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Dülgar Ö, Türker S, Başaran G, Araz M, Sümbül AT, Çağlayan D, Gümüşay Ö, Biter S, Konca A, Özen M, Demir H, Özdemir M, Karataş F, Şahin E, Çavdar E, Yasin Aİ, Yaşar A, Derin S, Pehlivan M, Üyetürk Ü, Özdemir Ö, Kayıkçıoğlu E, Ak N, Şakalar T, Sakin A, Büyükşimşek M, Ay S, Ertürk İ, Akbaş S, Bir Yücel K, Gümüş M. Real-world data on the efficacy and safety of trastuzumab emtansine in patients with metastatic breast cancer previously treated with pertuzumab: Turkish oncology group multicenter study. J Chemother 2024:1-7. [PMID: 38904164 DOI: 10.1080/1120009x.2024.2366683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/05/2024] [Indexed: 06/22/2024]
Abstract
We aimed to evaluate the efficacy and safety of trastuzumab emtansine in patients with metastatic breast cancer previously treated with pertuzumab plus trastuzumab and taxane. We reviewed the medical records of patients who were diagnosed with Human Epidermal Growth Factor Receptor 2 (HER-2) positive metastatic breast cancer and received pertuzumab and then TDM-1 between January 2014 and January 2021 from twenty- five cancer centers. The Kaplan- Meier method estimated progression-free survival (PFS) and overall survival (OS). Additionally, objective response rate (ORR), clinical benefit rate (CBR), and safety were evaluated. One hundred fifty-three patients were included,79.1% of the patients received TDM-1 in the second line, 90.8% had visceral metastasis, and 30.7% had central nervous system involvement. The PFS and OS of TDM-1 were evaluated according to the number of previous lines (on the 2nd line or more than two lines) metastatic sites (visceral and non-visceral) and the presence of central nervous metastasis. In TDM-1 therapy, PFS in second line therapy was ten months (95% CI: 7.7 - 12.2); this was statistically higher than later-line PFS, which was six months (95% CI: 3.3 to 8.6) (p = 0.004). The median OS time was 25 months (95% CI: 21.0 to 28.9) in patients treated with TDM-1 in the second line and 19 months (95% CI: 12.3 to 25.6) in patients who received later than the second line(p = 0.175). There were no significant differences in PFS time of patients with and without visceral and central nervous metastases. Our study showed that TDM-1 was also effective in patients using pertuzumab, contributes significantly to PFS when used in the second line compared to its use in the later line, and does not make any difference in OS.
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Affiliation(s)
- Özgecan Dülgar
- Department of Medical Oncology, Health Science University, Umraniye Training and Research Hospital, Istanbul, Turkey
| | - Sema Türker
- Department of Internal Medicine, Bahcesehir University, Istanbul, Turkey
| | - Gül Başaran
- Department of Medical Oncology, Acıbadem University, Istanbul, Turkey
| | - Murat Araz
- Department of Medical Oncology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Ahmet Taner Sümbül
- Department of Medical Oncology, Medical Park Hospital Groups, Adana, Turkey
| | - Dilek Çağlayan
- Department of Medical Oncology, Necmettin Erbakan University Faculty of Medicine, Konya, Turkey
| | - Özge Gümüşay
- Department of Medical Oncology, Acıbadem University, Istanbul, Turkey
| | - Sedat Biter
- Department of Medical Oncology, Cukurova University, Faculty of Medicine, Adana, Turkey
| | - Ahmet Konca
- Department of Medical Oncology, Gaziantep Univesity, Sahinbey Training and Research Hospital, Gaziantep, Turkey
| | - Miraç Özen
- Department of Medical Oncology, Sakarya University, Sakarya, Turkey
| | - Hacer Demir
- Department of Medical Oncology, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
| | - Melek Özdemir
- Department of Medical Oncology, Pamukkale University, Denizli, Turkey
| | - Fatih Karataş
- Department of Medical Oncology, Karabuk University, Karabuk, Turkey
| | - Elif Şahin
- Department of Medical Oncology, Kocaeli University, İzmit, Turkey
| | - Eyyüp Çavdar
- Department of Medical Oncology, Tekirdag Namık Kemal University, Tekirdag, Turkey
| | - Ayşe İrem Yasin
- Department of Medical Oncology, Bezmi Alem Vakıf University, Istanbul, Turkey
| | - Alper Yaşar
- Department of Medical Oncology, Marmara University School of Medicine, Istanbul, Turkey
| | - Sümeyra Derin
- Department of Medical Oncology, Istanbul University Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Metin Pehlivan
- Department of Medical Oncology, Zonguldak Ataturk State Hospital, Zonguldak, Turkey
| | - Ümmügül Üyetürk
- Department of Medical Oncology, Okan University, Istanbul, Turkey
| | - Özlem Özdemir
- Department of Medical Oncology, Bozyaka Research and Training Hospital, İzmir, Turkey
| | - Erkan Kayıkçıoğlu
- Department of Medical Oncology, Süleyman Demirel University, Isparta, Turkey
| | - Naziye Ak
- Department of Medical Oncology, Yozgat City Hospital, Yozgat, Turkey
| | - Teoman Şakalar
- Department of Medical Oncology, Necip Fazıl City Hospital, Kahramanmaraş, Turkey
| | - Abdullah Sakin
- Department of Medical Oncology, Medipol University, Istanbul, Turkey
| | - Mahmut Büyükşimşek
- Department of Medical Oncology, University of Health Sciences-Adana City Training and Research Hospital, Adana, Turkey
| | - Seval Ay
- Department of Medical Oncology, Balıkesir Atatürk City Hospital, Balıkesir, Turkey
| | - İsmail Ertürk
- Department of Medical Oncology, Ankara Gulhane Training and Research Hospital, Ankara, Turkey
| | - Sinem Akbaş
- Department of Medical Oncology, Koc University, Faculty of Medicine, Istanbul, Turkey
| | - Kadriye Bir Yücel
- Department of Medical Oncology, Gazi University School of Medicine, Ankara, Turkey
| | - Mahmut Gümüş
- Department of Medical Oncology, Medeniyet University, Faculty of Medicine, Istanbul, Turkey
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Bao Y, Chen J, Duan L, Wang F, Lai H, Mo Z, Zhu W. Comparing the difference of adverse events with HER2 inhibitors: a study of the FDA adverse event reporting system (FAERS). Front Pharmacol 2024; 15:1288362. [PMID: 38327983 PMCID: PMC10847310 DOI: 10.3389/fphar.2024.1288362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 01/08/2024] [Indexed: 02/09/2024] Open
Abstract
Aim and background: This study attempted to identify similarities and differences in adverse events (AEs) between human epidermal growth factor receptor 2 (HER2) inhibitors, especially those related to hemorrhagic events and nervous system disorders. Methods: This study summarized the types, frequencies, and system organ classes (SOCs) of AEs of HER2 inhibitors. The US Food and Drug Administration Adverse Event Reporting System (FAERS) data from January 2004 through March 2022 was collected and analyzed. Disproportionality analyses were conducted to detect AEs signals for every HER2 inhibitor. The chi-square test, Wilcoxon test, and descriptive analysis were used to compare the differences of AEs for specific SOCs or drugs. Results: A total of 47,899 AE reports were obtained for eight HER2 inhibitors. Trastuzumab-related AEs were reported in the highest number and combination of regimens. In monotherapy, trastuzumab had the highest reported rate of cardiac disorders-related AEs (24.0%). However, small-molecule drugs exceeded other drugs in the reported rates of AEs related to gastrointestinal disorders, metabolism and nutrition disorders. The highest reported rates of respiratory disorders (47.3%) and hematologic disorders (22.4%) were associated with treatment with trastuzumab deruxtecan (T-DXd). Patients treated with trastuzumab emtansine (TDM-1) had the highest reported rate (7.28%) of hemorrhagic events, especially intracranial haemorrhage events. In addition, patients treated with TDM-1 with concomitant thrombocytopenia were likely to experience hemorrhagic events compared to other HER2 inhibitors (p < 0.001). The median time to onset of intracranial haemorrhage associated with trastuzumab (0.5 months) and TDM-1 (0.75 months) was short. However, there was no significant difference in median time to onset intracranial haemorrhage between patients in different age groups or with different outcomes. Disproportionality analysis results reveal that cerebral haemorrhage is a positive signal associated with T-DXd and TDM-1. In addition, tucatinib was the drug with the highest rate of reported nervous system disorders (31.38%). Memory impairment (83 cases) is a positive signal for tucatinib. Conclusion: The types and reporting rates of AEs associated with different HER2 inhibitors vary across multiple systems. In addition, hemorrhagic events concomitant with TDM-1 treatment and nervous system disorders concomitant with tucatinib treatment may be worthy of attention.
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Affiliation(s)
- Yiwen Bao
- Department of Oncology, The People’s Hospital of Qiannan, Duyun, Guizhou, China
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jiaju Chen
- Gastrointestinal Surgery, The Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, China
| | - Luting Duan
- Department of Cardiovascular Medicine, The People’s Hospital of Qiannan, Duyun, Guizhou, China
| | - Fujue Wang
- State Key Laboratory of Biotherapy and Cancer Center, West China Hospital, Sichuan University and Collaborative Innovation Center, Chengdu, China
| | - Han Lai
- Department of Oncology, The People’s Hospital of Qiannan, Duyun, Guizhou, China
| | - Zeming Mo
- Department of Oncology, The People’s Hospital of Qiannan, Duyun, Guizhou, China
- Division of Head and Neck Tumor Multimodality Treatment, Cancer Center, West China Hospital, Sichuan University, Chengdu, China
| | - Weiliang Zhu
- Department of Oncology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
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Li Y, Qi L, Wang Y, Zhao X, Lv S, Feng Y, Liu C, Li P, Xiong B, Guo Y, Lv D, Liu Y, Mao T, Yuan K, Cheng X, Li Y, Wang X. Safety, tolerability, pharmacokinetics and immunogenicity of an antibody-drug conjugate (SHR-A1201) in patients with HER2-positive advanced breast cancer: an open, phase I dose-escalation study. Anticancer Drugs 2023; 34:763-774. [PMID: 36730296 DOI: 10.1097/cad.0000000000001456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
SHR-A1201 is an antibody-drug conjugate (ADC) that combines trastuzumab with DM1 (a chemotherapeutic agent) using a chemical connector. This phase I study investigated the safety, tolerability and pharmacokinetics of SHR-A1201 in patients with human epidermal growth factor receptor 2-positive advanced breast cancer. This phase I study enrolled patients in a traditional 3 + 3 dose-escalation design to receive a single dose of SHR-A1201 (1.2 mg/kg, 2.4 mg/kg, 3.6 mg/kg or 4.8 mg/kg). The observation period of dose-limiting toxicity (DLT) was 21 days. A total of 12 patients were enrolled and received SHR-A1201. Most treatment-emergent adverse events (TEAEs) were grade 1 or 2 in severity, with elevated aspartate aminotransferase (75%), thrombocytopenia (75%), and nausea (66.7%) being reported most frequently. The common grade 3 TEAEs were thrombocytopenia and decreased lymphocyte count, and there were no grade 4 or above TEAEs. There were no serious adverse events or drug-related deaths. One DLT occurred in one patient treated with SHR-A1201 4.8 mg/kg (asymptomatic grade 3 increased γ-glutamyltransferase). The maximum tolerated dose of SHR-A1201 was not lower than that of T-DM1 (3.6 mg/kg). A total of 8.3% (1/12) of patients had ADA-positive reactions 504 h after administration, but no differences were observed in the type, incidence, or severity of TEAEs between patients with and without ADA. SHR-A1201 exhibited the pharmacokinetics characteristics of typical ADCs. An encouraging antitumor effect was observed in the 4.8 mg/kg dose group. SHR-A1201 was well tolerated and safe in patients with advanced HER2-positive breast cancer. The pharmacokinetics parameters showed a linear trend, and the immunogenicity results met the clinical expectations.
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Affiliation(s)
- Yinjuan Li
- Department of Phase I Clinical Trial Center
| | - Lu Qi
- Department of Phase I Clinical Trial Center
| | - Yu Wang
- Department of Phase I Clinical Trial Center
| | - Xia Zhao
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Shuzhen Lv
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yu Feng
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Chen Liu
- Department of Phase I Clinical Trial Center
| | - Pu Li
- Department of Phase I Clinical Trial Center
| | - Bingjun Xiong
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yihui Guo
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Dapeng Lv
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Yongbo Liu
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Ting Mao
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Keyu Yuan
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | | | - Yanping Li
- Department of Breast Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
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Najjar MK, Manore SG, Regua AT, Lo HW. Antibody-Drug Conjugates for the Treatment of HER2-Positive Breast Cancer. Genes (Basel) 2022; 13:2065. [PMID: 36360302 PMCID: PMC9691220 DOI: 10.3390/genes13112065] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 11/03/2022] [Accepted: 11/04/2022] [Indexed: 11/09/2022] Open
Abstract
Human epidermal growth factor receptor 2 (HER2) receptor tyrosine kinase is overexpressed in 20-30% of breast cancers and is associated with poor prognosis and worse overall patient survival. Most women with HER2-positive breast cancer receive neoadjuvant chemotherapy plus HER2-targeted therapies. The development of HER2-directed therapeutics is an important advancement in targeting invasive breast cancer. Despite the efficacy of anti-HER2 monoclonal antibodies, they are still being combined with adjuvant chemotherapy to improve overall patient outcomes. Recently, significant progress has been made towards the development of a class of therapeutics known as antibody-drug conjugates (ADCs), which leverage the high specificity of HER2-targeted monoclonal antibodies with the potent cytotoxic effects of various small molecules, such as tubulin inhibitors and topoisomerase inhibitors. To date, two HER2-targeting ADCs have been approved by the FDA for the treatment of HER2-positive breast cancer: Ado-trastuzumab emtansine (T-DM1; Kadcyla®) and fam-trastuzumab deruxtecan-nxki (T-Dxd; Enhertu®). Kadcyla and Enhertu are approved for use as a second-line treatment after trastuzumab-taxane-based therapy in patients with HER2-positive breast cancer. The success of ADCs in the treatment of HER2-positive breast cancer provides novel therapeutic advancements in the management of the disease. In this review, we discuss the basic biology of HER2, its downstream signaling pathways, currently available anti-HER2 therapeutic modalities and their mechanisms of action, and the latest clinical and safety characteristics of ADCs used for the treatment of HER2-positive breast cancer.
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Affiliation(s)
- Mariana K. Najjar
- Wake Forest Graduate School of Biomedical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Sara G. Manore
- Wake Forest Graduate School of Biomedical Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Angelina T. Regua
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, MSE R162, 6431 Fannin Street, Houston, TX 77030, USA
| | - Hui-Wen Lo
- Department of Neurosurgery, McGovern Medical School, University of Texas Health Science Center at Houston, MSE R162, 6431 Fannin Street, Houston, TX 77030, USA
- Department of Cancer Biology, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
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5
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Strategies for Mitigating Antibody-Drug Conjugate Related Adverse Events for Precision Therapy. Cancer J 2022; 28:496-507. [DOI: 10.1097/ppo.0000000000000627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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D'Angelo A, Chapman R, Sirico M, Sobhani N, Catalano M, Mini E, Roviello G. An update on antibody-drug conjugates in urothelial carcinoma: state of the art strategies and what comes next. Cancer Chemother Pharmacol 2022; 90:191-205. [PMID: 35953604 PMCID: PMC9402760 DOI: 10.1007/s00280-022-04459-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2022] [Accepted: 07/22/2022] [Indexed: 11/30/2022]
Abstract
In recent years, considerable progress has been made in increasing the knowledge of tumour biology and drug resistance mechanisms in urothelial cancer. Therapeutic strategies have significantly advanced with the introduction of novel approaches such as immune checkpoint inhibitors and Fibroblast Growth Factor Receptor inhibitors. However, despite these novel agents, advanced urothelial cancer is often still progressive in spite of treatment and correlates with a poor prognosis. The introduction of antibody–drug conjugates consisting of a target-specific monoclonal antibody covalently linked to a payload (cytotoxic agent) is a novel and promising therapeutic strategy. In December 2019, the US Food and Drug Administration (FDA) granted accelerated approval to the nectin-4-targeting antibody–drug conjugate, enfortumab vedotin, for the treatment of advanced or metastatic urothelial carcinomas that are refractory to both immune checkpoint inhibitors and platinum-based treatment. Heavily pre-treated urothelial cancer patients reported a significant, 40% response to enfortumab vedotin while other antibody–drug conjugates are currently still under investigation in several clinical trials. We have comprehensively reviewed the available treatment strategies for advanced urothelial carcinoma and outlined the mechanism of action of antibody–drug conjugate agents, their clinical applications, resistance mechanisms and future strategies for urothelial cancer.
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Affiliation(s)
- Alberto D'Angelo
- Department of Biology and Biochemistry, University of Bath, Bath, BA2 7AY, UK.
| | - Robert Chapman
- Department of Medicine, Princess Alexandra Hospital NHS Foundation Trust, Harlow, CM20 1QX, UK
| | - Marianna Sirico
- Department of Medical Oncology, IRCCS Istituto Romagnolo per lo Studio dei Tumori (IRST) "Dino Amadori", Meldola, Italy
| | - Navid Sobhani
- Section of Epidemiology and Population Science, Department of Medicine, Baylor College of Medicine, Houston, TX, 77030, USA
| | - Martina Catalano
- School of Human Health Sciences, University of Florence, Largo Brambilla 3, 50134, Florence, Italy
| | - Enrico Mini
- Department of Health Sciences, University of Florence, vialePieraccini, 6, 50139, Florence, Italy
| | - Giandomenico Roviello
- Department of Health Sciences, University of Florence, vialePieraccini, 6, 50139, Florence, Italy
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Omarini C, Piacentini F, Sperduti I, Cerma K, Barbolini M, Canino F, Nasso C, Isca C, Caggia F, Dominici M, Moscetti L. T-DM1 efficacy in trastuzumab-pertuzumab pre-treated HER2 positive metastatic breast cancer patients: a meta-analysis. BMC Cancer 2022; 22:623. [PMID: 35672679 PMCID: PMC9172020 DOI: 10.1186/s12885-022-09556-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 04/17/2022] [Indexed: 11/23/2022] Open
Abstract
Background Current guidelines consider T-DM1 the standard 2nd line therapy for HER2 positive metastatic breast cancer (MBC) patients following trastuzumab (T) + pertuzumab (P) and taxane 1st line treatment. Despite this, there are no prospective studies supporting this sequence. Methods We performed a meta-analysis using real world data to determine the efficacy of T-DM1 after 1st line TP in HER2 positive MBC patients. We used a random-effect model to find differences in the rate of 1-year progression free survival (PFS) between TP pre-treated population and the EMILIA phase III pivotal trial. Results Seven studies were eligible. The meta-analysis showed a combined 1-year PFS risk difference for T-DM1 efficacy after TP in 2nd or more lines of -0.122, with lower and upper limits of -0.253 and 0.010, respectively (p = 0.07), with low heterogeneity among studies (I2 0.01%, p = 0.836). Considering the four studies on T-DM1 in 2nd line setting, 1-year PFS risk was -0.034 (95% CI -0.207 – 0,139; p = 0.701) (I2 0.01%, p = 0.91). Conclusion Overall, the efficacy of T-DM1 after TP seems to be similar to that previously reported in the EMILIA trial. In the second line setting, data are not mature enough to confirm T-DM1 efficacy in TP pre-treated population. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09556-7.
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Affiliation(s)
- Claudia Omarini
- Division of Medical Oncology, University Hospital of Modena, Via del Pozzo 71, 41122, Modena, Italy.
| | - Federico Piacentini
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Isabella Sperduti
- Department of Bio-Statistics, RCCS Regina Elena National Cancer Institute, 00144, Rome, Italy
| | - Krisida Cerma
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Monica Barbolini
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Fabio Canino
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Cecilia Nasso
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Christel Isca
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Federica Caggia
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Massimo Dominici
- Department of Medical and Surgical Sciences for Children & Adults, University Hospital of Modena, Modena, Italy
| | - Luca Moscetti
- Division of Medical Oncology, University Hospital of Modena, Via del Pozzo 71, 41122, Modena, Italy
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Tricarico D, Convertino AS, Mehmeti I, Ranieri G, Leonetti F, Laface C, Zizzo N. Inflammatory Related Reactions in Humans and in Canine Breast Cancers, A Spontaneous Animal Model of Disease. Front Pharmacol 2022; 13:752098. [PMID: 35222017 PMCID: PMC8873370 DOI: 10.3389/fphar.2022.752098] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Inflammatory cells are emerging markers in various cancers in human trials. The relationship between the inflammatory cells response, cancer grade, and progression has been investigated experimentally in a spontaneous canine model of breast cancer and in the unselected population (18–64 years.o.) under anti-HER2 treatments that represent the most prevalent population in this cancer type. The canine data (N samples = 101) were collected retrospectively for diagnosis in our regional area and evaluated by immunohistochemistry and haemato-chemistry. The inflammatory and immune-related adverse reactions (ADR) in humans were evaluated using EudraVigilance. The “Proportional Reporting Ratio” (PRR) of the mabs was calculated for each ADR with values >2 indicative of high risk. In dogs, we found elevated immunostaining of CD68-macrophages in the lymph node of the aggressive cancer G3 and infiltrating CD20+-lymphocyte. A high density of CD20 + lymphocytes was observed in G1 and a decrease in the density was observed with the histological degree of the tumors. The animals with the sample in G1 showed reduced serum platelet and neutrophil count and elevated lymphocytes and the opposite in severely affected animals. Inflammatory reactions with edema, skin reactions, extravasation, loss of effectiveness, and platelet count decrease (PRR > 13) were found with trastuzumab emtansine in humans, in the absence of immune system reactions. Trastuzumab i.v.-s.c. showed immune system reactions, loss of effectiveness, intolerances with drug withdrawal, technological issues (PRR > 7), and neutrophil count decrease reports. These reactions were less frequently reported for pertuzumab i.v. Case reports of platelet and neutrophil count decrease were not associated with disease progression with a better outcome in humans as in canine breast cancer. Therefore, infiltrating CD68-macrophages are associated with G3, while infiltrating CD20+ and elevated serum lymphocytes in parallel with reduced platelet and neutrophil count play a favorable role in human and canine breast cancer.
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Affiliation(s)
- Domenico Tricarico
- Department of Pharmacy‐Pharmaceutical Sciences, University Aldo Moro, Bari, Italy
- *Correspondence: Domenico Tricarico,
| | - Anna Sara Convertino
- Department of Pharmacy‐Pharmaceutical Sciences, University Aldo Moro, Bari, Italy
| | - Irsida Mehmeti
- Department of Pharmaceutical Science, Faculty of Pharmacy, “Catholic University Our Lady of Good Counsel”, Tirana, Albania
| | - Girolamo Ranieri
- Interventional and Medical Oncology Unit, Department of Pathology National Cancer Research Centre, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Francesco Leonetti
- Department of Pharmacy‐Pharmaceutical Sciences, University Aldo Moro, Bari, Italy
| | - Carmelo Laface
- Interventional and Medical Oncology Unit, Department of Pathology National Cancer Research Centre, IRCCS Istituto Tumori Giovanni Paolo II, Bari, Italy
| | - Nicola Zizzo
- Section of Veterinary Pathology and Comparative Oncology, Department of Veterinary Medicine, University of Bari “Aldo Moro”, Bari, Italy
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Díaz-Rodríguez E, Gandullo-Sánchez L, Ocaña A, Pandiella A. Novel ADCs and Strategies to Overcome Resistance to Anti-HER2 ADCs. Cancers (Basel) 2021; 14:154. [PMID: 35008318 PMCID: PMC8750930 DOI: 10.3390/cancers14010154] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/27/2021] [Accepted: 12/27/2021] [Indexed: 12/23/2022] Open
Abstract
During recent years, a number of new compounds against HER2 have reached clinics, improving the prognosis and quality of life of HER2-positive breast cancer patients. Nonetheless, resistance to standard-of-care drugs has motivated the development of novel agents, such as new antibody-drug conjugates (ADCs). The latter are a group of drugs that benefit from the potency of cytotoxic agents whose action is specifically guided to the tumor by the target-specific antibody. Two anti-HER2 ADCs have reached the clinic: trastuzumab-emtansine and, more recently, trastuzumab-deruxtecan. In addition, several other HER2-targeted ADCs are in preclinical or clinical development, some of them with promising signs of activity. In the present review, the structure, mechanism of action, and potential resistance to all these ADCs will be described. Specific attention will be given to discussing novel strategies to circumvent resistance to ADCs.
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Affiliation(s)
- Elena Díaz-Rodríguez
- Instituto de Biología Molecular y Celular del Cáncer, CSIC-IBSAL and CIBERONC, 37007 Salamanca, Spain; (E.D.-R.); (L.G.-S.)
- Departamento de Bioquímica y Biología Molecular, University of Salamanca, 37007 Salamanca, Spain
| | - Lucía Gandullo-Sánchez
- Instituto de Biología Molecular y Celular del Cáncer, CSIC-IBSAL and CIBERONC, 37007 Salamanca, Spain; (E.D.-R.); (L.G.-S.)
| | - Alberto Ocaña
- Hospital Clínico San Carlos, Centro de Investigación Biomédica en Red de Oncología (CIBERONC), 28040 Madrid, Spain;
| | - Atanasio Pandiella
- Instituto de Biología Molecular y Celular del Cáncer, CSIC-IBSAL and CIBERONC, 37007 Salamanca, Spain; (E.D.-R.); (L.G.-S.)
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10
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Pizzuti L, Krasniqi E, Sperduti I, Barba M, Gamucci T, Mauri M, Veltri EM, Meattini I, Berardi R, Di Lisa FS, Natoli C, Pistelli M, Iezzi L, Risi E, D’Ostilio N, Tomao S, Ficorella C, Cannita K, Riccardi F, Cassano A, Bria E, Fabbri MA, Mazzotta M, Barchiesi G, Botticelli A, D’Auria G, Ceribelli A, Michelotti A, Russo A, Salimbeni BT, Sarobba G, Giotta F, Paris I, Saltarelli R, Marinelli D, Corsi D, Capomolla EM, Sini V, Moscetti L, Mentuccia L, Tonini G, Raffaele M, Marchetti L, Minelli M, Ruggeri EM, Scavina P, Bacciu O, Salesi N, Livi L, Tinari N, Grassadonia A, Fedele Scinto A, Rossi R, Valerio MR, Landucci E, Stani S, Fratini B, Maugeri-Saccà M, De Tursi M, Maione A, Santini D, Orlandi A, Lorusso V, Cortesi E, Sanguineti G, Pinnarò P, Cappuzzo F, Landi L, Botti C, Tomao F, Cappelli S, Bon G, Pelle F, Cavicchi F, Fiorio E, Foglietta J, Scagnoli S, Marchetti P, Ciliberto G, Vici P. PANHER study: a 20-year treatment outcome analysis from a multicentre observational study of HER2-positive advanced breast cancer patients from the real-world setting. Ther Adv Med Oncol 2021; 13:17588359211059873. [PMID: 35173816 PMCID: PMC8842182 DOI: 10.1177/17588359211059873] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Accepted: 10/27/2021] [Indexed: 12/16/2022] Open
Abstract
Background: The evolution of therapeutic landscape of human epidermal growth factor
receptor-2 (HER2)-positive breast cancer (BC) has led to an unprecedented
outcome improvement, even if the optimal sequence strategy is still debated.
To address this issue and to provide a picture of the advancement of
anti-HER2 treatments, we performed a large, multicenter, retrospective study
of HER2-positive BC patients. Methods: The observational PANHER study included 1,328 HER2-positive advanced BC
patients treated with HER2 blocking agents since June 2000 throughout July
2020. Endpoints of efficacy were progression-free survival (PFS) and overall
survival (OS). Results: Patients who received a first-line pertuzumab-based regimen showed better PFS
(p < 0.0001) and OS (p = 0.004)
than those receiving other treatments. Median PFS and mOS from second-line
starting were 8 and 28 months, without significant differences among various
regimens. Pertuzumab-pretreated patients showed a mPFS and a mOS from
second-line starting not significantly affected by type of second line, that
is, T-DM1 or lapatinib/capecitabine (p = 0.80 and
p = 0.45, respectively). Conversely, pertuzumab-naïve
patients receiving second-line T-DM1 showed a significantly higher mPFS
compared with that of patients treated with lapatinib/capecitabine
(p = 0.004). Median OS from metastatic disease
diagnosis was higher in patients treated with trastuzumab-based first line
followed by second-line T-DM1 in comparison to pertuzumab-based first-line
and second-line T-DM1 (p = 0.003), although these data
might be partially influenced by more favorable prognostic characteristics
of patients in the pre-pertuzumab era. No significant
differences emerged when comparing patients treated with ‘old’ or ‘new’
drugs (p = 0.43), even though differences in the length of
the follow-up between the two cohorts should be taken into account. Conclusion: Our results confirmed a relevant impact of first-line pertuzumab-based
treatment and showed lower efficacy of second-line T-DM1 in
trastuzumab/pertuzumab pretreated, as compared with pertuzumab-naïve
patients. Our findings may help delineate a more appropriate therapeutic
strategy in HER2-positive metastatic BC. Prospective randomized trials
addressing this topic are awaited.
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Affiliation(s)
- Laura Pizzuti
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Eriseld Krasniqi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | - Isabella Sperduti
- Biostatistics Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Maddalena Barba
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, via Elio Chianesi 53, 00144 Rome, Italy
| | | | - Maria Mauri
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | | | - Icro Meattini
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences ‘Mario Serio’, Careggi University Hospital, University of Florence, Florence, Italy
| | - Rossana Berardi
- Oncology Clinic, ‘Ospedali iuniti di Ancona’ Hospital, Ancona, Italy
| | - Francesca Sofia Di Lisa
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, ‘Sapienza’ University of Rome, Umberto I University Hospital, Rome, Italy
| | - Clara Natoli
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Mirco Pistelli
- Oncology Clinic, ‘Ospedali Riuniti di Ancona’ Hospital, Ancona, Italy
| | - Laura Iezzi
- Oncology Division, Hospital ‘Maria SS. dello Splendore’ ASL 4, Giulianova, Italy
| | - Emanuela Risi
- Sandro Pitigliani Medical Oncology Department, Hospital of Prato, Prato, Italy
| | | | - Silverio Tomao
- Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, ‘Sapienza’ University of Rome, Umberto I University Hospital, Rome, Italy
| | - Corrado Ficorella
- Medical Oncology, Department of Biotechnological and Applied Clinical Sciences, University of L’Aquila, L’Aquila, Italy
| | | | | | - Alessandra Cassano
- U.O.C. Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Emilio Bria
- U.O.C. Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | | | - Marco Mazzotta
- Medical Oncology Unit, Belcolle Hospital, Viterbo, Italy
| | - Giacomo Barchiesi
- Medical Oncology A, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Anatomo-Pathological Sciences, ‘Sapienza’ University of Rome, Umberto I University Hospital, Rome, Italy
- Medical Oncology Unit, Ospedale dell’Angelo, Mestre, Italy
| | - Andrea Botticelli
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuliana D’Auria
- Medical Oncology, Sandro Pertini Hospital, Rome, Italy
- Paola ScavinaSan Giovanni Addolorata Hospital, 00184 Rome, Italy
| | - Anna Ceribelli
- Medical Oncology Unit, San Camillo de Lellis Hospital, ASL Rieti, Rieti, Italy
| | - Andrea Michelotti
- UO Medical Oncology I, S. Chiara Hospital, Pisa, Italy
- Oncology, Transplant and New Technologies Department, Pisa University Hospital, Pisa, Italy
| | - Antonio Russo
- Medical Oncology, AOU Policlinico Paolo Giaccone, Palermo, Italy
| | | | | | - Francesco Giotta
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Ida Paris
- Gynaecology – Oncology Unit, IRCCS Catholic University of the Sacred Heart, Rome, Italy
| | - Rosa Saltarelli
- UOC Oncology, San Giovanni Evangelista Hospital, ASL RM5, Rome, Italy
| | - Daniele Marinelli
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Domenico Corsi
- Medical Oncology Unit, Fatebenefratelli Hospital, Rome, Italy
| | | | | | - Luca Moscetti
- Division of Medical Oncology, Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Lucia Mentuccia
- Medical Oncology, Ospedale ‘Parodi-Delfino’, Colleferro, Italy
| | - Giuseppe Tonini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Mimma Raffaele
- UOSD Presidio Oncologico Cassia – S. Andrea, ASL Roma 1, Rome, Italy
| | - Luca Marchetti
- UOC Oncology, San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Mauro Minelli
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | | | | | - Olivia Bacciu
- Division of Oncology, San Giovanni Hospital, Rome, Italy
| | - Nello Salesi
- Medical Oncology Unit, Santa Maria Goretti, Latina, Italy
| | - Lorenzo Livi
- Radiation Oncology Unit and Department of Clinical and Experimental Biomedical Sciences ‘Mario Serio’, Careggi University Hospital, University of Florence, Florence, Italy
| | - Nicola Tinari
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Antonino Grassadonia
- Department of Medical, Oral and Biotrechnological Sciences and Centre for Advanced Studues and Echnology (CAST), G. D’Annunzio University, Chieti, Italy
| | | | | | | | - Elisabetta Landucci
- UO Medical Oncology I, S. Chiara Hospital, Pisa, Italy
- Oncology, Transplant and New Technologies Department, Pisa University Hospital, Pisa, Italy
| | | | - Beatrice Fratini
- UO Medical Oncology I, S. Chiara Hospital, Pisa, Italy
- Oncology, Transplant and New Technologies Department, Pisa University Hospital, Pisa, Italy
| | - Marcello Maugeri-Saccà
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Michele De Tursi
- Department of Medical, Oral and Biotechnological Sciences and Center for Advanced Studies and Technology (CAST), G. D’Annunzio University, Chieti, Italy
| | - Angela Maione
- Oncology Unit, Antonio Cardarelli Hospital, Naples, Italy
| | - Daniele Santini
- Department of Oncology, University Campus Biomedico of Rome, Rome, Italy
| | - Armando Orlandi
- U.O.C. Medical Oncology, Comprehensive Cancer Center, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vito Lorusso
- Department of Medical Oncology, IRCCS Giovanni Paolo II Institute, Bari, Italy
| | - Enrico Cortesi
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Paola Pinnarò
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federico Cappuzzo
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Lorenza Landi
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Claudio Botti
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Federica Tomao
- Department of Gynecologic Oncology, European Institute of Oncology (IEO) IRCCS, Milan, Italy
| | - Sonia Cappelli
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giulia Bon
- Cellular Network and Molecular Therapeutic Target Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Fabio Pelle
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Flavia Cavicchi
- Department of Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Elena Fiorio
- U.O.C. Oncology, University of Verona, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | | | - Simone Scagnoli
- Department of Medical and Surgical Sciences and Translational Medicine, Sapienza University of Rome, Rome, Italy
| | - Paolo Marchetti
- Medical Oncology B, Policlinico Umberto I, Rome, Italy
- Department of Radiological, Oncological and Pathological Sciences, Sapienza University of Rome, Rome, Italy
| | - Gennaro Ciliberto
- Scientific Direction, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Patrizia Vici
- Division of Medical Oncology 2, IRCCS Regina Elena National Cancer Institute, Rome, Italy
- Sperimentazioni di Fase IV, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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Her2-Positive Cancers and Antibody-Based Treatment: State of the Art and Future Developments. Cancers (Basel) 2021; 13:cancers13225771. [PMID: 34830927 PMCID: PMC8616515 DOI: 10.3390/cancers13225771] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 11/12/2021] [Accepted: 11/15/2021] [Indexed: 01/05/2023] Open
Abstract
HER2 positive breast cancer represent about 20% of all breast cancer subtypes and it was considered the subtype with the worst prognosis until the discovery of therapies directed against the HER2 protein. The determination of the status of the HER2 must be very precise and well managed to identify this subtype, and there are very specific and updated guides that allow its characterization to be adjusted. Treatment in local disease has been considerably improved with less aggressive and highly effective approaches and very high cure rates. In metastatic disease, average median survival rates of 5 years have been achieved. New highly active molecules have also been discovered that allow disease control in very complicated situations. This article reviews all these options that can be used for the management of this disease.
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12
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Ferraro E, Drago JZ, Modi S. Implementing antibody-drug conjugates (ADCs) in HER2-positive breast cancer: state of the art and future directions. Breast Cancer Res 2021; 23:84. [PMID: 34380530 PMCID: PMC8356386 DOI: 10.1186/s13058-021-01459-y] [Citation(s) in RCA: 117] [Impact Index Per Article: 39.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/20/2021] [Indexed: 12/12/2022] Open
Abstract
The development of anti-HER2 agents has been one of the most meaningful advancements in the management of metastatic breast cancer, significantly improving survival outcomes. Despite the efficacy of anti-HER2 monoclonal antibodies, concurrent chemotherapy is still needed to maximize response. Antibody-drug conjugates (ADCs) are a class of therapeutics that combines an antigen-specific antibody backbone with a potent cytotoxic payload, resulting in an improved therapeutic index. Two anti-HER2 ADCs have been approved by the FDA with different indications in HER2-positive breast cancer. Ado-trastuzumab emtansine (T-DM1) was the first-in-class HER2-targeting ADC, initially approved in 2013 for metastatic patients who previously received trastuzumab and a taxane, and the label was expanded in 2019 to include adjuvant treatment of high-risk patients with residual disease after neoadjuvant taxane and trastuzumab-based therapy. In 2020, trastuzumab deruxtecan (T-DXd) was the second approved ADC for patients who had received at least 2 lines of anti-HER2-based therapy in the metastatic setting. The success of these two agents has transformed the treatment of HER2-positive breast cancer and has re-energized the field of ADC development. Given their advanced pharmaceutical properties, next-generation HER2-targeted ADCs have the potential to be active beyond traditional HER2-positive breast cancer and may be effective in cells with low expression of HER2 or ERBB2 mutations, opening a spectrum of new possible clinical applications. Ongoing challenges include improving target-specificity, optimizing the toxicity profile, and identifying biomarkers for patient selection. The aim of this review is to summarize the principal molecular, clinical, and safety characteristics of approved and experimental anti-HER2 ADCs, contextualizing the current and future landscape of drug development.
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Affiliation(s)
- Emanuela Ferraro
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Joshua Z Drago
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Weil Cornell Medical College, New York, NY, USA
| | - Shanu Modi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, USA. .,Weil Cornell Medical College, New York, NY, USA.
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13
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Schettini F, Conte B, Buono G, De Placido P, Parola S, Griguolo G, Fabi A, Bighin C, Riccardi F, Cianniello D, De Laurentiis M, Puglisi F, Pelizzari G, Bonotto M, Russo S, Frassoldati A, Pazzola A, Montemurro F, Lambertini M, Guarneri V, Cognetti F, Locci M, Generali D, Conte P, De Placido S, Giuliano M, Arpino G, Del Mastro L. T-DM1 versus pertuzumab, trastuzumab and a taxane as first-line therapy of early-relapsed HER2-positive metastatic breast cancer: an Italian multicenter observational study. ESMO Open 2021; 6:100099. [PMID: 33819752 PMCID: PMC8047485 DOI: 10.1016/j.esmoop.2021.100099] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/06/2021] [Accepted: 02/27/2021] [Indexed: 02/06/2023] Open
Abstract
Background The current standard first-line treatment of human epidermal growth factor receptor 2 (HER2)-positive (+) metastatic breast cancer is the combination of pertuzumab, trastuzumab and a taxane (P + T + taxane), while standard second-line is ado-trastuzumab-emtansine (T-DM1). The registration trial of pertuzumab, however, did not include early-relapsing patients, defined as patients experiencing tumor relapse ≤12 months from the end of (neo)adjuvant anti-HER2 therapy. Conversely, the pivotal trial of T-DM1 included some patients relapsing ≤6 months after the end of (neo)adjuvant trastuzumab. Thus, a proportion of early-relapsing patients are currently eligible to receive T-DM1 as first-line treatment. Nevertheless, no direct comparison exists between the two regimens in this clinical setting. Patients and methods We retrospectively compared T-DM1 versus P + T + taxane as first-line treatment in two cohorts of early-relapsing patients in an Italian ‘real-world’ setting, involving 14 public health care institutions. The primary endpoint was progression-free survival. Secondary endpoints included patients' characterization, overall survival and post-progression survival. Univariate and multivariate analyses were carried out. All tests were two-sided and a P ≤ 0.05 was considered statistically significant. Results Among 1252 screened patients, 75 met the inclusion criteria. Forty-four (58.7%) received P + T + taxane and 31 (41.3%) received T-DM1. The two cohorts showed similar characteristics of aggressiveness and no significant differences in treatment history. T-DM1, compared with P + T + taxane was associated with worse progression-free survival (adjusted hazard ratio: 2.26, 95% confidence interval: 1.13-4.52, P = 0.021) and overall survival (adjusted hazard ratio: 3.95, 95% confidence interval: 1.38-11.32, P = 0.010), irrespective of previous (neo)adjuvant treatment, age, hormone receptors status, time-to-relapse (≤6 months or within 6-12 months) and presence of visceral/brain metastases. No differences were observed in post-progression survival (P = 0.095). Conclusions Our study suggests superiority for P + T + taxane over T-DM1 as up-front treatment of early-relapsing HER2+ metastatic breast cancer, which merits further assessment in larger and prospective trials. This is the first study comparing pertuzumab + trastuzumab + taxane (P + T + taxane) with T-DM1 in early-relapsing HER2+ MBC. The majority of early-relapsing HER2+ MBC have high-grade, node-positive, large primary tumors. First-line T-DM1 compared with P + T + taxane is associated with worse progression-free survival. First-line T-DM1 compared with P + T + taxane is associated with worse overall survival. Post-progression survival does not differ between the two treatments cohorts.
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Affiliation(s)
- F Schettini
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy; Translational Genomics and Targeted Therapies in Solid Tumors Group, August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Barcelona, Spain; SOLTI Breast Cancer Research Group, Barcelona, Spain.
| | - B Conte
- SOLTI Breast Cancer Research Group, Barcelona, Spain; Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - G Buono
- Oncology Unit, San Rocco Hospital, Sessa Aurunca, Italy
| | - P De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - S Parola
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Griguolo
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - A Fabi
- Division of Medical Oncology 1, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - C Bighin
- Medical Oncology Unit 2, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - F Riccardi
- Medical Oncology, 'A. Cardarelli' Hospital, Naples, Italy
| | - D Cianniello
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - M De Laurentiis
- National Cancer Institute Fondazione 'G. Pascale', Naples, Italy
| | - F Puglisi
- Department of Medicine (DAME), University of Udine, Udine, Italy; Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - G Pelizzari
- Department of Clinical Oncology, CRO Aviano National Cancer Institute, Aviano, Italy
| | - M Bonotto
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - S Russo
- Department of Oncology, ASUFC University Hospital, Udine, Italy
| | - A Frassoldati
- Oncology Unit, University Hospital St. Anna, Ferrara, Italy
| | - A Pazzola
- Division of Medical Oncology, AOU Sassari, Sassari, Italy
| | - F Montemurro
- Depertment of Medical Oncology, Candiolo Cancer Institute, Candiolo, Italy
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - V Guarneri
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - F Cognetti
- Department of Clinic and Molecular Medicine, 'La Sapienza' University of Rome, Rome, Italy
| | - M Locci
- Department of Neuroscience, Reproductive Medicine, Odontostomatology, University of Naples 'Federico II', Naples, Italy
| | - D Generali
- Breast Cancer Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy; Department of Medical, Surgery and Health Sciences, University of Trieste, Trieste, Italy
| | - P Conte
- Division of Oncology 2, Istituto Oncologico Veneto IRCCS, Padua, Italy; Department of Surgery, Oncology and Gastroenterology, University of Padova, Padua, Italy
| | - S De Placido
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - M Giuliano
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - G Arpino
- Department of Clinical Medicine and Surgery, University of Naples 'Federico II', Naples, Italy
| | - L Del Mastro
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genoa, Italy; U.O.S.D. Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
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14
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Molinelli C, Parisi F, Razeti MG, Arecco L, Cosso M, Fregatti P, Del Mastro L, Poggio F, Lambertini M. Trastuzumab emtansine (T-DM1) as adjuvant treatment of HER2-positive early breast cancer: safety and efficacy. Expert Rev Anticancer Ther 2020; 21:241-250. [PMID: 33245671 DOI: 10.1080/14737140.2021.1857243] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Introduction: The prognosis of patients with HER2-positive early breast cancer has radically improved after the introduction of (neo)adjuvant anti-HER2 targeted therapy. Trastuzumab emtansine (T-DM1) is an antibody-drug conjugate combining the anticancer properties of the anti-HER2 agent trastuzumab and the antineoplastic cytotoxic drug DM1. After demonstrating to be an effective and safe treatment for patients with HER2-positive advanced breast cancer, the development of T-DM1 has moved to the early setting.Areas covered: The aim of this review is to explore the current role of T-DM1 in the treatment landscape of HER2-positive early breast cancer, focusing specifically on the efficacy and safety data available in the adjuvant setting.Expert opinion: T-DM1 is an effective and safe treatment option in the adjuvant setting for patients with HER2-positive breast cancer without pathologic complete response after standard neoadjuvant chemotherapy plus anti-HER2 targeted therapy. With the availability of more effective anti-HER2 targeted agents, including T-DM1, there is an urgent need for more chemotherapy de-escalation research efforts in the early setting.
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Affiliation(s)
- Chiara Molinelli
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Francesca Parisi
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maria Grazia Razeti
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Arecco
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Maurizio Cosso
- Department of Radiology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Piero Fregatti
- Department of Surgery, U.O.C. Clinica di Chirurgia Senologica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Integrated Diagnostic Surgical Sciences, School of Medicine, University of Genova, Genova, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - Francesca Poggio
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Matteo Lambertini
- Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy.,Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova, Italy
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