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Cheang MCU, Martin M, Nielsen TO, Prat A, Voduc D, Rodriguez-Lescure A, Ruiz A, Chia S, Shepherd L, Ruiz-Borrego M, Calvo L, Alba E, Carrasco E, Caballero R, Tu D, Pritchard KI, Levine MN, Bramwell VH, Parker J, Bernard PS, Ellis MJ, Perou CM, Di Leo A, Carey LA. Defining breast cancer intrinsic subtypes by quantitative receptor expression. Oncologist 2015; 20:474-82. [PMID: 25908555 PMCID: PMC4425383 DOI: 10.1634/theoncologist.2014-0372] [Citation(s) in RCA: 113] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 03/18/2015] [Indexed: 12/18/2022] Open
Abstract
PURPOSE To determine intrinsic breast cancer subtypes represented within categories defined by quantitative hormone receptor (HR) and HER2 expression. METHODS We merged 1,557 cases from three randomized phase III trials into a single data set. These breast tumors were centrally reviewed in each trial for quantitative ER, PR, and HER2 expression by immunohistochemistry (IHC) stain and by reverse transcription-quantitative polymerase chain reaction (RT-qPCR), with intrinsic subtyping by research-based PAM50 RT-qPCR assay. RESULTS Among 283 HER2-negative tumors with <1% HR expression by IHC, 207 (73%) were basal-like; other subtypes, particularly HER2-enriched (48, 17%), were present. Among the 1,298 HER2-negative tumors, borderline HR (1%-9% staining) was uncommon (n = 39), and these tumors were heterogeneous: 17 (44%) luminal A/B, 12 (31%) HER2-enriched, and only 7 (18%) basal-like. Including them in the definition of triple-negative breast cancer significantly diminished enrichment for basal-like cancer (p < .05). Among 106 HER2-positive tumors with <1% HR expression by IHC, the HER2-enriched subtype was the most frequent (87, 82%), whereas among 127 HER2-positive tumors with strong HR (>10%) expression, only 69 (54%) were HER2-enriched and 55 (43%) were luminal (39 luminal B, 16 luminal A). Quantitative HR expression by RT-qPCR gave similar results. Regardless of methodology, basal-like cases seldom expressed ER/ESR1 or PR/PGR and were associated with the lowest expression level of HER2/ERBB2 relative to other subtypes. CONCLUSION Significant discordance remains between clinical assay-defined subsets and intrinsic subtype. For identifying basal-like breast cancer, the optimal HR IHC cut point was <1%, matching the American Society of Clinical Oncology and College of American Pathologists guidelines. Tumors with borderline HR staining are molecularly diverse and may require additional assays to clarify underlying biology.
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Affiliation(s)
- Maggie C U Cheang
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Miguel Martin
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Torsten O Nielsen
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Aleix Prat
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - David Voduc
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Alvaro Rodriguez-Lescure
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Amparo Ruiz
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Stephen Chia
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Lois Shepherd
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Manuel Ruiz-Borrego
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Lourdes Calvo
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Emilio Alba
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Eva Carrasco
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Rosalia Caballero
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Dongsheng Tu
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Kathleen I Pritchard
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Mark N Levine
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Vivien H Bramwell
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Joel Parker
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Philip S Bernard
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Matthew J Ellis
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Charles M Perou
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Angelo Di Leo
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
| | - Lisa A Carey
- Lineberger Comprehensive Cancer Center and Department of Genetics, University of North Carolina, Chapel Hill, North Carolina, USA; Clinical Trials and Statistics Unit at The Institute of Cancer Research, London, United Kingdom; Servicio de Oncología Médica, Instituto de Investigacion Sanitaria Hospital Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense, Madrid, Spain; Department of Pathology, University of British Columbia, Vancouver, British Columbia, Canada; Translation Genomics Unit, Vall d´Hebron Institute of Oncology, Barcelona, Spain; British Columbia Cancer Agency, Vancouver, British Columbia, Canada; Department of Medical Oncology, Hospital General Universitario de Elche, Alicante, Spain; Department of Medical Oncology, Instituto Valenciano de Oncologia, Valencia, Spain; National Cancer Institute of Canada Clinical Trials Group, Kingston, Ontario, Canada; Department of Medical Oncology, Hospital Universitario Virgen del Rocio, Seville, Spain; Department of Medical Oncology, Complejo Hospitalario Universitario A Coruña, Coruña, Spain; Department of Medical Oncology, Hospital Universitario Virgen de la Victoria, Málaga, Spain; GEICAM, Madrid, Spain; Sunnybrook Odette Cancer Centre, University of Toronto, Toronto, Ontario, Canada; McMaster University, Hamilton, Ontario, Canada; Department of Oncology, Tom Baker Cancer Centre, University of Calgary, Calgary, Alberta, Canada; Department of Pathology, University of Utah Health Sciences Center, Salt Lake City, Utah, USA; Department of Medicine, Washington University, St. Louis, Missouri, USA; Department of Oncology, Hospital of Prato, Istituto Toscani Tumori, Florence, Italy
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