing activity in premenopausal women might be faster and free of estrodial breakthrough on continued treatment compared with a GnRH angonist, and thereby provide significant clinical value for pts who are candidates for short-term NET.
Methods: Eligible pts were premenopausal women with cT2-4b, any nodal stage, ER and PgR >50%, HER2-negative (by IHC and/or ISH) breast cancer who were not candidates for breast conserving surgery. Premenopausal status was determined locally with estradiol (E2) levels >54 pg/mL (or >198 pmol/L), measured within 14 days prior to randomization. Pts were randomized 1:1 to Triptorelin (T) 3.75 mg i.m. on day 1 of every cycle or Degarelix (D) 240 mg s.c. given as two injections of 120 mg on day 1 of cycle 1, then 80 mg s.c. on day 1 of cycles 2-6 with letrozole (L) 2.5 mg/day for 6 cycles. Each cycle was 28 days. Definitive surgery was performed within 2-3 weeks after the last administration of T or D. Serum was collected prior to the first injection (baseline), 24 and 72 hours, 7 and 14 days, then prior to injection on day 1 of cycles 2-6. The primary endpoint was time to optimal ovarian function suppression (OFS) calculated as time from the first injection of D or T to the first assessment of centrally assessed 17-β-estradiol (E2) level in the range of optimal OFS (≤2.72 pg/mL or ≤10 pmol/L) during the 6 cycles of NET. The trial had 90% power to detect a difference using a logrank test, 2-sided α=0.05. Secondary endpoints included tolerability, Ki67changes, PEPI score, best overall response. NCT02005887
Results: TREND completed accrual of 51 pts in January 2017. A preliminary analysis based on the first 45 pts is reported here. 89% of patients were ≥40 yrs, 76% had T1-2 and 22% T3 tumors, and 51% were node-positive. Dominant histology type was ductal (93%). The table summarizes centrally-assessed E2 according to treatment at baseline and for the first 5 assessment time points indicating immediate suppression for the D+L arm. E2 levels on day 1 of cycles 2-6 were all below the limit of quantification (0.625 pg/mL) for the D+L arm. For the T+L arm continued OFS was not maintained in 4 pts.
BaselineCycle 1Cycle 2Day:01371429No. Pts D+L222221212221T+L232321232222Median (IQR) D+L96.2 (64.2,206.8)10.1 (4.0,21.8)0.6 (0.6,1.0)0.6 (0.6,0.6)0.6 (0.6,0.6)0.6 (0.6, 0.6)T+L85.1 (49.7,118.0)37.4 (17.9,59.2)12.8 (7.7,23.8)9.0 (1.2,29.7)0.6 (0.6,1.4)0.6 (0.6, 0.6)
Conclusion: Evidence from this first analysis demonstrates rapid and maintained OFS with the combination of D+L as a NET in premenopausal breast cancer patients. The final analysis of the total population, including secondary endpoints, will be presented at the symposium.
Citation Format: Colleoni M, Gray K, Munzone E, Dellapasqua S, Zamagni C, Gianni L, Johansson H, Viale G, Kammler R, Maibach R, Rabaglio-Poretti M, Di Leo A, Coates AS, Gelber RD, Regan MM, Goldhirsch A. A randomized phase II trial evaluating the endocrine activity and efficacy of neoadjuvant degarelix versus triptorelin in premenopausal patients receiving letrozole for primary endocrine responsive breast cancer (TREND; IBCSG 41-13) [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 P1-10-06.
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Affiliation(s)
| | - K Gray
- International Breast Cancer Study Group
| | - E Munzone
- International Breast Cancer Study Group
| | | | - C Zamagni
- International Breast Cancer Study Group
| | - L Gianni
- International Breast Cancer Study Group
| | | | - G Viale
- International Breast Cancer Study Group
| | - R Kammler
- International Breast Cancer Study Group
| | - R Maibach
- International Breast Cancer Study Group
| | | | - A Di Leo
- International Breast Cancer Study Group
| | - AS Coates
- International Breast Cancer Study Group
| | - RD Gelber
- International Breast Cancer Study Group
| | - MM Regan
- International Breast Cancer Study Group
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Nielsen TO, Leung SCY, Zabaglo LA, Arun I, Badve SS, Bane AL, Bartlet JMS, Borgquist S, Chang MC, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hugh JC, Kos Z, Lænkholm AV, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Sugie T, van der Vegt B, Viale G, Hayes DF, McShane LM, Dowsett M. Abstract P2-03-01: Analytical validation of a standardized scoring protocol for Ki67 assessed on breast excision whole sections: An international multicenter collaboration. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p2-03-01] [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
Aims: (i) Determine whether between-observer reproducibility for Ki67 when assessed on whole sections according to a standardized scoring protocol is adequate for clinical application. (ii) Compare between-observer reproducibility of Ki67 scores assessed on hot-spots to scores using a global method that averages across a tissue section.
Background: The nuclear proliferation biomarker Ki67 has multiple potential roles in breast cancer, including aiding decisions based on prognosis, but unacceptable levels of between-laboratory variability have been observed. The International Ki67 in Breast Cancer Working Group has undertaken a systematic program to determine whether Ki67 measurement can be analytically validated and standardized across labs. In phase 1, variability in visual interpretation was identified as an important source of variability. Phases 2 and 3a showed that adherence to defined scoring methods substantially improved reproducibility in scoring tissue microarrays and core-cut biopsies. We now assess whether acceptable reproducibility can be achieved on whole sections.
Methods: Adjacent sections from 30 primary ER+ breast cancers were centrally stained for Ki67 to assemble 4 sets of 30 stained tumor sections, circulated around 23 labs in 12 countries. Ki67 was scored by 2 methods by all labs: (a) global: 4 fields of 100 tumor cells each were selected to reflect observed heterogeneity in nuclear staining (b) hot-spot: the field with highest Ki67 percentage of tumor cells with nuclear staining was selected and up to 500 cells scored. Ki67 scores were log2-transformed for statistical analyses and back-transformed for presentation. The primary objective was to assess whether either method could achieve an intraclass correlation coefficient (ICC) significantly greater than 0.8, considered substantial to almost-perfect reproducibility. Secondary objectives were to assess which method had highest observed ICC and to assess whether observers identified the same “hot-spots”.
Results: ICC for the global method was 0.87 (95%CI: 0.799-0.93), marginally meeting the prespecified success criterion. The ICC for the hot-spot method was 0.83 (95%CI: 0.74-0.90) and had a CI extending below the success criterion. Across the 23 labs, geometric mean value of the 30 scores ranged from 8.5 to 19.6 for the global method and from 12.8 to 30.3 for the hot-spot method. The overall mean (95% CI) of these values was 12.9 (11.9-14.0) and 20.9 (19.1-22.8), respectively. Visually, between-laboratory agreement in location of selected hot-spot varies between cases. The median times for scoring were 9 and 6 minutes for global and hot-spot methods respectively.
Conclusions: The global method marginally met the prespecified criterion of success; it should now be evaluated for clinical validity in appropriate cohorts of cases. The hot-spot method was observed to have slightly less reproducibility between labs. The time taken for scoring by either method is practical using counting software we are making publicly available. Establishment of external quality assessment schemes is likely to improve the reproducibility between labs further.
(Supported by a grant from the Breast Cancer Research Foundation)
Citation Format: Nielsen TO, Leung SCY, Zabaglo LA, Arun I, Badve SS, Bane AL, Bartlet JMS, Borgquist S, Chang MC, Dodson A, Ehinger A, Fineberg S, Focke CM, Gao D, Gown AM, Gutierrez C, Hugh JC, Kos Z, Lænkholm A-V, Mastropasqua MG, Moriya T, Nofech-Mozes S, Osborne CK, Penault-Llorca FM, Piper T, Sakatani T, Salgado R, Starczynski J, Sugie T, van der Vegt B, Viale G, Hayes DF, McShane LM, Dowsett M. Analytical validation of a standardized scoring protocol for Ki67 assessed on breast excision whole sections: An international multicenter collaboration [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 P2-03-01.
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Affiliation(s)
- TO Nielsen
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - SCY Leung
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - LA Zabaglo
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - I Arun
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - SS Badve
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - AL Bane
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - JMS Bartlet
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - S Borgquist
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - MC Chang
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - A Dodson
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - A Ehinger
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - S Fineberg
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - CM Focke
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - D Gao
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - AM Gown
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - C Gutierrez
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - JC Hugh
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - Z Kos
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - A-V Lænkholm
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - MG Mastropasqua
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Moriya
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - S Nofech-Mozes
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - CK Osborne
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - FM Penault-Llorca
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Piper
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Sakatani
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - R Salgado
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - J Starczynski
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - T Sugie
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - B van der Vegt
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - G Viale
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - DF Hayes
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - LM McShane
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
| | - M Dowsett
- University of British Columbia, Vancouver, BC, Canada; The Institute of Cancer Research, London, United Kingdom; Tata Medical Center, Kolkata, West Bengal, India; Indiana University Simon Cancer Center, Indianapolis, IN; Juravinski Hospital and Cancer Centre, McMaster University, Hamilton, ON, Canada; Ontario Institute for Cancer Research, Toronto, ON, Canada; Lund University, Lund, Sweden; Sinai Health System and University of Toronto, Toronto, ON, Canada; Ralph Lauren Centre for Breast Cancer Research, The Royal Marsden Hospital, London, United Kingdom; Montefiore Medical Center and the Albert Einstein College of Medicine, Bronx, NY; Dietrich-Bonhoeffer Medical Center, Neubrandenburg, Mecklenburg-Vorpommern, Germany; PhenoPath Laboratories, Seattle, WA; Lester and Sue Smith Breast Center and Dan L. Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, TX; University of Alberta, Edmonton, AB, Canada; University of Ottawa and The Ottawa Hospital, Ottawa, ON, Canada; Zealand University Hosp
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Sestak I, Regan M, Dodson A, Viale G, Thürlimann B, Colleoni M, Cuzick J, Dowsett M. Abstract GS6-01: Integration of clinical variables for the prediction of late distant recurrence in patients with oestrogen receptor positive breast cancer treated with 5 years of endocrine therapy. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs6-01] [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: The prediction of late distant recurrence (DR) is an important clinical goal for managing women with hormone receptor positive disease who have reached the end of 5 years' endocrine treatment without recurrence. Molecular profiles have produced conflicting results for the prediction of late DR. Here, we develop and validate a simple clinicopathological tool (Clinical Treatment Score post-5 years (CTS5)) to estimate the residual risk of DR after 5 years' endocrine treatment, which should help in discussions with patients about the potential benefits or not of continued endocrine therapy.
Patients and Methods: The ATAC dataset (N=4735) of postmenopausal women with oestrogen receptor (ER) positive breast cancer treated with 5 years' tamoxifen or anastrozole was used as a training cohort to establish a prognostic score for post-5-year risk of DR. CTS5 was based on five categories for nodal status, linear and quadratic terms for tumour size (capped at 30mm), three categories for grade, and continuous age. The validity of the CTS5 was tested in the BIG1-98 dataset (N=6711), which included postmenopausal women with ER-positive breast cancer treated with tamoxifen or letrozole (either monotherapy or sequential). Both cohorts included women who were alive and DR-free 5 years after randomization. Time to late DR, defined beginning at 5 years after ATAC or BIG 1-98 randomization, was the primary endpoint. Cox regression models estimated the prognostic performance of the CTS5. Hazard Ratios (HRs) are for a change of one Standard Deviation.
Results: The CTS5 model was a significant predictor for late DR in ATAC (HR=2.47 (95% CI, 2.24-2.73), P<0.001) and performed better than the established 0-10 year CTS model (Cuzick et al., JCO, 2011). CTS5 was confirmed as highly predictive for late DR in the BIG1-98 validation cohort (HR=2.07 (1.88-2.28), P<0.001). Of greatest importance was that CTS5 risk stratification defined in the training cohort as low (<5% risk of DR during years 5-10), intermediate (5-10% risk), high (>10% risk), identified 43% of the validation cohort as low risk, with an observed DR rate of 3.6% (95% CI 2.7-4.9) during years 5-10. Within nodal subgroups, 63% of node-negative were low risk with 3.9% (2.9-5.3) DR rate between years 5-10, and 24% having 1-3 nodes positive were low risk with 1.5% (0.5-3.8) DR rate between years 5-10. Separation of intermediate-risk from high-risk categories was also shown in the training set but improvements in calibration seem necessary for clinical utility for that assessment.
Conclusion: The CTS5 is a simple tool based on information that is readily available to all clinicians. It was more accurate in its prediction of DR risk in years 5-10 than the published CTS model. CTS5 was validated as highly prognostic for late DR in the independent BIG 1-98 study. The algorithm identified a subgroup of women with either node-negative disease or 1-3 positive nodes as having less than 1% per year risk of DR who could be advised of the limited value of extended endocrine therapy.
Citation Format: Sestak I, Regan M, Dodson A, Viale G, Thürlimann B, Colleoni M, Cuzick J, Dowsett M. Integration of clinical variables for the prediction of late distant recurrence in patients with oestrogen receptor positive breast cancer treated with 5 years of 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 GS6-01.
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Affiliation(s)
- I Sestak
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, United Kingdom; Dana Farber Cancer Institute; Ralph Lauren Centre for Breast Cancer Research, United Kingdom; European Institute of Oncology, Italy; Kantonsspital St. Gallen, Switzerland
| | - M Regan
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, United Kingdom; Dana Farber Cancer Institute; Ralph Lauren Centre for Breast Cancer Research, United Kingdom; European Institute of Oncology, Italy; Kantonsspital St. Gallen, Switzerland
| | - A Dodson
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, United Kingdom; Dana Farber Cancer Institute; Ralph Lauren Centre for Breast Cancer Research, United Kingdom; European Institute of Oncology, Italy; Kantonsspital St. Gallen, Switzerland
| | - G Viale
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, United Kingdom; Dana Farber Cancer Institute; Ralph Lauren Centre for Breast Cancer Research, United Kingdom; European Institute of Oncology, Italy; Kantonsspital St. Gallen, Switzerland
| | - B Thürlimann
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, United Kingdom; Dana Farber Cancer Institute; Ralph Lauren Centre for Breast Cancer Research, United Kingdom; European Institute of Oncology, Italy; Kantonsspital St. Gallen, Switzerland
| | - M Colleoni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, United Kingdom; Dana Farber Cancer Institute; Ralph Lauren Centre for Breast Cancer Research, United Kingdom; European Institute of Oncology, Italy; Kantonsspital St. Gallen, Switzerland
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, United Kingdom; Dana Farber Cancer Institute; Ralph Lauren Centre for Breast Cancer Research, United Kingdom; European Institute of Oncology, Italy; Kantonsspital St. Gallen, Switzerland
| | - M Dowsett
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, QMUL, United Kingdom; Dana Farber Cancer Institute; Ralph Lauren Centre for Breast Cancer Research, United Kingdom; European Institute of Oncology, Italy; Kantonsspital St. Gallen, Switzerland
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Johansson H, Gandini S, Aristarco V, Macis D, Guerrieri-Gonzaga A, Serrano D, Pruneri G, Lazzeroni M, Viale G, Toesca A, Rajasekaran A, Bonanni B, DeCensi A. Abstract P4-08-05: Impact of common polymorphisms of CYP19A1 and UGT2B17 gene deletion on early endocrine-responsive postmenopausal breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-08-05] [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 Polymorphisms of genes involved in estrogen production have been linked to breast cancer risk, prognosis and treatment response. Polymorphisms of the aromatase gene CYP19A1 influence its activity. The UGT2B17 catalyzes glucuronic acid transfer to a variety of substrates, including steroids and drugs like the aromatase inhibitor exemestane. We investigated the impact of two variants of CYP19A1 (rs10046, rs4646) and the UGT2B17 gene deletion on disease outcome in 125 postmenopausal women operated for ER-positive primary breast cancer enrolled in a randomized pre-surgical trial.
Patients Briefly, upon informed consent, postmenopausal patients with ER-positive breast cancer (stage T1–2, N0–1, M0) eligible for surgery were randomized to receive either exemestane (25 mg/day), or celecoxib (800 mg/day), or placebo for 6 weeks prior to surgery at the European Institute of Oncology (2004-2008). Exemestane showed a significant 10% absolute reduction in Ki67 labeling index compared to the other two arms. Serum and whole blood was taken at baseline and the day before surgery and stored at -80°C until assayed.
Methods DNA was extracted from blood by QIAamp DNA Blood Kits. The CYP19A1 rs1004/rs46466 were analyzed by Taqman genotyping assays in real-time PCR. The UGT2B17 deletion was estimated by copy number assay (Lifetechnologies). Serum estradiol (E2) and estrone (E1) levels were measured by gas chromatography tandem mass spectrometry detection (GS-MS/MS) after liquid-liquid extraction. The lower limit of quantitation were 0.625 pg/mL for estradiol and 1.56 pg/mL for estrone. The association of genetic polymorphisms with “any event” was assessed by the Cox proportional hazards models adjusted for confounders.
Results The genetic polymorphisms did not deviate from Hardy-Weinberg equilibrium (P-value >0.41) and minor allele frequency of rs10046 (A/G), rs4646 (C/A), and UGT2B17Del were 0.45, 0.22, and 0.31, respectively. The rs10046 A and rs4646 C alleles were associated with higher estrogen levels. Carriers of rs10046 AA had median levels of 7.57 pg/ml E2 and 35.9 pg/mL E1 versus 3,9 pg/mL E2 and 27.4 E1 pg/mL in CA/AA genotypes (P<0.003). Carriers of rs4646 CC had 5.6 pg/ml E2 and 30.45 pg/mL E1 versus 3,95 pg/mL E2 and 27.4 E1 pg/mL in CA/AA genotypes (P=0.05 only for E1). After 6 weeks treatment with exemestane, we observed steeper decreases in estrogen levels in the rs10046 AA/rs4646 CC carriers (P=0.02 for E2). After a median follow-up of 7 years we found that women carrying at least one SNP of rs10046 and one SNP of rs4646 had a better prognosis compared with women carrying homozygote wt SNPs (HR=0.44; 95% CI: 0.2-0.99 P=0.049). Similarly, the UGT2B17 deletion was associated with a better prognosis (HR= 0.43; 95% CI: 0.19-0.97; P=0.0439). There was no interaction with pre-surgical or adjuvant treatment.
Conclusions Our analysis confirms previous findings of an association of CYP19A1 rs10046/rs4646 with estrogen levels in postmenopausal women. Interestingly, the carriers of the variants associated with lower estrogen levels at diagnosis had better prognosis. Further genomic profiling in larger trials aimed to enhance tailored treatment efficacy in endocrine-responsive postmenopausal breast cancer are warranted.
Citation Format: Johansson H, Gandini S, Aristarco V, Macis D, Guerrieri-Gonzaga A, Serrano D, Pruneri G, Lazzeroni M, Viale G, Toesca A, Rajasekaran A, Bonanni B, DeCensi A. Impact of common polymorphisms of CYP19A1 and UGT2B17 gene deletion on early endocrine-responsive postmenopausal 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 P4-08-05.
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Affiliation(s)
- H Johansson
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - S Gandini
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - V Aristarco
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - D Macis
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - A Guerrieri-Gonzaga
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - D Serrano
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - G Pruneri
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - M Lazzeroni
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - G Viale
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - A Toesca
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - A Rajasekaran
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - B Bonanni
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
| | - A DeCensi
- European Institute of Oncology, Milan, Italy; inVentiv Health,, USA, Princeton, NJ; E.O. Ospedali Galliera, Genoa, Italy
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Bines J, de Azambuja E, Zardavas D, Procter M, Restuccia E, Viale G, Suter T, Arahmani A, van Dooren V, Clark E, Eng-Wong J, Gelber R, Piccart M, von Minckwitz G, Baselga J. Abstract P1-13-07: Incidence and management of diarrhea with adjuvant pertuzumab and trastuzumab in HER2-Positive breast cancer. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p1-13-07] [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
Diarrhea is the most commonly reported adverse event (AE) on pertuzumab (Ptz) in both early and metastatic breast cancer (BC) settings. We report safety analyses of diarrhea from the large adjuvant APHINTY study in HER2 positive early breast cancer (EBC).
Patients and methods
In this exploratory analysis, the safety population included 2364 patients in the Ptz arm and 2405 in the placebo (Pla) arm. No specific prophylaxis was mandated by the protocol, however early intervention with loperamide as well as fluid and electrolyte replacement was recommended. Diarrhea incidence, severity (NCI-CTCAE v4.0), onset and management were analyzed.
Results
Diarrhea was the most common AE in the Ptz arm (71.3% vs. 45.2% in the Pla arm) and the events were mostly G1. Diarrhea ≥G3 was observed in 9.8% and 3.7% in Ptz and Pla arms, respectively. The highest incidence was reported during administration of HER2 targeted therapy and taxane (61.4% vs. 33.8% with Ptz and Pla, respectively) with a marked decrease observed upon chemotherapy cessation (18.1% vs. 9.2% with Ptz and Pla, respectively). The median time from first targeted treatment to onset of diarrhea during the chemotherapy phase was 7 and 10 days (Ptz/Pla). On average, diarrhea events lasted longer in the Ptz than in the Pla arm (median 8 vs. 6 days). Diarrhea events were more frequent with the administration of docetaxel + carboplatin and targeted agents, irrespective of the severity. Detailed results are reported in Table 1.
Conclusions
In the curative setting, diarrhea due to Ptz was mild, generally manageable with common antidiarrheals and did not affect patients' ability to receive treatment. The APHINITY findings are consistent with the well-characterized pattern of pertuzumab-related diarrhea across the HER2 BC spectrum.
Diarrhea incidence, severity (NCI-CTCAE v4.0), onset and management Ptz, n=2364Pla, n=2405Incidence and severityTotal number of patients with at least one adverse event$1685 (71.3%)1086 (45.2%)Total number of events$34151792NCI CTC AE Grade (highest grade per patient)!n1683 (71.2%)1085 (45.1%)Grade 1829 (35.1%)690 (28.7%)Grade 2622 (26.3%)305 (12.7%)Grade 3229 (9.7%)90 (3.7%)Grade 43 (0.1%)0Onset and duration$Median time (days) from 1st HER2 targeted treatment to onset (min-max)7 (1 – 358)10 (1 - 384)Median Duration (days) of each event (min-max)8 (1 - 811)6 (1 - 1022)ManagementAntidiarrheals$898 (38.0%)386 (16.0%)Dose modification* of any study drug!210 (8.9%)74 (3.1%)Dose modification* of HER2 targeted treatment!69 (2.9%)18 (0.7%)Discontinuation of any study drug!38 (1.6%)7 (0.3%)Discontinuation of HER2 Targeted treatment!20 (0.8%)2 (<0.1%)$ Based on a basket of preferred terms for diarrhea ! Based only on the preferred term diarrhea * Includes dose reductions (chemotherapy only), delays or interruptions during infusion
Citation Format: Bines J, de Azambuja E, Zardavas D, Procter M, Restuccia E, Viale G, Suter T, Arahmani A, van Dooren V, Clark E, Eng-Wong J, Gelber R, Piccart M, von Minckwitz G, Baselga J. Incidence and management of diarrhea with adjuvant pertuzumab and trastuzumab in HER2-Positive 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 P1-13-07.
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Affiliation(s)
- J Bines
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - E de Azambuja
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - D Zardavas
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - M Procter
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - E Restuccia
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - G Viale
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - T Suter
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - A Arahmani
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - V van Dooren
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - E Clark
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - J Eng-Wong
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - R Gelber
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - M Piccart
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - G von Minckwitz
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
| | - J Baselga
- Instituto Nacional de Câncer, Rio de Janeiro, Brazil; Breast European Adjuvant Study Team (BrEAST) Data Center, Brussels, Belgium; Breast International Group (BIG), Brussels, Belgium; Frontier Science (Scotland), Kincraig, United Kingdom; Roche Pharma, Basel, Switzerland; European Institute of Oncology, University of Milan, Milan, Italy; Bern University Hospital, Bern, Switzerland; Roche Pharma, Basel, Basel, Switzerland; Genentech, San Francisco; Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation, Boston; Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium; German Breast Group, Neu-Isenburg, Germany; Memorial Sloan Kettering Cancer Center, New York
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Galimberti V, Cole BF, Viale G, Veronesi P, Vicini E, Intra M, Mazzarol G, Massarut S, Zgajnar J, Taffurelli M, Littlejohn D, Egli T, Tondini C, Di Leo A, Colleoni M, Regan MM, Coates AS, Gelber RD, Goldhirsch A. Abstract GS5-02: Axillary dissection vs. no axillary dissection in patients with cT1-T2cN0M0 breast cancer and only micrometastases in the sentinel node(s): Ten-year results of the IBCSG 23-01 trial. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-gs5-02] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: The phase III IBCSG 23-01 multicenter, randomized, non-inferiority trial compared disease-free survival (DFS) in breast cancer patients with one or more micrometastatic (≤2 mm) sentinel nodes (SNs) randomized to either axillary dissection (AD) or no axillary dissection (no-AD). Results after 5 years showed no difference in DFS between the arms. Here we report results after a median follow-up of 9.8 years.
METHODS: Eligible patients had cancers of pathological diameter ≤5 cm and one or more micrometastatic (≤2 mm) foci, including isolated tumor cells, in the SNs. Patients with axillary macrometastases were excluded. Breast surgery was conservative or mastectomy. Eligible patients were randomized to AD vs. no-AD. The primary endpoint was disease-free survival (DFS); secondary endpoints were overall survival (OS), site of recurrence (particularly axillary recurrence), and surgical complications of AD. DFS and OS were estimated using the product-limit method, and the log-rank test was used to compare the treatment groups. Patients without a DFS or OS event were censored at the date of last follow-up. Non-inferiority margin for no-AD vs. AD was defined as a DFS hazard ratio (HR, no-AD relative to AD) of <1.25, and was assessed using a z-test applied to the log HR. Active follow-up of patients was terminated in February 2017.
RESULTS: From 2001 to 2010, 934 patients were randomized at 27 centers; 931 were evaluable (467 in the no-AD group and 464 in the AD group). Median follow-up was 9.8 (IQR: 7.8–12.7) years. The number and types of first DFS events according to treatment group are shown in the Table.
Disease-free Survival EventsNo-ADADTotal101117Breast cancer related events7475Local1413Contralateral breast1012Regional [ipsilateral axillary events]9 [8]3 [2]Distant4147Non-breast cancer related events2742Second malignancies1723Death without prior cancer event62Death with unknown cancer status417
10-year DFS was 75% (95% confidence interval [CI]: 72%–81%) in the no-AD group and 75% (95% CI: 71%–79%) in the AD group (HR [no-AD vs. AD]=0.85; 95% CI: 0.65–1.11; log-rank p=0.23; non-inferiority p=0.002). There were 45 deaths in the no-AD group and 58 in the AD group. 10-year OS was 91% (95% CI: 88%–94%) in the no-AD group and 88% (95% CI: 85%–92%) in the AD group (HR [no-AD vs. AD]=0.77; 95% CI: 0.56–1.07; log-rank p=0.19).
CONCLUSION: Findings after a median follow-up of 9.8 years fully support the findings at 5 years in that no-AD is not inferior to AD with respect to DFS, and there is no significant difference between the arms for DFS and OS, thus confirming that AD is not indicated in patients with micrometastatic SNs.
Citation Format: Galimberti V, Cole BF, Viale G, Veronesi P, Vicini E, Intra M, Mazzarol G, Massarut S, Zgajnar J, Taffurelli M, Littlejohn D, Egli T, Tondini C, Di Leo A, Colleoni M, Regan MM, Coates AS, Gelber RD, Goldhirsch A. Axillary dissection vs. no axillary dissection in patients with cT1-T2cN0M0 breast cancer and only micrometastases in the sentinel node(s): Ten-year results of the IBCSG 23-01 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 GS5-02.
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Affiliation(s)
- V Galimberti
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - BF Cole
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - G Viale
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - P Veronesi
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - E Vicini
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - M Intra
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - G Mazzarol
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - S Massarut
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - J Zgajnar
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - M Taffurelli
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - D Littlejohn
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - T Egli
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - C Tondini
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - A Di Leo
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - M Colleoni
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - MM Regan
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - AS Coates
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - RD Gelber
- International Breast Cancer Study Group Trial 23-01 Investigators
| | - A Goldhirsch
- International Breast Cancer Study Group Trial 23-01 Investigators
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Guerrieri-Gonzaga A, Gandini S, Serrano D, Lazzeroni M, Pruneri G, Varricchio C, Cazzaniga M, Leonardi MC, Galimberti V, Viale G, De Censi A, Bonanni B. Abstract P4-15-06: Low dose tamoxifen lowers recurrences after mastectomy for in situ neoplasia. Ten-year results of a monoinstitutional study. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p4-15-06] [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
There is no agreement upon the need of a preventive treatment after breast mastectomy for in situ neoplasia. Low-dose tamoxifen (5 mg/day) has comparable antiproliferative effect than the standard dose of 20 mg/day in biomarker trials and has been shown to halve ipsilateral recurrence in a large cohort of postmenopausal ER positive DCIS treated with breast conserving surgery (Guerrieri-Gonzaga et al., Int J Cancer 2016).
Here we investigated the effect of low dose tamoxifen in patients treated with mastectomy for an in situ neoplasia and followed-up in a single Institution for a median of 10 years.
Our cohort consists of 404 consecutive premenopausal (n=281) or postmenopausal (n=123) women who underwent unilateral mastectomy at the European Institute of Oncology (IEO), with or without nipple preservation, between 1996 and 2011. Patients had a diagnosis of pure LCIS (n=12) or ER positive (ER>1%) DCIS (n=363) or both (n=29) and were treated with tamoxifen 5 mg/day (n=162) or no treatment (n=242) upon medical judgment, patient preference and/or clinical trial assignment. The main subject and tumor characteristics are reported in table 1.
Patient and tumor characteristics No tam (n=242)Low dose tam (n=162)P-valueMedian age, years (IQR)46 (41, 54)47 (42, 51)0.65Premenopausal status (n, %)160 (66)121 (75)0.07Median BMI (kg/m2, IQR)22 (20, 25)22 (20, 24)0.7Breast cancer family history (%)29320.44Histology (LCIS, DCIS, both; %)4/92/42/86/120.01Grading (G1,G2,G3;%)11/59/2918/61/200.04Median ER (%, IQR)90 (70, 95)90 (80, 95)0.005Median PgR (%, IQR)40 (5, 80)68 (25, 90)0.0002Median Ki67 (%, IQR)15 (10, 23)14 (10, 20)0.03Radiotherapy (n, %)95 (39)76 (47)0.13
After a median follow-up of 10 years (range 4-21 years) and a median low dose tamoxifen treatment of 4.9 years (IQR 2.7, 5.0), a total of 85 events were observed (28 in situ, 40 invasive breast cancers, 3 metastatic diseases, 12 other primary cancers, 2 deaths). A total of 36 ipsilateral breast events (23 versus 13 in the no tam versus tam group, respectively), 32 contralateral breast events (22 versus 10 in the no tam versus tam, respectively) and 17 other events (11 versus 6 in the no tam versus tam, respectively) occurred. Overall, eleven deaths (3%) occurred and no endometrial cancers were observed. A time-dependent competing risk model was applied for tamoxifen use and we have shown that low-dose tamoxifen was associated with a 48% reduction on all breast events (adjusted HR=0.52, 95% CI: 0.31–0.88, p=0.01), adjusting for radiotherapy and age.
Although limited by the observational nature of the study, we show for the first time that treatment with low dose tamoxifen is effective and safe in women who underwent mastectomy for non-invasive breast neoplasms and should be taken into consideration as a risk reduction strategy for premenopausal and postmenopausal women with breast intraepithelial neoplasia.
Citation Format: Guerrieri-Gonzaga A, Gandini S, Serrano D, Lazzeroni M, Pruneri G, Varricchio C, Cazzaniga M, Leonardi MC, Galimberti V, Viale G, De Censi A, Bonanni B. Low dose tamoxifen lowers recurrences after mastectomy for in situ neoplasia. Ten-year results of a monoinstitutional study [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-15-06.
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Affiliation(s)
- A Guerrieri-Gonzaga
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - S Gandini
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - D Serrano
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - M Lazzeroni
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - G Pruneri
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - C Varricchio
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - M Cazzaniga
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - MC Leonardi
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - V Galimberti
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - G Viale
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - A De Censi
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
| | - B Bonanni
- European Institute of Oncology, Milan, Italy; E.O. Ospedali Galliera, Genoa, Italy
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Gianni L, Bisagni G, Colleoni M, Del Mastro L, Zamagni C, Mansutti M, Zambetti M, Frassoldati A, De Fato R, Valagussa P, Viale G. Neoadjuvant treatment with trastuzumab and pertuzumab plus palbociclib and fulvestrant in HER2-positive, ER-positive breast cancer (NA-PHER2): an exploratory, open-label, phase 2 study. Lancet Oncol 2018; 19:249-256. [DOI: 10.1016/s1470-2045(18)30001-9] [Citation(s) in RCA: 85] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 10/05/2017] [Accepted: 10/16/2017] [Indexed: 12/13/2022]
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Cheang MCU, Bliss JM, Viale G, Speirs V, Palmieri C, Shaaban A, Lønning PE, Morden J, Porta N, Jassem J, van De Velde CJ, Rasmussen BB, Verhoeven D, Bartlett JMS, Coombes RC. Evaluation of applying IHC4 as a prognostic model in the translational study of Intergroup Exemestane Study (IES): PathIES. Breast Cancer Res Treat 2018; 168:169-178. [PMID: 29177605 PMCID: PMC5847042 DOI: 10.1007/s10549-017-4543-7] [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] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2017] [Accepted: 10/16/2017] [Indexed: 12/05/2022]
Abstract
BACKGROUND Intergroup Exemestane Study (IES) was a randomised study that showed a survival benefit of switching adjuvant endocrine therapy after 2-3 years from tamoxifen to exemestane. This PathIES aimed to assess the role of immunohistochemical (IHC)4 score in determining the relative sensitivity to either tamoxifen or sequential treatment with tamoxifen and exemestane. PATIENTS AND METHODS Primary tumour samples were available for 1274 patients (27% of IES population). Only patients for whom the IHC4 score could be calculated (based on oestrogen receptor, progesterone receptor, HER2 and Ki67) were included in this analysis (N = 430 patients). The clinical score (C) was based on age, grade, tumour size and nodal status. The association of clinicopathological parameters, IHC4(+C) scores and treatment effect with time to distant recurrence-free survival (TTDR) was assessed in univariable and multivariable Cox regression analyses. A modified clinical score (PathIEscore) (N = 350) was also estimated. RESULTS Our results confirm the prognostic importance of the original IHC4, alone and in conjunction with clinical scores, but no significant difference with treatment effects was observed. The combined IHC4 + Clinical PathIES score was prognostic for TTDR (P < 0.001) with a hazard ratio (HR) of 5.54 (95% CI 1.29-23.70) for a change from 1st quartile (Q1) to Q1-Q3 and HR of 15.54 (95% CI 3.70-65.24) for a change from Q1 to Q4. CONCLUSION In the PathIES population, the IHC4 score is useful in predicting long-term relapse in patients who remain disease-free after 2-3 years. This is a first trial to suggest the extending use of IHC4+C score for prognostic indication for patients who have switched endocrine therapies at 2-3 years and who remain disease-free after 2-3 years.
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Affiliation(s)
- M C U Cheang
- The Institute of Cancer Research, Clinical Trials and Statistics Unit (ICR-CTSU) Section of Clinical Trials, Sir Richard Doll Building, Sutton, SM2 5NG, UK
| | - J M Bliss
- The Institute of Cancer Research, Clinical Trials and Statistics Unit (ICR-CTSU) Section of Clinical Trials, Sir Richard Doll Building, Sutton, SM2 5NG, UK
| | - G Viale
- Department of Pathology, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - V Speirs
- Leeds Institute of Molecular Medicine, University of Leeds, St James's University Hospital, Wellcome Trust Brenner Building, Leeds, LS9 7TF, UK
| | - C Palmieri
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, L69 3BX, UK
| | - A Shaaban
- Department of Pathology, Queen Elizabeth Medical Centre, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust and the University of Birmingham, Birmingham, UK
| | - P E Lønning
- Department of Oncology, University of Bergen, Haukeland University Hospital, 5021, Bergen, Norway
| | - J Morden
- The Institute of Cancer Research, Clinical Trials and Statistics Unit (ICR-CTSU) Section of Clinical Trials, Sir Richard Doll Building, Sutton, SM2 5NG, UK
| | - N Porta
- The Institute of Cancer Research, Clinical Trials and Statistics Unit (ICR-CTSU) Section of Clinical Trials, Sir Richard Doll Building, Sutton, SM2 5NG, UK
| | - J Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdansk, 7 Debinki St, 80-211, Gdansk, Poland
| | - C J van De Velde
- Department of Surgery, Leiden University Medical Center, Albinusdreef 2, 2300 ZA, Leiden, Netherlands
| | - B B Rasmussen
- Department of Pathology, Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - D Verhoeven
- Department of Medical Oncology, AZ Klina, Braschaat, Belgium
| | - J M S Bartlett
- Transformative Pathology, Ontario Institute for Cancer Research, MaRS Centre, 661 University Avenue, Suite 510, Toronto, ON, M5G 0A3, Canada
| | - R C Coombes
- Department of Cancer and Surgery, Faculty of Medicine, Imperial College London, Du Cane Road, London, W12 0NN, UK.
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Zanobini M, Dello Russo A, Saccocci M, Conti S, De Camilli E, Vettor G, Catto V, Roberto M, Fiorentini C, Viale G, Tondo C, Casella M. Endomyocardial biopsy guided by intracardiac echocardiography as a key step in intracardiac mass diagnosis. BMC Cardiovasc Disord 2018; 18:15. [PMID: 29382308 PMCID: PMC5791188 DOI: 10.1186/s12872-018-0749-9] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [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: 08/09/2017] [Accepted: 01/17/2018] [Indexed: 11/20/2022] Open
Abstract
Background Based on a plenty of different applications, intracardiac echocardiography (ICE) is now a well-established technology in complex electrophysiological procedures. Recently, ICE has become the most widely used ultrasound-based imaging tool to guide diagnostic endomyocardial biopsy (EMB). EMB of cardiac mass guided by ICE is an interesting application of ICE. Allowing a correct positioning of the bioptome, ICE reduce the procedure-related risks and the need of a diagnostic open-chest procedure reserving the more invasive approach to selected cases. Case presentation Hereby we report a case series of right ventricular masses in which the EMB was safely and effectively performed under ICE guidance giving essential information for planning the therapeutic strategy. Conclusions The diagnosis of both metastatic and primary cardiac tumors relies on the histopathological analyses. The endomyocardial biopsy is a valuable tool for preoperative diagnosis and surgical planning of intracardiac masses suspected for tumors. In our experience, the use of ICE for right ventricle EMB of an intracardiac mass is an attractive modality thanks to the precise localization of the cardiac structures and the ability to guide bioptic withdrawal in the target area. Electronic supplementary material The online version of this article (10.1186/s12872-018-0749-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Marco Zanobini
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Antonio Dello Russo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Matteo Saccocci
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy.
| | - Sergio Conti
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Elisa De Camilli
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy
| | - Giulia Vettor
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Valentina Catto
- Department of Cardiology, Centro Cardiologico Monzino IRCCS, Milan, Italy
| | - Maurizio Roberto
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy
| | - Cesare Fiorentini
- Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Via Carlo Parea 4, 20138, Milan, Italy.,Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Giuseppe Viale
- Division of Pathology and Laboratory Medicine, European Institute of Oncology, Milan, Italy.,Department of Oncology and Haemato-oncology, University of Milan, Milan, Italy
| | - Claudio Tondo
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy.,Department of Cardiovascular Sciences, University of Milan, Milan, Italy
| | - Michela Casella
- Cardiac Arrhythmia Research Center, Centro Cardiologico Monzino IRCCS, Milan, Italy
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Dama E, Tillhon M, Bertalot G, de Santis F, Troglio F, Pessina S, Passaro A, Pece S, de Marinis F, Dell'Orto P, Viale G, Spaggiari L, Di Fiore PP, Bianchi F, Barberis M, Vecchi M. Sensitive and affordable diagnostic assay for the quantitative detection of anaplastic lymphoma kinase (ALK) alterations in patients with non-small cell lung cancer. Oncotarget 2018; 7:37160-37176. [PMID: 27206799 PMCID: PMC5095066 DOI: 10.18632/oncotarget.9471] [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: 01/04/2016] [Accepted: 04/25/2016] [Indexed: 11/25/2022] Open
Abstract
Accurate detection of altered anaplastic lymphoma kinase (ALK) expression is critical for the selection of lung cancer patients eligible for ALK-targeted therapies. To overcome intrinsic limitations and discrepancies of currently available companion diagnostics for ALK, we developed a simple, affordable and objective PCR-based predictive model for the quantitative measurement of any ALK fusion as well as wild-type ALK upregulation. This method, optimized for low-quantity/-quality RNA from FFPE samples, combines cDNA pre-amplification with ad hoc generated calibration curves. All the models we derived yielded concordant predictions when applied to a cohort of 51 lung tumors, and correctly identified all 17 ALK FISH-positive and 33 of the 34 ALK FISH-negative samples. The one discrepant case was confirmed as positive by IHC, thus raising the accuracy of our test to 100%. Importantly, our method was accurate when using low amounts of input RNA (10 ng), also in FFPE samples with limited tumor cellularity (5-10%) and in FFPE cytology specimens. Thus, our test is an easily implementable diagnostic tool for the rapid, efficacious and cost-effective screening of ALK status in patients with lung cancer.
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Affiliation(s)
- Elisa Dama
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy.,Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Micol Tillhon
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
| | - Giovanni Bertalot
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy
| | - Francesca de Santis
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy.,Present address: Advanced Cell Diagnostics, Segrate, Milan, Italy
| | - Flavia Troglio
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy.,Present address: Division of Immunology, Transplantantion and Infectious Disease, Leukocyte Biology Unit, San Raffaele Scientific Institute, Milan, Italy
| | - Simona Pessina
- Department of Pathology, European Institute of Oncology, Milan, Italy
| | - Antonio Passaro
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | - Salvatore Pece
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy.,DIPO, Department of Hemato-Oncology and Oncology, University of Milan, Milan, Italy
| | - Filippo de Marinis
- Division of Thoracic Oncology, European Institute of Oncology, Milan, Italy
| | | | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology, Milan, Italy.,DIPO, Department of Hemato-Oncology and Oncology, University of Milan, Milan, Italy
| | - Lorenzo Spaggiari
- DIPO, Department of Hemato-Oncology and Oncology, University of Milan, Milan, Italy.,Division of Thoracic Surgery, European Institute of Oncology, Milan, Italy
| | - Pier Paolo Di Fiore
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy.,DIPO, Department of Hemato-Oncology and Oncology, University of Milan, Milan, Italy.,IFOM, The FIRC Institute of Molecular Oncology, Milan, Italy
| | - Fabrizio Bianchi
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy.,Present address: Institute for Stem-cell Biology, Regenerative Medicine and Innovative Therapies (ISBReMIT), IRCCS Casa Sollievo della Sofferenza, Foggia, Italy
| | - Massimo Barberis
- Department of Pathology, European Institute of Oncology, Milan, Italy
| | - Manuela Vecchi
- Molecular Medicine Program, European Institute of Oncology, Milan, Italy.,IFOM, The FIRC Institute of Molecular Oncology, Milan, Italy
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Asselain B, Barlow W, Bartlett J, Bergh J, Bergsten-Nordström E, Bliss J, Boccardo F, Boddington C, Bogaerts J, Bonadonna G, Bradley R, Brain E, Braybrooke J, Broet P, Bryant J, Burrett J, Cameron D, Clarke M, Coates A, Coleman R, Coombes RC, Correa C, Costantino J, Cuzick J, Danforth D, Davidson N, Davies C, Davies L, Di Leo A, Dodwell D, Dowsett M, Duane F, Evans V, Ewertz M, Fisher B, Forbes J, Ford L, Gazet JC, Gelber R, Gettins L, Gianni L, Gnant M, Godwin J, Goldhirsch A, Goodwin P, Gray R, Hayes D, Hill C, Ingle J, Jagsi R, Jakesz R, James S, Janni W, Liu H, Liu Z, Lohrisch C, Loibl S, MacKinnon L, Makris A, Mamounas E, Mannu G, Martín M, Mathoulin S, Mauriac L, McGale P, McHugh T, Morris P, Mukai H, Norton L, Ohashi Y, Olivotto I, Paik S, Pan H, Peto R, Piccart M, Pierce L, Poortmans P, Powles T, Pritchard K, Ragaz J, Raina V, Ravdin P, Read S, Regan M, Robertson J, Rutgers E, Scholl S, Slamon D, Sölkner L, Sparano J, Steinberg S, Sutcliffe R, Swain S, Taylor C, Tutt A, Valagussa P, van de Velde C, van der Hage J, Viale G, von Minckwitz G, Wang Y, Wang Z, Wang X, Whelan T, Wilcken N, Winer E, Wolmark N, Wood W, Zambetti M, Zujewski JA. Long-term outcomes for neoadjuvant versus adjuvant chemotherapy in early breast cancer: meta-analysis of individual patient data from ten randomised trials. Lancet Oncol 2018; 19:27-39. [PMID: 29242041 PMCID: PMC5757427 DOI: 10.1016/s1470-2045(17)30777-5] [Citation(s) in RCA: 597] [Impact Index Per Article: 99.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/22/2017] [Accepted: 09/25/2017] [Indexed: 12/30/2022]
Abstract
BACKGROUND Neoadjuvant chemotherapy (NACT) for early breast cancer can make breast-conserving surgery more feasible and might be more likely to eradicate micrometastatic disease than might the same chemotherapy given after surgery. We investigated the long-term benefits and risks of NACT and the influence of tumour characteristics on outcome with a collaborative meta-analysis of individual patient data from relevant randomised trials. METHODS We obtained information about prerandomisation tumour characteristics, clinical tumour response, surgery, recurrence, and mortality for 4756 women in ten randomised trials in early breast cancer that began before 2005 and compared NACT with the same chemotherapy given postoperatively. Primary outcomes were tumour response, extent of local therapy, local and distant recurrence, breast cancer death, and overall mortality. Analyses by intention-to-treat used standard regression (for response and frequency of breast-conserving therapy) and log-rank methods (for recurrence and mortality). FINDINGS Patients entered the trials from 1983 to 2002 and median follow-up was 9 years (IQR 5-14), with the last follow-up in 2013. Most chemotherapy was anthracycline based (3838 [81%] of 4756 women). More than two thirds (1349 [69%] of 1947) of women allocated NACT had a complete or partial clinical response. Patients allocated NACT had an increased frequency of breast-conserving therapy (1504 [65%] of 2320 treated with NACT vs 1135 [49%] of 2318 treated with adjuvant chemotherapy). NACT was associated with more frequent local recurrence than was adjuvant chemotherapy: the 15 year local recurrence was 21·4% for NACT versus 15·9% for adjuvant chemotherapy (5·5% increase [95% CI 2·4-8·6]; rate ratio 1·37 [95% CI 1·17-1·61]; p=0·0001). No significant difference between NACT and adjuvant chemotherapy was noted for distant recurrence (15 year risk 38·2% for NACT vs 38·0% for adjuvant chemotherapy; rate ratio 1·02 [95% CI 0·92-1·14]; p=0·66), breast cancer mortality (34·4% vs 33·7%; 1·06 [0·95-1·18]; p=0·31), or death from any cause (40·9% vs 41·2%; 1·04 [0·94-1·15]; p=0·45). INTERPRETATION Tumours downsized by NACT might have higher local recurrence after breast-conserving therapy than might tumours of the same dimensions in women who have not received NACT. Strategies to mitigate the increased local recurrence after breast-conserving therapy in tumours downsized by NACT should be considered-eg, careful tumour localisation, detailed pathological assessment, and appropriate radiotherapy. FUNDING Cancer Research UK, British Heart Foundation, UK Medical Research Council, and UK Department of Health.
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Pruneri G, Lazzeroni M, Bagnardi V, Tiburzio GB, Rotmensz N, DeCensi A, Guerrieri-Gonzaga A, Vingiani A, Curigliano G, Zurrida S, Bassi F, Salgado R, Van den Eynden G, Loi S, Denkert C, Bonanni B, Viale G. The prevalence and clinical relevance of tumor-infiltrating lymphocytes (TILs) in ductal carcinoma in situ of the breast. Ann Oncol 2017; 28:321-328. [PMID: 28426105 DOI: 10.1093/annonc/mdw623] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Tumor-infiltrating lymphocytes (TILs) are a robust prognostic adjunct in invasive breast cancer, but their clinical role in ductal carcinoma in situ (DCIS) has not been ascertained. Patients and methods We evaluated the prevalence and clinical relevance of TILs in a well annotated series of 1488 consecutive DCIS women with a median follow-up of 8.2 years. Detailed criteria for TILs evaluation were pre-defined involving the International Immuno-Oncology Biomarker Working Group. TILs percentage was considered both as a continuous and categorical variable. Levels of TILs were examined for their associations with ipsilateral breast event (IBE), whether in situ or invasive. Results Of the 1488 patients with DCIS under study, 35.1% had <1%, 58.3% 1-49% and 6.5% ≥50% peri-ductal stromal lymphocytes. The interobserver agreement in TILs evaluation, measured by the intraclass correlation coefficient (ICC) was 0.96 (95% CI 0.95-0.97). At univariable analysis, clinical factors significantly associated with TILs (P ≤0.001) were intrinsic subtype, grade, necrosis, type of surgery. Her-2 positive DCIS were more frequently associated with TILs (24% of patients with TILs ≥50%), followed by the triple negative (11%), Luminal B/Her-2 positive (9%) and Luminal A/B subtypes (1%) (P < 0.0001). We did not find any association between TILs as a continuous variable and the risk of IBEs. Likewise, when patients were stratified by TILs percentage (<1%, between 1% and 49.9%, and ≥50%), no statistically significant association was observed (10-year cumulative incidence of IBEs: 19%, 17.3%, and 18.7% respectively, P = 0.767). Conclusion TILs occur more frequently in the Her-2 positive DCIS. Although we did not find a significant association between TILs and the 10-year risk of IBE, our data suggest that immunotherapies might be considered in subsets of DCIS patients.
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Affiliation(s)
- G Pruneri
- Department of Pathology, European Institute of Oncology, Milan.,School of Medicine, University of Milan, Milan
| | - M Lazzeroni
- Cancer Prevention and Genetics, European Institute of Oncology, Milan
| | - V Bagnardi
- Epidemiology and Biostatistics, European Institute of Oncology, Milan.,Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan
| | - G B Tiburzio
- Department of Pathology, European Institute of Oncology, Milan
| | - N Rotmensz
- Epidemiology and Biostatistics, European Institute of Oncology, Milan
| | - A DeCensi
- Cancer Prevention and Genetics, European Institute of Oncology, Milan.,Division of Medical Oncology, E.O. Ospedali Galliera, Genoa
| | | | - A Vingiani
- Department of Pathology, European Institute of Oncology, Milan
| | - G Curigliano
- Experimental Therapeutics European Institute of Oncology, Milan
| | - S Zurrida
- Division of Senology, European Institute of Oncology, Milan, Italy
| | - F Bassi
- Division of Senology, European Institute of Oncology, Milan, Italy
| | - R Salgado
- Department of Pathology, GZA, Breast Cancer Translational Research Group, Jules Bordet Institute, Brussels
| | - G Van den Eynden
- Molecular Immunology Lab, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - S Loi
- Division of Research and Cancer Medicine, Peter MacCallum Cancer Centre University of Melbourne, East Melbourne, Victoria, Australia
| | - C Denkert
- Institute of Pathology Charité University Hospital, Berlin, Germany and German Cancer Consortium, Berlin, Germany
| | - B Bonanni
- Cancer Prevention and Genetics, European Institute of Oncology, Milan
| | - G Viale
- Department of Pathology, European Institute of Oncology, Milan.,School of Medicine, University of Milan, Milan
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Sonnenblick A, Salgado R, Brohée S, Zahavi T, Peretz T, Van den Eynden G, Rouas G, Salmon A, Francis PA, Di Leo A, Crown JPA, Viale G, Daly L, Javdan B, Fujisawa S, De Azambuja E, Lieveke A, Piccart MJ, Bromberg JF, Sotiriou C. p-STAT3 in luminal breast cancer: Integrated RNA-protein pooled analysis and results from the BIG 2-98 phase III trial. Int J Oncol 2017; 52:424-432. [PMID: 29207087 DOI: 10.3892/ijo.2017.4212] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Accepted: 11/15/2017] [Indexed: 12/24/2022] Open
Abstract
In the present study, in order to investigate the role of signal transducer and activator of transcription 3 (STAT3) in estrogen receptor (ER)-positive breast cancer prognosis, we evaluated the phosphorylated STAT3 (p-STAT3) status and investigated its effect on the outcome in a pooled analysis and in a large prospective adjuvant trial. By using the TCGA repository, we developed gene signatures that reflected the level of p-STAT3. Using pooled analysis of the expression data from luminal breast cancer patients, we assessed the effects of the p-STAT3 expression signature on prognosis. We further validated the p-STAT3 prognostic effect using immunohistochemistry (IHC) and immunofluorescence staining of p-STAT3 tissue microarrays from a large randomised prospective trial. Our analysis demonstrated that p-STAT3 expression was elevated in luminal A-type breast cancer (Kruskal-Wallis test, P<10e-10) and was significantly associated with a good prognosis (log-rank, P<10e-10). Notably, the p-STAT3 expression signature identified patients with a good prognosis irrespective of the luminal subtype (log-rank: luminal A, P=0.026; luminal B, P=0.006). p-STAT3 staining by IHC in the stroma or tumour was detected in 174 out of 610 ER-positive samples (28.5%) from the BIG 2-98 randomised trial. With a median follow-up of 10.1 years, p-STAT3 was associated with a reduced risk of recurrence in ER-positive/HER2-negative breast cancer (Cox univariate HR, 0.66; 95% CI, 0.44-0.98; P=0.04). On the whole, our data indicate that p-STAT3 is associated with an improved outcome in ER-positive breast cancer.
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Affiliation(s)
- Amir Sonnenblick
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Sylvain Brohée
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Tamar Zahavi
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Tamar Peretz
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Gert Van den Eynden
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Ghizlane Rouas
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Asher Salmon
- Sharett Institute of Oncology, Hadassah-Hebrew University Medical Center, Jerusalem 91120, Israel
| | - Prudence A Francis
- Peter MacCallum Cancer Centre, Melbourne VIC 3000, Victoria, on behalf of The Australian and New Zealand Breast Cancer Trials Group, Newcastle, NSW 2298, Australia, and International Breast Cancer Study Group, 3008 Bern, Switzerland
| | - Angelo Di Leo
- 'Sandro Pitigliani' Medical Oncology Department, Hospital of Prato, Istituto Toscano Tumori, 50139 Firenze, Prato, Italy
| | - John P A Crown
- St. Vincet's University Hospital, Elm Park, on behalf of the Irish Clinical Oncology Research, Dublin 4, Ireland
| | - Giuseppe Viale
- Division of Pathology, European Institute of Oncology, 20146 Milano, Italy
| | - Laura Daly
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA
| | - Bahar Javdan
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA
| | - Sho Fujisawa
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA
| | - Evandro De Azambuja
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Ameye Lieveke
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Martine J Piccart
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
| | - Jacqueline F Bromberg
- Department of Medicine, Memorial Sloan Kettering Cancer Center (MSKCC), New York, NY 10065, USA
| | - Christos Sotiriou
- Breast Cancer Translational Research Laboratory J.-C. Heuson, Institut Jules Bordet, Université Libre de Bruxelles, 1000 Brussels, Belgium
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Hendry S, Salgado R, Gevaert T, Russell PA, John T, Thapa B, Christie M, van de Vijver K, Estrada MV, Gonzalez-Ericsson PI, Sanders M, Solomon B, Solinas C, Van den Eynden GGGM, Allory Y, Preusser M, Hainfellner J, Pruneri G, Vingiani A, Demaria S, Symmans F, Nuciforo P, Comerma L, Thompson EA, Lakhani S, Kim SR, Schnitt S, Colpaert C, Sotiriou C, Scherer SJ, Ignatiadis M, Badve S, Pierce RH, Viale G, Sirtaine N, Penault-Llorca F, Sugie T, Fineberg S, Paik S, Srinivasan A, Richardson A, Wang Y, Chmielik E, Brock J, Johnson DB, Balko J, Wienert S, Bossuyt V, Michiels S, Ternes N, Burchardi N, Luen SJ, Savas P, Klauschen F, Watson PH, Nelson BH, Criscitiello C, O’Toole S, Larsimont D, de Wind R, Curigliano G, André F, Lacroix-Triki M, van de Vijver M, Rojo F, Floris G, Bedri S, Sparano J, Rimm D, Nielsen T, Kos Z, Hewitt S, Singh B, Farshid G, Loibl S, Allison KH, Tung N, Adams S, Willard-Gallo K, Horlings HM, Gandhi L, Moreira A, Hirsch F, Dieci MV, Urbanowicz M, Brcic I, Korski K, Gaire F, Koeppen H, Lo A, Giltnane J, Ziai J, Rebelatto MC, Steele KE, Zha J, Emancipator K, Juco JW, Denkert C, Reis-Filho J, Loi S, Fox SB. Assessing Tumor-Infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method from the International Immuno-Oncology Biomarkers Working Group: Part 2: TILs in Melanoma, Gastrointestinal Tract Carcinomas, Non-Small Cell Lung Carcinoma and Mesothelioma, Endometrial and Ovarian Carcinomas, Squamous Cell Carcinoma of the Head and Neck, Genitourinary Carcinomas, and Primary Brain Tumors. Adv Anat Pathol 2017; 24:311-335. [PMID: 28777143 PMCID: PMC5638696 DOI: 10.1097/pap.0000000000000161] [Citation(s) in RCA: 438] [Impact Index Per Article: 62.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Assessment of the immune response to tumors is growing in importance as the prognostic implications of this response are increasingly recognized, and as immunotherapies are evaluated and implemented in different tumor types. However, many different approaches can be used to assess and describe the immune response, which limits efforts at implementation as a routine clinical biomarker. In part 1 of this review, we have proposed a standardized methodology to assess tumor-infiltrating lymphocytes (TILs) in solid tumors, based on the International Immuno-Oncology Biomarkers Working Group guidelines for invasive breast carcinoma. In part 2 of this review, we discuss the available evidence for the prognostic and predictive value of TILs in common solid tumors, including carcinomas of the lung, gastrointestinal tract, genitourinary system, gynecologic system, and head and neck, as well as primary brain tumors, mesothelioma and melanoma. The particularities and different emphases in TIL assessment in different tumor types are discussed. The standardized methodology we propose can be adapted to different tumor types and may be used as a standard against which other approaches can be compared. Standardization of TIL assessment will help clinicians, researchers and pathologists to conclusively evaluate the utility of this simple biomarker in the current era of immunotherapy.
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Affiliation(s)
- Shona Hendry
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels, Belgium
- Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - Thomas Gevaert
- Department of Development and Regeneration, Laboratory of Experimental Urology, KU Leuven, Leuven, Belgium
- Department of Pathology, AZ Klina, Brasschaat, Belgium
| | - Prudence A. Russell
- Department of Anatomical Pathology, St Vincent’s Hospital Melbourne, Fitzroy, Australia
- Department of Pathology, University of Melbourne, Parkville, Australia
| | - Tom John
- Department of Medical Oncology, Austin Health, Heidelberg, Australia
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- School of Cancer Medicine, La Trobe University, Bundoora, Australia
| | - Bibhusal Thapa
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia
- Department of Medicine, University of Melbourne, Parkville, Australia
| | - Michael Christie
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Koen van de Vijver
- Divisions of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M. Valeria Estrada
- Department of Pathology, School of Medicine, University of California, San Diego, USA
| | | | - Melinda Sanders
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Cinzia Solinas
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gert GGM Van den Eynden
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
- Department of Pathology, GZA Ziekenhuizen, Antwerp, Belgium
| | - Yves Allory
- Université Paris-Est, Créteil, France
- INSERM, UMR 955, Créteil, France
- Département de pathologie, APHP, Hôpital Henri-Mondor, Créteil, France
| | - Matthias Preusser
- Department of Medicine, Clinical Division of Oncology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Johannes Hainfellner
- Institute of Neurology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Giancarlo Pruneri
- European Institute of Oncology, Milan, Italy
- University of Milan, School of Medicine, Milan, Italy
| | - Andrea Vingiani
- European Institute of Oncology, Milan, Italy
- University of Milan, School of Medicine, Milan, Italy
| | - Sandra Demaria
- New York University Medical School, New York, USA
- Perlmutter Cancer Center, New York, USA
| | - Fraser Symmans
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Laura Comerma
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | - Sunil Lakhani
- Centre for Clinical Research and School of Medicine, The University of Queensland, Brisbane, Australia
- Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Seong-Rim Kim
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Stuart Schnitt
- Cancer Research Institute and Department of Pathology, Beth Israel Deaconess Cancer Center, Boston, USA
- Harvard Medical School, Boston, USA
| | - Cecile Colpaert
- Department of Pathology, GZA Ziekenhuizen, Sint-Augustinus, Wilrijk, Belgium
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan J. Scherer
- Academic Medical Innovation, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - Michail Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - Robert H. Pierce
- Cancer Immunotherapy Trials Network, Central Laboratory and Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Nicolas Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Frederique Penault-Llorca
- Department of Surgical Pathology and Biopathology, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France
- University of Auvergne UMR1240, Clermont-Ferrand, France
| | - Tomohagu Sugie
- Department of Surgery, Kansai Medical School, Hirakata, Japan
| | - Susan Fineberg
- Montefiore Medical Center, Bronx, New York, USA
- The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Soonmyung Paik
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
- Severance Biomedical Science Institute and Department of Medical Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ashok Srinivasan
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Andrea Richardson
- Harvard Medical School, Boston, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, USA
- Department of Cancer Biology, Dana Farber Cancer Institute, Boston, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Providence, USA
- Warren Alpert Medical School of Brown University, Providence, USA
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland
- Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jane Brock
- Harvard Medical School, Boston, USA
- Department of Pathology, Brigham and Women’s Hospital, Boston, USA
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA
- Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Justin Balko
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA
- Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Stephan Wienert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
- VMscope GmbH, Berlin, Germany
| | - Veerle Bossuyt
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Stefan Michiels
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | - Nils Ternes
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | | | - Stephen J. Luen
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Savas
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Peter H. Watson
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
- Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Brad H. Nelson
- Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada
- Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada
- Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sandra O’Toole
- The Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia
- Australian Clinical Labs, Bella Vista, Australia
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Roland de Wind
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Fabrice André
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Faculté de Médecine, Université Paris Sud, Kremlin-Bicêtre, France
| | - Magali Lacroix-Triki
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Mark van de Vijver
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Federico Rojo
- Pathology Department, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - Giuseppe Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Shahinaz Bedri
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Joseph Sparano
- Department of Oncology, Montefiore Medical Centre, Albert Einstein College of Medicine, Bronx, USA
| | - David Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Torsten Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Stephen Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baljit Singh
- Department of Pathology, New York University Langone Medical Centre, New York, USA
| | - Gelareh Farshid
- Directorate of Surgical Pathology, SA Pathology, Adelaide, Australia
- Discipline of Medicine, Adelaide University, Adelaide, Australia
| | | | | | - Nadine Tung
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Sylvia Adams
- New York University Medical School, New York, USA
- Perlmutter Cancer Center, New York, USA
| | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Hugo M. Horlings
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Leena Gandhi
- Perlmutter Cancer Center, New York, USA
- Dana-Farber Cancer Institute, Boston, USA
| | - Andre Moreira
- Pulmonary Pathology, New York University Center for Biospecimen Research and Development, New York University, New York, USA
| | - Fred Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
- Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maria Urbanowicz
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Iva Brcic
- Institute of Pathology, Medical University of Graz, Austria
| | - Konstanty Korski
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Fabien Gaire
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Hartmut Koeppen
- Research Pathology, Genentech Inc., South San Francisco, USA
| | - Amy Lo
- Research Pathology, Genentech Inc., South San Francisco, USA
- Department of Pathology, Stanford University, Palo Alto, USA
| | | | - James Ziai
- Research Pathology, Genentech Inc., South San Francisco, USA
| | | | | | - Jiping Zha
- Translational Sciences, MedImmune, Gaithersberg, USA
| | | | | | - Carsten Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jorge Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Sherene Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen B. Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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239
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Büttner R, Gosney JR, Skov BG, Adam J, Motoi N, Bloom KJ, Dietel M, Longshore JW, López-Ríos F, Penault-Llorca F, Viale G, Wotherspoon AC, Kerr KM, Tsao MS. Programmed Death-Ligand 1 Immunohistochemistry Testing: A Review of Analytical Assays and Clinical Implementation in Non-Small-Cell Lung Cancer. J Clin Oncol 2017; 35:3867-3876. [PMID: 29053400 DOI: 10.1200/jco.2017.74.7642] [Citation(s) in RCA: 301] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose Three programmed death-1/programmed death-ligand 1 (PD-L1) inhibitors are currently approved for treatment of non-small-cell lung cancer (NSCLC). Treatment with pembrolizumab in NSCLC requires PD-L1 immunohistochemistry (IHC) testing. Nivolumab and atezolizumab are approved without PD-L1 testing, though US Food and Drug Administration-cleared complementary PD-L1 tests are available for both. PD-L1 IHC assays used to assess PD-L1 expression in patients treated with programmed death-1/PD-L1 inhibitors in clinical trials include PD-L1 IHC 28-8 pharmDx (28-8), PD-L1 IHC 22C3 pharmDx (22C3), Ventana PD-L1 SP142 (SP142), and Ventana PD-L1 SP263 (SP263). Differences in antibodies and IHC platforms have raised questions about comparability among these assays and their diagnostic use. This review provides practical information to help physicians and pathologists understand analytical features and comparability of various PD-L1 IHC assays and their diagnostic use. Methods We reviewed and summarized published or otherwise reported studies (January 2016 to January 2017) on clinical trial and laboratory-developed PD-L1 IHC assays (LDAs). Studies assessing the effect of diagnostic methods on PD-L1 expression levels were analyzed to address practical issues related to tissue samples used for testing. Results High concordance and interobserver reproducibility were observed with the 28-8, 22C3, and SP263 clinical trial assays for PD-L1 expression on tumor cell membranes, whereas lower PD-L1 expression was detected with SP142. Immune-cell PD-L1 expression was variable and interobserver concordance was poor. Inter- and intratumoral heterogeneity had variable effects on PD-L1 expression. Concordance among LDAs was variable. Conclusion High concordance among 28-8, 22C3, and SP263 when assessing PD-L1 expression on tumor cell membranes suggests possible interchangeability of their clinical use for NSCLC but not for assessment of PD-L1 expression on immune cells. Development of LDAs requires stringent standardization before their recommendation for routine clinical use.
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Affiliation(s)
- Reinhard Büttner
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - John R Gosney
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Birgit Guldhammer Skov
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Julien Adam
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Noriko Motoi
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Kenneth J Bloom
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Manfred Dietel
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - John W Longshore
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Fernando López-Ríos
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Frédérique Penault-Llorca
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Giuseppe Viale
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Andrew C Wotherspoon
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Keith M Kerr
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
| | - Ming-Sound Tsao
- Reinhard Büttner, University Hospital Cologne, Cologne; Manfred Dietel, Charité Universitätsmedizin Berlin, Berlin, Germany; John R. Gosney, Royal Liverpool University Hospital, Liverpool; Andrew C. Wotherspoon, Royal Marsden Hospital, London; Keith M. Kerr, Aberdeen University Medical School and Aberdeen Royal Infirmary, Aberdeen, Scotland, United Kingdom; Birgit Guldhammer Skov, Copenhagen University Hospital, Copenhagen, Denmark; Julien Adam, Gustave Roussy Cancer Center, Villejuif; Frédérique Penault-Llorca, Jean Perrin Comprehensive Cancer Center, Clermont-Ferrand, France; Noriko Motoi, National Cancer Center Hospital, Tokyo, Japan; Kenneth J. Bloom, Human Longevity, San Diego, CA; John W. Longshore, Carolinas Pathology Group, Charlotte, NC; Fernando López-Ríos, Hospital Universitario HM Sanchinarro, Madrid, Spain; Giuseppe Viale, University of Milan, Milan, Italy; and Ming-Sound Tsao, University Health Network, Princess Margaret Cancer Centre and University of Toronto, Toronto, Ontario, Canada
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240
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Willis S, Sun Y, Abramovitz M, Fei T, Young B, Lin X, Ni M, Achua J, Regan MM, Gray KP, Gray R, Wang V, Long B, Kammler R, Sparano JA, Williams C, Goldstein LJ, Salgado R, Loi S, Pruneri G, Viale G, Brown M, Leyland-Jones B. High Expression of FGD3, a Putative Regulator of Cell Morphology and Motility, Is Prognostic of Favorable Outcome in Multiple Cancers. JCO Precis Oncol 2017; 1:1700009. [PMID: 32913979 PMCID: PMC7446538 DOI: 10.1200/po.17.00009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Purpose Identification of single-gene biomarkers that are prognostic of outcome can shed new insights on the molecular mechanisms that drive breast cancer and other cancers. Methods Exploratory analysis of 20,464 single-gene messenger RNAs (mRNAs) in the Molecular Taxonomy of Breast Cancer International Consortium (METABRIC) discovery cohort indicates that low expression of FGD3 mRNA is prognostic for poor outcome. Prognostic significance of faciogenital dysplasia 3 (FGD3), SUSD3, and other single-gene proliferation markers was evaluated in breast cancer and The Cancer Genome Atlas (TCGA) cohorts. Results A meta-analysis of Cox regression of FGD3 mRNA as a continuous variable for overall survival of estrogen receptor (ER)–positive samples in METABRIC discovery, METABRIC validation, TCGA breast cancer, and Combination Chemotherapy in Treating Women With Breast Cancer (E2197) cohorts resulted in a combined hazard ratio (HR) of 0.69 (95% CI, 0.63 to 0.75), indicating better outcome with high expression. In the ER-negative samples, the combined meta-analysis HR was 0.72 (95% CI, 0.63 to 0.82), suggesting that FGD3 is prognostic regardless of ER status. The potential of FGD3 as a biomarker for freedom from recurrence was evaluated in the Breast International Group 1-98 (BIG 1-98; Letrozole or Tamoxifen in Treating Postmenopausal Women With Breast Cancer) study (HR, 0.85; 95% CI, 0.76 to 0.93) for breast cancer–free interval. In the Hungarian Academy of Science (HAS) breast cancer cohort, splitting on the median had an HR of 0.49 (95% CI, 0.42 to 0.58) for recurrence-free survival. A comparison of the Stouffer P value in five ER-positive cohorts showed that FGD3 (P = 3.8E-14) outperformed MKI67 (P = 1.06E-8) and AURKA (P = 2.61E-5). A comparison of the Stouffer P value in four ER-negative cohorts showed that FGD3 (P = 3.88E-5) outperformed MKI67 (P = .477) and AURKA (P = .820). Conclusion FGD3 was previously shown to inhibit cell migration. FGD3 mRNA is regulated by ESR1 and is associated with favorable outcome in six distinct breast cancer cohorts and four TCGA cancer cohorts. This suggests that FGD3 is an important clinical biomarker.
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Affiliation(s)
- Scooter Willis
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Yuliang Sun
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Mark Abramovitz
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Teng Fei
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Brandon Young
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Xiaoqian Lin
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Min Ni
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Justin Achua
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Meredith M Regan
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Kathryn P Gray
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Robert Gray
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Victoria Wang
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Bradley Long
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Roswitha Kammler
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Joseph A Sparano
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Casey Williams
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Lori J Goldstein
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Roberto Salgado
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Sherene Loi
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Giancarlo Pruneri
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Giuseppe Viale
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Myles Brown
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
| | - Brian Leyland-Jones
- , , , , , , , and , Avera Cancer Institute, Sioux Falls, SD; , , , , , and , Dana-Farber Cancer Institute, Boston, MA; , Children's Medical Center Research Institute, University of Texas Southwestern Medical Center, Dallas, TX; , Molecular Core, Scripps Florida, Jupiter, FL; , International Breast Cancer Study Group, Bern, Switzerland; , Montefiore Medical Center, Bronx, NY; , Fox Chase Cancer Center, Philadelphia, PA; , Breast Cancer Translational Research Laboratory/Institut Jules Bordet, Brussels, Belgium; , Peter MacCallum Cancer Centre, East Melbourne, VIC, Australia; and and , European Institute of Oncology, University of Milan, Milan, Italy
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Gulluni F, Martini M, De Santis MC, Campa CC, Ghigo A, Margaria JP, Ciraolo E, Franco I, Ala U, Annaratone L, Disalvatore D, Bertalot G, Viale G, Noatynska A, Compagno M, Sigismund S, Montemurro F, Thelen M, Fan F, Meraldi P, Marchiò C, Pece S, Sapino A, Chiarle R, Di Fiore PP, Hirsch E. Mitotic Spindle Assembly and Genomic Stability in Breast Cancer Require PI3K-C2α Scaffolding Function. Cancer Cell 2017; 32:444-459.e7. [PMID: 29017056 DOI: 10.1016/j.ccell.2017.09.002] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/25/2017] [Accepted: 09/05/2017] [Indexed: 12/11/2022]
Abstract
Proper organization of the mitotic spindle is key to genetic stability, but molecular components of inter-microtubule bridges that crosslink kinetochore fibers (K-fibers) are still largely unknown. Here we identify a kinase-independent function of class II phosphoinositide 3-OH kinase α (PI3K-C2α) acting as limiting scaffold protein organizing clathrin and TACC3 complex crosslinking K-fibers. Downregulation of PI3K-C2α causes spindle alterations, delayed anaphase onset, and aneuploidy, indicating that PI3K-C2α expression is required for genomic stability. Reduced abundance of PI3K-C2α in breast cancer models initially impairs tumor growth but later leads to the convergent evolution of fast-growing clones with mitotic checkpoint defects. As a consequence of altered spindle, loss of PI3K-C2α increases sensitivity to taxane-based therapy in pre-clinical models and in neoadjuvant settings.
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Affiliation(s)
- Federico Gulluni
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy
| | - Miriam Martini
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy.
| | - Maria Chiara De Santis
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy
| | - Carlo Cosimo Campa
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy
| | - Alessandra Ghigo
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy
| | - Jean Piero Margaria
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy
| | - Elisa Ciraolo
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy
| | - Irene Franco
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy
| | - Ugo Ala
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy
| | - Laura Annaratone
- Department of Medical Sciences, University of Torino, Turin, Italy; Pathology Unit, Department of Laboratory Medicine, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Davide Disalvatore
- IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy
| | - Giovanni Bertalot
- Program of Molecular Medicine, IEO, European Institute of Oncology, Milan, Italy
| | - Giuseppe Viale
- Division of Pathology, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
| | - Anna Noatynska
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Mara Compagno
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Sara Sigismund
- IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy
| | - Filippo Montemurro
- Unit of Investigative Oncology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - Marcus Thelen
- Institute for Research in Biomedicine, Università della Svizzera Italiana, Bellinzona, Switzerland
| | - Fan Fan
- Department of Biological Science and Bioengineering, Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology, Xi'an Jiaotong University, Xi'an, Shaanxi, P. R. China
| | - Patrick Meraldi
- Department of Cell Physiology and Metabolism, University of Geneva, Geneva, Switzerland
| | - Caterina Marchiò
- Department of Medical Sciences, University of Torino, Turin, Italy; Pathology Unit, Department of Laboratory Medicine, Azienda Ospedaliera Universitaria Città della Salute e della Scienza di Torino, Turin, Italy
| | - Salvatore Pece
- Program of Molecular Medicine, IEO, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
| | - Anna Sapino
- Department of Medical Sciences, University of Torino, Turin, Italy; Unit of Pathology, Candiolo Cancer Institute - FPO, IRCCS, Candiolo (TO), Italy
| | - Roberto Chiarle
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy; Department of Pathology, Boston Children's Hospital and Harvard Medical School, Boston, MA, USA
| | - Pier Paolo Di Fiore
- IFOM, The FIRC Institute for Molecular Oncology Foundation, Milan, Italy; Program of Molecular Medicine, IEO, European Institute of Oncology, Milan, Italy; Department of Oncology and Hemato-oncology (DIPO), University of Milan, Milan, Italy
| | - Emilio Hirsch
- Molecular Biotechnology Center, Department of Molecular Biotechnology and Health Sciences, University of Torino, Turin 10126, Italy.
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Tryfonidis K, Poncet C, Slaets L, Viale G, de Snoo F, Aalders K, Van 't Veer L, Rutgers E, Piccart M, Bogaerts J, Cardoso F. Not all small node negative (pT1abN0) breast cancers are similar: Outcome results from an EORTC 10041/BIG 3-04 (MINDACT) trial substudy. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx440.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Hendry S, Salgado R, Gevaert T, Russell PA, John T, Thapa B, Christie M, van de Vijver K, Estrada MV, Gonzalez-Ericsson PI, Sanders M, Solomon B, Solinas C, Van den Eynden GGGM, Allory Y, Preusser M, Hainfellner J, Pruneri G, Vingiani A, Demaria S, Symmans F, Nuciforo P, Comerma L, Thompson EA, Lakhani S, Kim SR, Schnitt S, Colpaert C, Sotiriou C, Scherer SJ, Ignatiadis M, Badve S, Pierce RH, Viale G, Sirtaine N, Penault-Llorca F, Sugie T, Fineberg S, Paik S, Srinivasan A, Richardson A, Wang Y, Chmielik E, Brock J, Johnson DB, Balko J, Wienert S, Bossuyt V, Michiels S, Ternes N, Burchardi N, Luen SJ, Savas P, Klauschen F, Watson PH, Nelson BH, Criscitiello C, O’Toole S, Larsimont D, de Wind R, Curigliano G, André F, Lacroix-Triki M, van de Vijver M, Rojo F, Floris G, Bedri S, Sparano J, Rimm D, Nielsen T, Kos Z, Hewitt S, Singh B, Farshid G, Loibl S, Allison KH, Tung N, Adams S, Willard-Gallo K, Horlings HM, Gandhi L, Moreira A, Hirsch F, Dieci MV, Urbanowicz M, Brcic I, Korski K, Gaire F, Koeppen H, Lo A, Giltnane J, Ziai J, Rebelatto MC, Steele KE, Zha J, Emancipator K, Juco JW, Denkert C, Reis-Filho J, Loi S, Fox SB. Assessing Tumor-infiltrating Lymphocytes in Solid Tumors: A Practical Review for Pathologists and Proposal for a Standardized Method From the International Immunooncology Biomarkers Working Group: Part 1: Assessing the Host Immune Response, TILs in Invasive Breast Carcinoma and Ductal Carcinoma In Situ, Metastatic Tumor Deposits and Areas for Further Research. Adv Anat Pathol 2017; 24:235-251. [PMID: 28777142 PMCID: PMC5564448 DOI: 10.1097/pap.0000000000000162] [Citation(s) in RCA: 423] [Impact Index Per Article: 60.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Assessment of tumor-infiltrating lymphocytes (TILs) in histopathologic specimens can provide important prognostic information in diverse solid tumor types, and may also be of value in predicting response to treatments. However, implementation as a routine clinical biomarker has not yet been achieved. As successful use of immune checkpoint inhibitors and other forms of immunotherapy become a clinical reality, the need for widely applicable, accessible, and reliable immunooncology biomarkers is clear. In part 1 of this review we briefly discuss the host immune response to tumors and different approaches to TIL assessment. We propose a standardized methodology to assess TILs in solid tumors on hematoxylin and eosin sections, in both primary and metastatic settings, based on the International Immuno-Oncology Biomarker Working Group guidelines for TIL assessment in invasive breast carcinoma. A review of the literature regarding the value of TIL assessment in different solid tumor types follows in part 2. The method we propose is reproducible, affordable, easily applied, and has demonstrated prognostic and predictive significance in invasive breast carcinoma. This standardized methodology may be used as a reference against which other methods are compared, and should be evaluated for clinical validity and utility. Standardization of TIL assessment will help to improve consistency and reproducibility in this field, enrich both the quality and quantity of comparable evidence, and help to thoroughly evaluate the utility of TILs assessment in this era of immunotherapy.
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Affiliation(s)
- Shona Hendry
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
| | - Roberto Salgado
- Breast Cancer Translational Research Laboratory/Breast International Group, Institut Jules Bordet, Brussels, Belgium,Department of Pathology and TCRU, GZA, Antwerp, Belgium
| | - Thomas Gevaert
- Department of Development and Regeneration, Laboratory of Experimental Urology, KU Leuven, Leuven, Belgium,Department of Pathology, AZ Klina, Brasschaat, Belgium
| | - Prudence A. Russell
- Department of Anatomical Pathology, St Vincent’s Hospital Melbourne, Fitzroy, Australia,Department of Pathology, University of Melbourne, Parkville, Australia
| | - Tom John
- Department of Medical Oncology, Austin Health, Heidelberg, Australia,Olivia Newton-John Cancer Research Institute, Heidelberg, Australia,School of Cancer Medicine, La Trobe University, Bundoora, Australia
| | - Bibhusal Thapa
- Olivia Newton-John Cancer Research Institute, Heidelberg, Australia,Department of Medicine, University of Melbourne, Parkville, Australia
| | - Michael Christie
- Department of Anatomical Pathology, Royal Melbourne Hospital, Parkville, Australia
| | - Koen van de Vijver
- Divisions of Diagnostic Oncology & Molecular Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - M. Valeria Estrada
- Department of Pathology, School of Medicine, University of California, San Diego, USA
| | | | - Melinda Sanders
- Department of Pathology, Microbiology and Immunology, Vanderbilt University Medical Center, Nashville, USA
| | - Benjamin Solomon
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Cinzia Solinas
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Gert GGM Van den Eynden
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium,Department of Pathology, GZA Ziekenhuizen, Antwerp, Belgium
| | - Yves Allory
- Université Paris-Est, Créteil, France,INSERM, UMR 955, Créteil, France,Département de pathologie, APHP, Hôpital Henri-Mondor, Créteil, France
| | - Matthias Preusser
- Department of Medicine, Clinical Division of Oncology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Johannes Hainfellner
- Institute of Neurology, Comprehensive Cancer Centre Vienna, Medical University of Vienna, Vienna, Austria
| | - Giancarlo Pruneri
- European Institute of Oncology, Milan, Italy,University of Milan, School of Medicine, Milan, Italy
| | - Andrea Vingiani
- European Institute of Oncology, Milan, Italy,University of Milan, School of Medicine, Milan, Italy
| | - Sandra Demaria
- New York University Medical School, New York, USA,Perlmutter Cancer Center, New York, USA
| | - Fraser Symmans
- Department of Pathology, University of Texas M.D. Anderson Cancer Center, Houston, USA
| | - Paolo Nuciforo
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | - Laura Comerma
- Molecular Oncology Group, Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | - Sunil Lakhani
- Centre for Clinical Research and School of Medicine, The University of Queensland, Brisbane, Australia,Pathology Queensland, Royal Brisbane and Women’s Hospital, Brisbane, Australia
| | - Seong-Rim Kim
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Stuart Schnitt
- Cancer Research Institute and Department of Pathology, Beth Israel Deaconess Cancer Center, Boston, USA,Harvard Medical School, Boston, USA
| | - Cecile Colpaert
- Department of Pathology, GZA Ziekenhuizen, Sint-Augustinus, Wilrijk, Belgium
| | - Christos Sotiriou
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Stefan J. Scherer
- Academic Medical Innovation, Novartis Pharmaceuticals Corporation, East Hanover, USA
| | - Michail Ignatiadis
- Department of Medical Oncology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Sunil Badve
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, USA
| | - Robert H. Pierce
- Cancer Immunotherapy Trials Network, Central Laboratory and Program in Immunology, Fred Hutchinson Cancer Research Center, Seattle, USA
| | - Giuseppe Viale
- Department of Pathology, Istituto Europeo di Oncologia, University of Milan, Milan, Italy
| | - Nicolas Sirtaine
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Frederique Penault-Llorca
- Department of Surgical Pathology and Biopathology, Jean Perrin Comprehensive Cancer Centre, Clermont-Ferrand, France,University of Auvergne UMR1240, Clermont-Ferrand, France
| | - Tomohagu Sugie
- Department of Surgery, Kansai Medical School, Hirakata, Japan
| | - Susan Fineberg
- Montefiore Medical Center, Bronx, New York, USA,The Albert Einstein College of Medicine, Bronx, New York, USA
| | - Soonmyung Paik
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania,Severance Biomedical Science Institute and Department of Medical Oncology, Yonsei University College of Medicine, Seoul, South Korea
| | - Ashok Srinivasan
- National Surgical Adjuvant Breast and Bowel Project Operations Center/NRG Oncology, Pittsburgh, Pennsylvania
| | - Andrea Richardson
- Harvard Medical School, Boston, USA,Department of Pathology, Brigham and Women’s Hospital, Boston, USA,Department of Cancer Biology, Dana Farber Cancer Institute, Boston, USA
| | - Yihong Wang
- Department of Pathology and Laboratory Medicine, Rhode Island Hospital and Lifespan Medical Center, Providence, USA,Warren Alpert Medical School of Brown University, Providence, USA
| | - Ewa Chmielik
- Tumor Pathology Department, Maria Sklodowska-Curie Memorial Cancer Center, Gliwice, Poland,Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Jane Brock
- Harvard Medical School, Boston, USA,Department of Pathology, Brigham and Women’s Hospital, Boston, USA
| | - Douglas B. Johnson
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA,Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Justin Balko
- Department of Medicine, Vanderbilt University Medical Centre, Nashville, USA,Vanderbilt Ingram Cancer Center, Nashville, USA
| | - Stephan Wienert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany,VMscope GmbH, Berlin, Germany
| | - Veerle Bossuyt
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Stefan Michiels
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | - Nils Ternes
- Service de Biostatistique et d’Epidémiologie, Gustave Roussy, CESP, Inserm U1018, Université-Paris Sud, Université Paris-Saclay, Villejuif, France
| | | | - Stephen J. Luen
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Savas
- The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia,Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | | | - Peter H. Watson
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada,Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada
| | - Brad H. Nelson
- Trev & Joyce Deeley Research Centre, British Columbia Cancer Agency, Victoria, British Columbia, Canada,Department of Biochemistry and Microbiology, University of Victoria, Victoria, Canada,Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Sandra O’Toole
- The Cancer Research Program, Garvan Institute of Medical Research, Darlinghurst, Australia,Australian Clinical Labs, Bella Vista, Australia
| | - Denis Larsimont
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Roland de Wind
- Department of Pathology, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Fabrice André
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France,Faculté de Médecine, Université Paris Sud, Kremlin-Bicêtre, France
| | - Magali Lacroix-Triki
- INSERM Unit U981, and Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Mark van de Vijver
- Department of Surgical Oncology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Federico Rojo
- Pathology Department, IIS-Fundacion Jimenez Diaz, UAM, Madrid, Spain
| | - Giuseppe Floris
- Department of Pathology, University Hospital Leuven, Leuven, Belgium
| | - Shahinaz Bedri
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, Doha, Qatar
| | - Joseph Sparano
- Department of Oncology, Montefiore Medical Centre, Albert Einstein College of Medicine, Bronx, USA
| | - David Rimm
- Department of Pathology, Yale University School of Medicine, New Haven, USA
| | - Torsten Nielsen
- Genetic Pathology Evaluation Centre, Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, Canada
| | - Zuzana Kos
- Department of Pathology and Laboratory Medicine, University of Ottawa, Ottawa, Canada
| | - Stephen Hewitt
- Laboratory of Pathology, Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - Baljit Singh
- Department of Pathology, New York University Langone Medical Centre, New York, USA
| | - Gelareh Farshid
- Directorate of Surgical Pathology, SA Pathology, Adelaide, Australia,Discipline of Medicine, Adelaide University, Adelaide, Australia
| | | | | | - Nadine Tung
- Division of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, USA
| | - Sylvia Adams
- New York University Medical School, New York, USA,Perlmutter Cancer Center, New York, USA
| | - Karen Willard-Gallo
- Molecular Immunology Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Hugo M. Horlings
- Department of Pathology, Netherlands Cancer Institute-Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Leena Gandhi
- Perlmutter Cancer Center, New York, USA,Dana-Farber Cancer Institute, Boston, USA
| | - Andre Moreira
- Pulmonary Pathology, New York University Center for Biospecimen Research and Development, New York University, New York, USA
| | - Fred Hirsch
- Division of Medical Oncology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, USA
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy,Medical Oncology 2, Veneto Institute of Oncology IOV-IRCCS, Padua, Italy
| | - Maria Urbanowicz
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Iva Brcic
- Institute of Pathology, Medical University of Graz, Austria
| | - Konstanty Korski
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Fabien Gaire
- Pathology and Tissue Analytics, Roche Innovation Centre Munich, Penzberg, Germany
| | - Hartmut Koeppen
- Research Pathology, Genentech Inc., South San Francisco, USA
| | - Amy Lo
- Research Pathology, Genentech Inc., South San Francisco, USA,Department of Pathology, Stanford University, Palo Alto, USA
| | | | - James Ziai
- Research Pathology, Genentech Inc., South San Francisco, USA
| | | | | | - Jiping Zha
- Translational Sciences, MedImmune, Gaithersberg, USA
| | | | | | - Carsten Denkert
- Institute of Pathology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Jorge Reis-Filho
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, USA
| | - Sherene Loi
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen B. Fox
- Department of Pathology, Peter MacCallum Cancer Centre, Melbourne, Australia,The Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Criscitiello C, Golshan M, Barry W, Viale G, Wong S, Santangelo M, Curigliano G. Impact of neoadjuvant therapy (NT) and pathological complete response (pCR) on breast-conserving surgery (BCS) in patients (pts) with breast cancer (BC): A meta-analysis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Leonardi MC, Maisonneuve P, Mastropasqua MG, Cattani F, Fanetti G, Morra A, Lazzari R, Bazzani F, Caputo M, Rotmensz N, Gerardi MA, Ricotti R, Enrica Galimberti V, Veronesi P, Dicuonzo S, Viale G, Jereczek-Fossa BA, Orecchia R. Comparison of Treatment Outcome Between Invasive Lobular and Ductal Carcinomas in Patients Receiving Partial Breast Irradiation With Intraoperative Electrons. Int J Radiat Oncol Biol Phys 2017; 99:173-181. [DOI: 10.1016/j.ijrobp.2017.04.033] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2016] [Revised: 03/16/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
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246
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Tutt A, Kaufman B, Garber J, Gelber R, McFadden E, Goessl C, Viale G, Geyer C, Zardavas D, Arahmani A, Fumagalli D, De Azambuja E, Ponde N, Herbolsheimer P, Wu W, Constantino J, Rastogi P. OlympiA: A randomized phase III trial of olaparib as adjuvant therapy in patients with high-risk HER2-negative breast cancer (BC) and a germline BRCA1/2 mutation (gBRCAm). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx362.065] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [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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247
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Cano-Rodriguez D, Campagnoli S, Grandi A, Parri M, Camilli ED, Song C, Jin B, Lacombe A, Pierleoni A, Bombaci M, Cordiglieri C, Ruiters MH, Viale G, Terracciano L, Sarmientos P, Abrignani S, Grandi G, Pileri P, Rots MG, Grifantini R. TCTN2: a novel tumor marker with oncogenic properties. Oncotarget 2017; 8:95256-95269. [PMID: 29221125 PMCID: PMC5707019 DOI: 10.18632/oncotarget.20438] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [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: 02/17/2017] [Accepted: 07/25/2017] [Indexed: 12/21/2022] Open
Abstract
Tectonic family member 2 (TCTN2) encodes a transmembrane protein that belongs to the tectonic family, which is involved in ciliary functions. Previous studies have demonstrated the role of tectonics in regulating a variety of signaling pathways at the transition zone of cilia. However, the role of tectonics in cancer is still unclear. Here we identify that TCTN2 is overexpressed in colorectal, lung and ovary cancers. We show that different cancer cell lines express the protein that localizes at the plasma membrane, facing the intracellular milieu. TCTN2 over-expression in cancer cells resulted in an increased ability to form colonies in an anchorage independent way. On the other hand, downregulation of TCTN2 using targeted epigenetic editing in cancer cells significantly reduced colony formation, cell invasiveness, increased apoptosis and impaired assembly of primary cilia. Taken together, our results indicate that TCTN2 acts as an oncogene, making it an interesting cancer-associated protein and a potential candidate for therapeutic applications.
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Affiliation(s)
- David Cano-Rodriguez
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | | | | | | | - Elisa De Camilli
- Department of Pathology, European Institute of Oncology, Milan, Italy
| | - Chaojun Song
- Department of Immunology, The Fourth Military Medical University, Xi'an, China
| | - Boquan Jin
- Department of Immunology, The Fourth Military Medical University, Xi'an, China
| | - Aurelien Lacombe
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | - Andrea Pierleoni
- Externautics SpA, Siena, Italy.,Present affiliation: European Bioinformatics Institute (EMBL-EBI), Wellcome Genome Campus, Hinxton, Cambridge, UK
| | - Mauro Bombaci
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Chiara Cordiglieri
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Marcel Hj Ruiters
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Giuseppe Viale
- Department of Pathology, European Institute of Oncology, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Luigi Terracciano
- Institute of Pathology, University Hospital Basel, Basel, Switzerland
| | | | - Sergio Abrignani
- Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
| | - Guido Grandi
- Centre for Integrative Biology - CIBIO, University of Trento, Trento, Italy
| | | | - Marianne G Rots
- Department of Pathology and Medical Biology, University of Groningen, University Medical Center, Groningen, The Netherlands
| | - Renata Grifantini
- Externautics SpA, Siena, Italy.,Istituto Nazionale Genetica Molecolare, Padiglione Romeo ed Enrica Invernizzi, IRCCS Ospedale Maggiore Policlinico, Milan, Italy
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248
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Botteri E, Veronesi P, Vila J, Rotmensz N, Galimberti V, Thomazini MV, Viale G, Orecchia R, Goldhirsch A, Gentilini O. Improved prognosis of young patients with breast cancer undergoing breast-conserving surgery. Br J Surg 2017; 104:1802-1810. [PMID: 28791694 DOI: 10.1002/bjs.10658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 05/15/2017] [Accepted: 06/24/2017] [Indexed: 12/16/2022]
Abstract
BACKGROUND The aim of the present study was to evaluate how breast cancer prognosis has evolved over time in young women treated with breast-conserving surgery (BCS). METHODS Data from patients younger than 40 years who had BCS and whole-breast radiotherapy in a single cancer centre between 1997 and 2010 were analysed. The patients were followed until 2016. Endpoints were local recurrence, any breast cancer-related event and death from any cause. RESULTS A total of 1331 patients were included in the study. After a median follow-up of 9·3 years, 114 local recurrences, 289 breast cancer-related events and 138 deaths had occurred. Women were divided into three groups of similar size based on tertiles of the date of diagnosis: 1997-2002 (524 patients), 2003-2005 (350) and 2006-2010 (457). The risk of local recurrence was 1·42 per 100 person-years in women diagnosed in the first interval, 0·85 per 100 person-years in the second and 0·48 per 100 person-years in the third (P for trend = 0·028). The respective values were 3·01, 2·52 and 2·07 per 100 person-years for any breast cancer-related event (P = 0·004), and 1·59, 1·22 and 0·64 per 100 person-years for death (P = 0·003). Each passing year was associated with a decreasing risk of local recurrence (hazard ratio (HR) 0·93, 95 per cent c.i. 0·87 to 1·00), any breast cancer-related event (HR 0·94, 0·91 to 0·98) and death (HR 0·89, 0·83 to 0·94). A major improvement in prognosis was observed after 2005, when the classification of breast cancer molecular subtypes and use of trastuzumab were implemented in routine clinical practice. CONCLUSION In the past two decades, both local control and overall prognosis have improved significantly in young women (aged less than 40 years) with breast cancer who undergo BCS.
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Affiliation(s)
- E Botteri
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy.,National Advisory Unit for Women's Health, Women's Clinic, Oslo University Hospital, Oslo, Norway.,Department of Bowel Cancer Screening, Cancer Registry of Norway, Oslo, Norway
| | - P Veronesi
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - J Vila
- Scientific Directorate, European Institute of Oncology, Milan, Italy.,Department of Breast Surgery, La Fe University Hospital, Valencia, Spain
| | - N Rotmensz
- Division of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - V Galimberti
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
| | - M V Thomazini
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
| | - G Viale
- Department of Pathology, European Institute of Oncology, Milan, Italy.,School of Medicine, University of Milan, Milan, Italy
| | - R Orecchia
- Scientific Directorate, European Institute of Oncology, Milan, Italy.,Department of Oncology, Haemato-oncology, University of Milan, Milan, Italy
| | - A Goldhirsch
- Scientific Directory and Medical Senology, European Institute of Oncology, Milan, Italy
| | - O Gentilini
- Division of Breast Surgery, European Institute of Oncology, Milan, Italy
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249
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Curigliano G, Burstein HJ, Winer EP, Gnant M, Dubsky P, Loibl S, Colleoni M, Regan MM, Piccart-Gebhart M, Senn HJ, Thürlimann B, André F, Baselga J, Bergh J, Bonnefoi H, Brucker SY, Cardoso F, Carey L, Ciruelos E, Cuzick J, Denkert C, Di Leo A, Ejlertsen B, Francis P, Galimberti V, Garber J, Gulluoglu B, Goodwin P, Harbeck N, Hayes DF, Huang CS, Huober J, Khaled H, Jassem J, Jiang Z, Karlsson P, Morrow M, Orecchia R, Osborne KC, Pagani O, Partridge AH, Pritchard K, Ro J, Rutgers EJT, Sedlmayer F, Semiglazov V, Shao Z, Smith I, Toi M, Tutt A, Viale G, Watanabe T, Whelan TJ, Xu B. De-escalating and escalating treatments for early-stage breast cancer: the St. Gallen International Expert Consensus Conference on the Primary Therapy of Early Breast Cancer 2017. Ann Oncol 2017; 28:1700-1712. [PMID: 28838210 PMCID: PMC6246241 DOI: 10.1093/annonc/mdx308] [Citation(s) in RCA: 696] [Impact Index Per Article: 99.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The 15th St. Gallen International Breast Cancer Conference 2017 in Vienna, Austria reviewed substantial new evidence on loco-regional and systemic therapies for early breast cancer. Treatments were assessed in light of their intensity, duration and side-effects, seeking where appropriate to escalate or de-escalate therapies based on likely benefits as predicted by tumor stage and tumor biology. The Panel favored several interventions that may reduce surgical morbidity, including acceptance of 2 mm margins for DCIS, the resection of residual cancer (but not baseline extent of cancer) in women undergoing neoadjuvant therapy, acceptance of sentinel node biopsy following neoadjuvant treatment of many patients, and the preference for neoadjuvant therapy in HER2 positive and triple-negative, stage II and III breast cancer. The Panel favored escalating radiation therapy with regional nodal irradiation in high-risk patients, while encouraging omission of boost in low-risk patients. The Panel endorsed gene expression signatures that permit avoidance of chemotherapy in many patients with ER positive breast cancer. For women with higher risk tumors, the Panel escalated recommendations for adjuvant endocrine treatment to include ovarian suppression in premenopausal women, and extended therapy for postmenopausal women. However, low-risk patients can avoid these treatments. Finally, the Panel recommended bisphosphonate use in postmenopausal women to prevent breast cancer recurrence. The Panel recognized that recommendations are not intended for all patients, but rather to address the clinical needs of the majority of common presentations. Individualization of adjuvant therapy means adjusting to the tumor characteristics, patient comorbidities and preferences, and managing constraints of treatment cost and access that may affect care in both the developed and developing world.
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Affiliation(s)
- G Curigliano
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - H J Burstein
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - E P Winer
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Gnant
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
| | - P Dubsky
- Department of Surgery, Comprehensive Cancer Center Vienna, Medical University of Vienna, Vienna, Austria
- Klinik St. Anna, Luzern, Switzerland
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Colleoni
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - M M Regan
- Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M Piccart-Gebhart
- Department of Medical Oncology, Institut Jules Bordet, UniversitÕ Libre de Bruxelles, Brussels, Belgium
| | - H-J Senn
- Tumor and Breast Center ZeTuP, St. Gallen
| | - B Thürlimann
- Breast Center, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - F André
- Institut de Cancérologie Gustave Roussy, Villejuif, France
| | - J Baselga
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - J Bergh
- Karolinska Institute and University Hospital, Stockholm, Sweden
| | - H Bonnefoi
- University of Bordeaux, Bordeaux, France
| | - S Y Brucker
- Universitäts-Frauenklinik Tübingen, Tübingen, Germany
| | - F Cardoso
- Champalimaud Cancer Centre, Lisbon, Portugal
| | - L Carey
- Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, USA
| | - E Ciruelos
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - J Cuzick
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Denkert
- Institut für Pathologie, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - A Di Leo
- Azienda Usl Toscana Centro, Prato, Italy
| | | | - P Francis
- Peter McCallum Cancer Centre, Melbourne, Australia
| | - V Galimberti
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | - J Garber
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - B Gulluoglu
- Marmara University School of Medicine, Istanbul, Turkey
| | - P Goodwin
- University of Toronto, Mount Sinai Hospital, Toronto, Canada
| | - N Harbeck
- University of Munich, München, Germany
| | - D F Hayes
- Comprehensive Cancer Center, University of Michigan, Ann-Arbor, USA
| | - C-S Huang
- National Taiwan University Hospital, Taipei, Taiwan
| | | | - H Khaled
- The National Cancer Institute, Cairo University, Cairo, Egypt
| | - J Jassem
- Medical University of Gdansk, Gdansk, Poland
| | - Z Jiang
- Hospital Affiliated to Military Medical Science, Beijing, China
| | - P Karlsson
- Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrensky University Hospital, Gothenburg, Sweden
| | - M Morrow
- Memorial Sloan Kettering Cancer Center, New York, USA
| | - R Orecchia
- Breast Cancer Program, Istituto Europeo di Oncologia, Milano, Italy
| | | | - O Pagani
- Institute of Oncology Southern Switzerland, Ospedale San Giovanni, Bellinzona, Switzerland
| | - A H Partridge
- Breast Oncology Center, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - K Pritchard
- Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Canada
| | - J Ro
- National Cancer Center, Ilsandong-gu, Goyang-si, Gyeonggi-do, Korea
| | - E J T Rutgers
- Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - F Sedlmayer
- LKH Salzburg, Paracelsus Medical University Clinics, Salzburg, Austria
| | - V Semiglazov
- N.N. Petrov Research Institute of Oncology, St. Petersburg, Russian Federation
| | - Z Shao
- Fudan University Cancer Hospital, Shanghai, China
| | - I Smith
- The Royal Marsden, Sutton, Surrey, UK
| | - M Toi
- Graduate School of Medicine Kyoto University, Sakyo-ku, Kyoto City, Japan
| | - A Tutt
- Breast Cancer Now Research Centre, The Institute of Cancer Research, London, UK
| | - G Viale
- University of Milan, Milan, Italy
- Istituto Europeo di Oncologia, Milan, Italy
| | - T Watanabe
- Hamamatsu Oncology Center, Hamamatsu, Japan
| | | | - B Xu
- National Cancer Center, Chaoyang District, Beijing, China
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250
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von Minckwitz G, Procter M, de Azambuja E, Zardavas D, Benyunes M, Viale G, Suter T, Arahmani A, Rouchet N, Clark E, Knott A, Lang I, Levy C, Yardley DA, Bines J, Gelber RD, Piccart M, Baselga J. Adjuvant Pertuzumab and Trastuzumab in Early HER2-Positive Breast Cancer. N Engl J Med 2017; 377:122-131. [PMID: 28581356 PMCID: PMC5538020 DOI: 10.1056/nejmoa1703643] [Citation(s) in RCA: 867] [Impact Index Per Article: 123.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pertuzumab increases the rate of pathological complete response in the preoperative context and increases overall survival among patients with metastatic disease when it is added to trastuzumab and chemotherapy for the treatment of human epidermal growth factor receptor 2 (HER2)-positive breast cancer. In this trial, we investigated whether pertuzumab, when added to adjuvant trastuzumab and chemotherapy, improves outcomes among patients with HER2-positive early breast cancer. METHODS We randomly assigned patients with node-positive or high-risk node-negative HER2-positive, operable breast cancer to receive either pertuzumab or placebo added to standard adjuvant chemotherapy plus 1 year of treatment with trastuzumab. We assumed a 3-year invasive-disease-free survival rate of 91.8% with pertuzumab and 89.2% with placebo. RESULTS In the trial population, 63% of the patients who were randomly assigned to receive pertuzumab (2400 patients) or placebo (2405 patients) had node-positive disease and 36% had hormone-receptor-negative disease. Disease recurrence occurred in 171 patients (7.1%) in the pertuzumab group and 210 patients (8.7%) in the placebo group (hazard ratio, 0.81; 95% confidence interval [CI], 0.66 to 1.00; P=0.045). The estimates of the 3-year rates of invasive-disease-free survival were 94.1% in the pertuzumab group and 93.2% in the placebo group. In the cohort of patients with node-positive disease, the 3-year rate of invasive-disease-free survival was 92.0% in the pertuzumab group, as compared with 90.2% in the placebo group (hazard ratio for an invasive-disease event, 0.77; 95% CI, 0.62 to 0.96; P=0.02). In the cohort of patients with node-negative disease, the 3-year rate of invasive-disease-free survival was 97.5% in the pertuzumab group and 98.4% in the placebo group (hazard ratio for an invasive-disease event, 1.13; 95% CI, 0.68 to 1.86; P=0.64). Heart failure, cardiac death, and cardiac dysfunction were infrequent in both treatment groups. Diarrhea of grade 3 or higher occurred almost exclusively during chemotherapy and was more frequent with pertuzumab than with placebo (9.8% vs. 3.7%). CONCLUSIONS Pertuzumab significantly improved the rates of invasive-disease-free survival among patients with HER2-positive, operable breast cancer when it was added to trastuzumab and chemotherapy. Diarrhea was more common with pertuzumab than with placebo. (Funded by F. Hoffmann-La Roche/Genentech; APHINITY ClinicalTrials.gov number, NCT01358877 .).
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Affiliation(s)
- Gunter von Minckwitz
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Marion Procter
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Evandro de Azambuja
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Dimitrios Zardavas
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Mark Benyunes
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Giuseppe Viale
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Thomas Suter
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Amal Arahmani
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Nathalie Rouchet
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Emma Clark
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Adam Knott
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Istvan Lang
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Christelle Levy
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Denise A Yardley
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Jose Bines
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Richard D Gelber
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Martine Piccart
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
| | - Jose Baselga
- From the German Breast Group, Neu-Isenburg, Germany (G.M.); Frontier Science (Scotland), Kincraig, United Kingdom (M. Procter); the Breast European Adjuvant Study Team (BrEAST) Data Center (E.A., N.R.), the Breast International Group (D.Z., A.A.), and Institut Jules Bordet, Université Libre de Bruxelles (M. Piccart) - all in Brussels; Roche Pharma (M.B., E.C., A.K.) and the Department of Cardiology, Cardio-Oncology, Bern University Hospital (T.S.) - both in Bern, Switzerland; the Department of Pathology, European Institute of Oncology, University of Milan, Milan (G.V.); the National Institute of Oncology, Budapest, Hungary (I.L.); Centre François Baclesse, Caen, France (C.L.); the Sarah Cannon Research Institute and Tennessee Oncology, Nashville (D.A.Y.); Instituto Nacional de Câncer, Rio de Janeiro (J. Bines); Dana-Farber Cancer Institute, Harvard Medical School, Harvard T. H. Chan School of Public Health, and Frontier Science and Technology Research Foundation - all in Boston (R.D.G.); and the Department of Medicine, Memorial Sloan Kettering Cancer Center, New York (J. Baselga)
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