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Frenel JS, Zeghondy J, Guérin-Charbonnel C, Mailliez A, Volant E, Poumeaud F, Patsouris A, Arnedos M, Bailleux C, Cabal J, Galland L, de Nonneville A, Guiu S, Dalenc F, Pistilli B, Bachelot T, Pierga JY, Le Du F, Bocquet F, Larrouquere L, Loirat D. Tucatinib Combination Treatment After Trastuzumab-Deruxtecan in Patients With ERBB2-Positive Metastatic Breast Cancer. JAMA Netw Open 2024; 7:e244435. [PMID: 38568692 PMCID: PMC10993071 DOI: 10.1001/jamanetworkopen.2024.4435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 02/01/2024] [Indexed: 04/05/2024] Open
Abstract
Importance Little is known regarding the outcomes associated with tucatinib combined with trastuzumab and capecitabine (TTC) after trastuzumab-deruxtecan exposure among patients with ERBB2 (previously HER2)-positive metastatic breast cancer (MBC). Objective To investigate outcomes following TTC treatment in patients with ERBB2-positive MBC who had previously received trastuzumab-deruxtecan. Design, Setting, and Participants This cohort study included all patients with MBC who were treated in 12 French comprehensive cancer centers between August 1, 2020, and December 31, 2022. Exposure Tucatinib combined with trastuzumab and capecitabine administered at the recommended dose. Main Outcomes and Measures Clinical end points included progression-free survival (PFS), time to next treatment (TTNT), overall survival (OS), and overall response rate (ORR). Results A total of 101 patients with MBC were included (median age, 56 [range, 31-85] years). The median number of prior treatment lines for metastatic disease at TTC treatment initiation was 4 (range, 2-15), including 82 patients (81.2%) with previous trastuzumab and/or pertuzumab and 94 (93.1%) with previous ado-trastuzumab-emtansine) exposure. The median duration of trastuzumab-deruxtecan treatment was 8.9 (range, 1.4-25.8) months, and 82 patients (81.2%) had disease progression during trastuzumab-deruxtecan treatment, whereas 18 (17.8%) had stopped trastuzumab-deruxtecan for toxic effects and 1 (1.0%) for other reasons. Tucatinib combined with trastuzumab and capecitabine was provided as a third- or fourth-line treatment in 37 patients (36.6%) and was the immediate treatment after trastuzumab-deruxtecan in 86 (85.1%). With a median follow-up of 11.6 (95% CI, 10.5-13.4) months, 76 of 101 patients (75.2%) stopped TTC treatment due to disease progression. The median PFS was 4.7 (95% CI, 3.9-5.6) months; median TTNT, 5.2 (95% CI, 4.5-7.0) months; and median OS, 13.4 (95% CI, 11.1 to not reached [NR]) months. Patients who received TTC immediately after trastuzumab-deruxtecan had a median PFS of 5.0 (95% CI, 4.2-6.0) months; median TTNT of 5.5 (95% CI, 4.8-7.2) months, and median OS of 13.4 (95% CI, 11.9-NR) months. Those who received TTC due to trastuzumab-deruxtecan toxicity-related discontinuation had a median PFS of 7.3 (95% CI, 3.0-NR) months. Best ORR was 29 of 89 patients (32.6%). Sixteen patients with active brain metastasis had a median PFS of 4.7 (95% CI, 3.0-7.3) months, median TTNT of 5.6 (95% CI, 4.4 to NR), and median OS of 12.4 (95% CI, 8.3-NR) months. Conclusions and Relevance In this study, TTC therapy was associated with clinically meaningful outcomes in patients with ERBB2-positive MBC after previous trastuzumab-deruxtecan treatment, including those with brain metastases. Prospective data on optimal drug sequencing in this rapidly changing therapeutic landscape are needed.
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Affiliation(s)
- Jean-Sebastien Frenel
- Department of Medical Oncology, Institut de Cancerologie de l’Ouest, Saint-Herblain, France
| | - Jean Zeghondy
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | | | - Audrey Mailliez
- Department of Medical Oncology, Oscar Lambret Comprehensive Cancer Center, Lille, France
| | - Elsa Volant
- Department of Medical Oncology, Institut de Cancerologie de l’Ouest, Saint-Herblain, France
| | | | - Anne Patsouris
- Department of Medical Oncology, Institut de Cancerologie de l’Ouest, Angers, France
| | - Monica Arnedos
- Department of Medical Oncology Bordeaux, Institut Bergonie, Bordeaux, France
| | - Caroline Bailleux
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Julie Cabal
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - Loick Galland
- Department of Medical Oncology, Centre Georges Francois Leclerc, Dijon, France
| | | | - Séverine Guiu
- Department of Medical Oncology, Montpellier Cancer Institute, Montpellier, France
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | | | - Fanny Le Du
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | - François Bocquet
- Data Factory, Institut de Cancerologie de l’Ouest, Saint-Herblain, France
| | | | - Delphine Loirat
- Department of Medical Oncology, Institut Curie, Paris, France
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Ginzac A, Molnar I, Durando X, Motte Rouge TDL, Petit T, D'hondt V, Campone M, Bonichon-Lamichhane N, Venat Bouvet L, Levy C, Augereau P, Pistilli B, Arsene O, Jouannaud C, Nguyen S, Cayre A, Tixier L, Mahier Ait Oukhatar C, Nabholtz JM, Penault-Llorca F, Mouret-Reynier MA. Neoadjuvant anthracycline-based (5-FEC) or anthracycline-free (docetaxel/carboplatin) chemotherapy plus trastuzumab and pertuzmab in HER2 + BC patients according to their TOP2A: a multicentre, open-label, non-randomized phase II trial. Breast Cancer Res Treat 2024:10.1007/s10549-024-07285-y. [PMID: 38453781 DOI: 10.1007/s10549-024-07285-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 02/07/2024] [Indexed: 03/09/2024]
Abstract
PURPOSE Previous studies have reported the benefit of dual HER2-targeting combined to neoadjuvant chemotherapy in HER2-amplified breast cancer (HER2 + BC). Moreover, besides the cardiac toxicity following their association to Trastuzumab, anthracyclines chemotherapy may not profit all patients. The NeoTOP study was designed to evaluate the complementary action of Trastuzumab and Pertuzumab, and the relevance of an anthracycline-based regimen according to TOP2A amplification status. METHODS Open-label, multicentre, phase II study. Eligible patients were aged ≥ 18 with untreated, operable, histologically confirmed HER2 + BC. After centralized review of TOP2A status, TOP2A-amplified (TOP2A+) patients received FEC100 for 3 cycles then 3 cycles of Trastuzumab (8 mg/kg then 6 mg/kg), Pertuzumab (840 mg/kg then 420 mg/kg), and Docetaxel (75mg/m2 then 100mg/m2). TOP2A-not amplified (TOP2A-) patients received 6 cycles of Docetaxel (75mg/m2) and Carboplatin (target AUC 6 mg/ml/min) plus Trastuzumab and Pertuzumab. Primary endpoint was pathological Complete Response (pCR) using Chevallier's classification. Secondary endpoints included pCR (Sataloff), Progression-Free Survival (PFS), Overall Survival (OS), and toxicity. RESULTS Out of 74 patients, 41 and 33 were allocated to the TOP2A + and TOP2A- groups respectively. pCR rates (Chevallier) were 74.4% (95%CI: 58.9-85.4) vs. 71.9% (95%CI: 54.6-84.4) in the TOP2A + vs. TOP2A- groups. pCR rates (Sataloff), 5-year PFS and OS were 70.6% (95%CI: 53.8-83.2) vs. 61.5% (95%CI: 42.5-77.6), 82.4% (95%CI: 62.2-93.6) vs. 100% (95%CI: 74.1-100), and 90% (95%CI: 69.8-98.3) vs. 100% (95%CI: 74.1-100). Toxicity profile was consistent with previous reports. CONCLUSION Our results showed high pCR rates with Trastuzumab and Pertuzumab associated to chemotherapy. They were similar in TOP2A + and TOP2A- groups and the current role of neoadjuvant anthracycline-based chemotherapy remains questioned. TRIAL REGISTRATION NUMBER NCT02339532 (registered on 14/12/14).
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Affiliation(s)
- Angeline Ginzac
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, Clermont-Ferrand, F- 63000, France.
- Centre d'Investigation Clinique UMR501, Clermont-Ferrand, F-63000, France.
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand, F-63000, France.
| | - Ioana Molnar
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, Clermont-Ferrand, F- 63000, France
- Centre d'Investigation Clinique UMR501, Clermont-Ferrand, F-63000, France
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand, F-63000, France
| | - Xavier Durando
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, Clermont-Ferrand, F- 63000, France
- Centre d'Investigation Clinique UMR501, Clermont-Ferrand, F-63000, France
- Département de Recherche Clinique, Délégation Recherche Clinique et Innovation, Centre Jean PERRIN, Clermont-Ferrand, F-63000, France
- Service d'oncologie médicale, Centre Jean PERRIN, Clermont-Ferrand, F-63000, France
| | | | - Thierry Petit
- Service d'oncologie médicale, Institut de Cancérologie Strasbourg Europe, Strasbourg, France
| | - Véronique D'hondt
- Service d'oncologie médicale, Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - Mario Campone
- Service d'oncologie médicale, Institut de Cancérologie de l'Ouest, René GAUDUCHEAU, Saint Herblain, France
| | | | | | - Christelle Levy
- Service d'oncologie médicale, Centre François BACLESSE, Caen, France
| | - Paule Augereau
- Service d'oncologie médicale, Institut de Cancérologie de l'Ouest, René GAUDUCHEAU, Saint Herblain, France
| | - Barbara Pistilli
- Service d'oncologie médicale, Institut Gustave ROUSSY, Villejuif, France
| | - Olivier Arsene
- Service d'oncologie médicale, Centre Hospitalier de Blois, Blois, France
| | | | - Suzanne Nguyen
- Service d'oncologie médicale, Centre Hospitalier de Pau, Pau, France
| | - Anne Cayre
- Service d'anatomopathologie, Centre Jean PERRIN, Clermont-Ferrand, France
| | - Lucie Tixier
- Service d'anatomopathologie, Centre Jean PERRIN, Clermont-Ferrand, France
| | | | - Jean-Marc Nabholtz
- Centre d'oncologie, Université King Saud (Medical City), Riyadh, Arabi Saoudite
| | - Frédérique Penault-Llorca
- INSERM U1240 Imagerie Moléculaire et Stratégies Théranostiques (IMoST), Université Clermont Auvergne, Clermont-Ferrand, F- 63000, France
- Service d'anatomopathologie, Centre Jean PERRIN, Clermont-Ferrand, France
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Bardia A, Jhaveri K, Kalinsky K, Pernas S, Tsurutani J, Xu B, Hamilton E, Im SA, Nowecki Z, Sohn J, Laurentiis MD, Jañez NM, Adamo B, Lee KS, Jung KH, Rubovszky G, Tseng LM, Lu YS, Yuan Y, Maxwell MJ, Haddad V, Khan SS, Rugo HS, Pistilli B. TROPION-Breast01: Datopotamab deruxtecan vs chemotherapy in pre-treated inoperable or metastatic HR+/HER2- breast cancer. Future Oncol 2024; 20:423-436. [PMID: 37387213 DOI: 10.2217/fon-2023-0188] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Improving the prognosis for patients with metastatic HR+/HER2- breast cancer remains an unmet need. Patients with tumors that have progressed on endocrine therapy and/or are not eligible for endocrine therapy had limited treatment options beyond chemotherapy. Antibody-drug conjugates are a novel and promising treatment class in this setting. Datopotamab deruxtecan (Dato-DXd) consists of a TROP2-directed humanized IgG1 monoclonal antibody attached via a serum-stable cleavable linker to a topoisomerase I inhibitor payload. TROPION-Breast01 is an ongoing phase III study that is evaluating the efficacy and safety of Dato-DXd compared with investigator's choice of standard-of-care chemotherapy in patients with inoperable or metastatic HR+/HER2- breast cancer who have received one or two prior lines of systemic chemotherapy in the inoperable or metastatic setting. Clinical Trial Registration: NCT05104866 (ClinicalTrials.gov).
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Affiliation(s)
- Aditya Bardia
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Komal Jhaveri
- Memorial Sloan Kettering Cancer Center, New York, NY, USA
- Weill Cornell Medical College, New York, NY, USA
| | - Kevin Kalinsky
- Winship Cancer Institute at Emory University, Atlanta, GA, USA
| | - Sonia Pernas
- Institut Català d'Oncologia, IDIBELL, L'Hospitalet, Barcelona, Spain
| | | | - Binghe Xu
- National Cancer Center / National Clinical Research Center for Cancer / Cancer Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Erika Hamilton
- Sarah Cannon Research Institute / Tennessee Oncology, Nashville, TN, USA
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Zbigniew Nowecki
- Maria Sklodowska-Curie National Research Institute of Oncology, Warsaw, Poland
| | - Joohyuk Sohn
- Yonsei University College of Medicine, Seoul, Republic of Korea
| | | | - Noelia Martínez Jañez
- Ramón y Cajal University Hospital, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Barbara Adamo
- August Pi i Sunyer Biomedical Research Institute (IDIBAPS), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Keun Seok Lee
- Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | - Kyung Hae Jung
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | - Ling-Ming Tseng
- Comprehensive Breast Health Center, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yen-Shen Lu
- National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yuan Yuan
- Formerly City of Hope Comprehensive Cancer Center, Duarte, CA, USA; Currently: Cedars-Sinai Cancer Center, Los Angeles, CA, USA
| | | | | | | | - Hope S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
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Ferrigno Guajardo AS, Vaca-Cartagena BF, Mayer EL, Bousrih C, Oluchi O, Saura C, Peccatori F, Muñoz-Montaño W, Cabrera-Garcia A, Lambertini M, Corrales L, Becerril-Gaitan A, Sella T, Newman AB, Pistilli B, Martinez A, Ortiz C, Joval-Ramentol L, Scarfone G, Buonomo B, Lara-Medina F, Sanchez J, Arecco L, Ramos-Esquivel A, Susnjar S, Morgan G, Villarreal-Garza C, Azim HA. Taxanes for the treatment of breast cancer during pregnancy: an international cohort study. J Natl Cancer Inst 2024; 116:239-248. [PMID: 38059798 DOI: 10.1093/jnci/djad219] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 09/19/2023] [Accepted: 10/11/2023] [Indexed: 12/08/2023] Open
Abstract
INTRODUCTION The addition of taxanes to anthracycline-based chemotherapy is considered standard of care in the treatment of breast cancer. However, there are insufficient data regarding the safety of taxanes during pregnancy. The aim of this study was to describe the incidence of obstetric and neonatal adverse events associated with the use of taxane-containing chemotherapy regimens for the treatment of breast cancer during pregnancy. METHODS This is a multicenter, international cohort study of breast cancer patients treated with taxanes during pregnancy. A descriptive analysis was undertaken to synthetize available data. RESULTS A total of 103 patients were included, most of whom were treated with paclitaxel and anthracyclines given in sequence during gestation (90.1%). The median gestational age at taxane initiation was 28 weeks (range = 12-37 weeks). Grade 3-4 adverse events were reported in 7 of 103 (6.8%) patients. The most common reported obstetric complications were intrauterine growth restriction (n = 8 of 94, 8.5%) and preterm premature rupture of membranes (n = 5 of 94, 5.3%). The live birth rate was 92 of 94 (97.9%), and the median gestational age at delivery was 37 weeks (range = 32-40 weeks). Admission to an intensive care unit was reported in 14 of 88 (15.9%) neonates, and 17 of 70 (24.3%) live births resulted in small for gestational age neonates. Congenital malformations were reported in 2 of 93 (2.2%). CONCLUSION Obstetric and neonatal outcomes after taxane exposure during pregnancy were generally favorable and did not seem to differ from those reported in the literature with standard anthracycline-based regimens. This study supports the use of taxanes during gestation when clinically indicated.
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Affiliation(s)
| | - Bryan F Vaca-Cartagena
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Erica L Mayer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Chayma Bousrih
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Oke Oluchi
- Department of General Oncology and Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Cristina Saura
- Medical Oncology Service, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Fedro Peccatori
- Gynecologic Oncology Program, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS) European Institute of Oncology, Milan, Italy
| | - Wendy Muñoz-Montaño
- Clinica de Tumores Mamarios, Instituto Nacional de Cancerología, Ciudad de Mexico, Mexico
| | - Alvaro Cabrera-Garcia
- Servicio de Hematología, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, State of Mexico, Mexico
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Luis Corrales
- Department of Medical Oncology, Centro de Investigación y Manejo del Cáncer, San José, Costa Rica
| | | | - Tal Sella
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Department of Oncology, Sheba Medical Center, Tel HaShomer, Israel
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Ashley Martinez
- Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carolina Ortiz
- Medical Oncology Service, Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Laia Joval-Ramentol
- Oncology Data Science Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Giovanna Scarfone
- Gynecologic Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Barbara Buonomo
- Gynecologic Oncology Unit, Fondazione Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ca' Granda-Ospedale Maggiore Policlinico, Milan, Italy
| | - Fernando Lara-Medina
- Clinica de Tumores Mamarios, Instituto Nacional de Cancerología, Ciudad de Mexico, Mexico
| | - Jacqueline Sanchez
- Servicio de Hematología, Hospital Regional de Alta Especialidad de Ixtapaluca, Ixtapaluca, State of Mexico, Mexico
| | - Luca Arecco
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genova, Genova, Italy
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Ospedale Policlinico San Martino, Genova, Italy
| | - Allan Ramos-Esquivel
- Servicio de Oncología Medica, Hospital San Juan de Dios, Caja Costarricense de Seguro Social, San Jose, Costa Rica
| | - Snezana Susnjar
- Department of Medical Oncology, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | - Gilberto Morgan
- Division of Medical/Radiation Oncology and Hematology, Skåne University Hospital, Lund, Sweden
| | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
| | - Hatem A Azim
- Breast Cancer Center, Hospital Zambrano Hellion, Tecnologico de Monterrey, San Pedro Garza Garcia, Mexico
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Franzoi MA, Aupomerol M, Havas J, Soldato D, Lambertini M, Massarotti C, Hang H, Pistilli B, Fasse L, Tredan O, Gillanders E, Joly F, Cottu P, Mouret-Reynier MA, Tarpin C, Arnaud A, Everhard S, Martin AL, Di Meglio A, Vaz-Luis I. Investigating sexual health after breast cancer by longitudinal assessment of patient-reported outcomes. ESMO Open 2024; 9:102236. [PMID: 38350335 PMCID: PMC10937197 DOI: 10.1016/j.esmoop.2024.102236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 11/28/2023] [Accepted: 01/05/2024] [Indexed: 02/15/2024] Open
Abstract
BACKGROUND Sexual concerns are a major unaddressed need among survivors of breast cancer (BC) with significant negative effects on quality of life. We longitudinally analyzed sexual health over time, using patient-reported outcomes. METHODS Patients with stage I-III BC prospectively included from the CANcer TOxicity cohort (CANTO) provided data at diagnosis, then 1, 2, and 4 years afterward. Sexual concerns outcomes included poor body image (score ≤91/100), poor sexual functioning (≤16/100), poor sexual enjoyment (≤66/100), and sexual inactivity (EORTC QLQ-B23). Multivariate generalized estimating equation models assessed associations with sexual concerns after diagnosis, adjusting for age, sociodemographic, tumor, treatment, and clinical characteristics. RESULTS Nearly 78.1% among 7895 patients reported at least one sexual concern between diagnosis and 4 years' follow-up. Over time, the proportion of patients reporting sexual concerns either increased or remained constant with diagnosis. Less than half (46%, range 11.4-57) of the patients with sexual concerns reported the use of supportive care strategies, including gynecological or psychological consultations (range 11.4-57.4). Factors consistently associated with sexual concerns up to 4 years after diagnosis included already reporting the same concern at diagnosis [odds ratio (OR)poor body image 3.48 [95% confidence interval (CI) 3.11-3.89]; ORsexual inactivity 9.94 (95% CI 8.84-11.18), ORpoor sexual function 9.75 (95% CI 8.67-10.95), ORpoorsexual enjoyment 3.96 (95% CI 3.34-4.69)], endocrine therapy use [ORpoor body image 1.15 (95% CI 1.01-1.31); ORsexual inactivity 1.19 (95% CI 1.02-1.39), ORpoor sexual function 1.17 (95% CI 1.01-1.37), ORpoor sexual enjoyment 1.23 (95% CI 1.00-1.53)], and depression [ORpoor body image 2.00 (95% CI 1.72-2.34); ORsexual inactivity 1.66 (95% CI 1.40-1.97), ORpoor sexual function 1.69 (95% CI 1.43-2.00), ORpoor sexual enjoyment 1.94 (95% CI 1.50-2.51)]. Outcome-specific associations were also identified. CONCLUSIONS Sexual concerns seem frequent, persistent, and insufficiently addressed. Pretreatment concerns, endocrine therapy, and emotional distress are commonly associated factors. A proactive evaluation of sexual health across the care continuum is needed, to promptly identify patients suitable for multidisciplinary counseling, referral, and supportive interventions.
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Affiliation(s)
- M A Franzoi
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif.
| | - M Aupomerol
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - J Havas
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - D Soldato
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Gynecology Department, Policlinico San Martino, University of Genova, Genova; Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova
| | - C Massarotti
- Physiopatology of Human Reproduction Unit, IRCCS Ospedale Policlinico San Martino, Genova; Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal-Child Health (DiNOGMI department), School of Medicine, University of Genova, Genova, Italy
| | - H Hang
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - B Pistilli
- Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - L Fasse
- Interdisciplinary and Patient Pathway Department, Institut Gustave Roussy, Villejuif
| | | | - E Gillanders
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - F Joly
- Centre François Baclesse, Caen
| | | | | | - C Tarpin
- Institut Paoli Calmettes, Marseille
| | | | | | | | - A Di Meglio
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
| | - I Vaz-Luis
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, Villejuif
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6
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Benvenuti C, Laot L, Grinda T, Lambertini M, Pistilli B, Grynberg M. Is controlled ovarian stimulation safe in patients with hormone receptor-positive breast cancer receiving neoadjuvant chemotherapy? ESMO Open 2024; 9:102228. [PMID: 38232611 PMCID: PMC10803916 DOI: 10.1016/j.esmoop.2023.102228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 12/20/2023] [Accepted: 12/21/2023] [Indexed: 01/19/2024] Open
Abstract
INTRODUCTION Controlled ovarian stimulation (COS) for oocyte/embryo cryopreservation is the method of choice for fertility preservation (FP) in young patients diagnosed with early-stage breast cancer (eBC). Nevertheless, some challenges still question its role, particularly in the neoadjuvant setting, where concerns arise about potential delay in the onset of anticancer treatment, and in hormone receptor-positive (HR+) disease, as cancer cells may proliferate under the estrogenic peak associated with stimulation. Therefore, this review aims to examine the available evidence on the safety of COS in eBC patients eligible for neoadjuvant treatment (NAT), particularly in HR+ disease. METHODS A comprehensive literature search was conducted to identify studies evaluating the feasibility and safety of COS in eBC and including patients referred to NAT and/or with HR+ disease. Time to NAT and survival outcomes were assessed. RESULTS Of the three matched cohort studies assessing the impact of COS on time to start NAT, only one reported a significant small delay in the cohort undergoing COS compared with the control group, whereas the other studies found no difference. Regarding survival outcomes, overall, no increased risk of recurrence or death was found, either in patients undergoing COS in the neoadjuvant setting regardless of HR expression or in HR+ disease regardless of the timing of COS relative to surgery. However, there are no data on the safety of COS in the specific combined scenario of HR+ disease undergoing NAT. CONCLUSION Neither the indication to NAT nor the HR positivity constitutes per se an a priori contraindication to COS. Shared decision making between clinicians and patients is essential to carefully weigh the risks and benefits in each individual case. Prospective studies designed to specifically investigate this issue are warranted.
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Affiliation(s)
- C Benvenuti
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy
| | - L Laot
- Department of Reproductive Medicine and Fertility Preservation, Université Paris-Saclay, Assistance Publique, Hôpitaux de Paris, Antoine Beclere Hospital, Clamart, France
| | - T Grinda
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - M Lambertini
- Department of Internal Medicine and Medical Specialties (DiMI), School of Medicine, University of Genova, Genova; Department of Medical Oncology, U.O.C. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - B Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.
| | - M Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Université Sorbonne Paris Nord, Assistance Publique-Hôpitaux de Paris, Jean Verdier Hospital, Bondy, France
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Balazard F, Bertaut A, Vaz-Luis I, Pistilli B. Response to Sorscher. J Natl Cancer Inst 2024; 116:174. [PMID: 37952229 DOI: 10.1093/jnci/djad234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Revised: 11/06/2023] [Accepted: 11/06/2023] [Indexed: 11/14/2023] Open
Affiliation(s)
| | | | - Ines Vaz-Luis
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Department of Supportive Care and Pathways (DIOPP) Oncology, Gustave Roussy, Villejuif, France
- INSERM 981, Gustave Roussy, Villejuif, France
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8
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Zeghondy J, Rassy E, Lapidari P, Eid R, Pistilli B. Telehealth in breast cancer following the coronavirus disease 2019 pandemic. Explor Target Antitumor Ther 2023; 4:1249-1259. [PMID: 38213534 PMCID: PMC10776597 DOI: 10.37349/etat.2023.00195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 11/07/2023] [Indexed: 01/13/2024] Open
Abstract
Breast cancer (BC) is the second most diagnosed cancer in 2018 with around 2.3 million cases globally in 2020. In March 2020 and after its worldwide spread, the World Health Organization (WHO) declared the coronavirus disease 2019 (COVID-19) outbreak, a respiratory disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, a pandemic. During this time, cancer patients were heavily impacted and their treatment plans were changed due to measures to fight the disease and solutions had to be found to maintain their follow-up and management from a distance. Some cancer groups worldwide have recommended then the use of telemedicine for oncology patients to ensure the continuity of medical care during the pandemic. This method was considered effective and clinicians worldwide continued using telehealth even after the cessation of worldwide restrictions. To this end, current up-to-date data on the use of telemedicine in BC patient after the COVID-19 outbreak are summarized in this narrative review.
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Affiliation(s)
- Jean Zeghondy
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
| | - Elie Rassy
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
| | - Pietro Lapidari
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
| | - Roland Eid
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
| | - Barbara Pistilli
- Medical Oncology Department, Gustave Roussy, F-94805 Villejuif, France
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9
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Bosi C, Bartha Á, Galbardi B, Notini G, Naldini MM, Licata L, Viale G, Mariani M, Pistilli B, Ali HR, André F, Piras M, Callari M, Barreca M, Locatelli A, Viganò L, Criscitiello C, Pusztai L, Curigliano G, Győrffy B, Dugo M, Bianchini G. Pan-cancer analysis of antibody-drug conjugate targets and putative predictors of treatment response. Eur J Cancer 2023; 195:113379. [PMID: 37913680 DOI: 10.1016/j.ejca.2023.113379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 10/09/2023] [Indexed: 11/03/2023]
Abstract
BACKGROUND Antibody-drug conjugates (ADCs) are a rapidly expanding class of compounds in oncology. Our goal was to assess the expression of ADC targets and potential downstream determining factors of activity across pan-cancer and normal tissues. MATERIALS AND METHODS ADCs in clinical trials (n = 121) were identified through ClinicalTrials.gov, corresponding to 54 targets. Genes potentially implicated in treatment response were identified in the literature. Gene expression from The Cancer Genome Atlas (9000+ cancers of 31 cancer types), the Genotype-Tissue Expression database (n = 19,000 samples from 31 normal tissue types), and the TNMplot.com (n = 12,494 unmatched primary and metastatic samples) were used in this analysis. To compare relative expression across and within tumour types we used pooled normal tissues as reference. RESULTS For most ADC targets, mRNA levels correlated with protein expression. Pan-cancer target expression distributions identified appealing cancer types for each ADC development. Co-expression of multiple targets was common and suggested opportunities for ADC combinations. Expression levels of genes potentially implicated in ADC response downstream of the target might provide additional information (e.g. TOP1 was highly expressed in many tumour types, including breast and lung cancers). Metastatic compared to primary tissues overexpressed some ADCs targets. Single sample "targetgram" plots were generated to visualise the expression of potentially competing ADC targets and resistance/sensitivity markers highlighting high inter-patient heterogeneity. Off-cancer target expression only partially explains adverse events, while expression of determinants of payload activity explained more of the observed toxicities. CONCLUSION Our findings draw attention to new therapeutic opportunities for ADCs that can be tested in the clinic and our web platform (https://tnmplot.com) can assist in prioritising upcoming ADC targets for clinical development.
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Affiliation(s)
- Carlo Bosi
- Università Vita-Salute San Raffaele, Milan, Italy; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Áron Bartha
- Department of Bioinformatics, Semmelweis University, Tűzoltó Utca 7-9, 1094 Budapest, Hungary; Research Centre for Natural Sciences, Oncology Biomarker Research Group, Institute of Molecular Life Sciences, Eötvös Loránd Research Network, Magyar Tudósok Körútja 2, 1117 Budapest, Hungary
| | - Barbara Galbardi
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulia Notini
- Università Vita-Salute San Raffaele, Milan, Italy; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Matteo M Naldini
- Università Vita-Salute San Raffaele, Milan, Italy; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Luca Licata
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Giulia Viale
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Marco Mariani
- Università Vita-Salute San Raffaele, Milan, Italy; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - H Raza Ali
- CRUK Cambridge Institute, University of Cambridge, Cambridge, UK; Department of Histopathology, Addenbrookes Hospital, Cambridge, UK
| | - Fabrice André
- Department of Medical Oncology, Gustave Roussy Cancer Center, Villejuif, France
| | - Marta Piras
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | | | | | - Alberta Locatelli
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Lucia Viganò
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Carmen Criscitiello
- Division of Early Drug Development, European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | - Lajos Pusztai
- Department of Internal Medicine, Section of Medical Oncology, Yale School of Medicine, New Haven, CT, USA
| | - Giuseppe Curigliano
- Division of Early Drug Development, European Institute of Oncology, IRCCS, Milano, Italy; Department of Oncology and Hemato-Oncology, University of Milano, Milano, Italy
| | - Balázs Győrffy
- Department of Bioinformatics, Semmelweis University, Tűzoltó Utca 7-9, 1094 Budapest, Hungary; Research Centre for Natural Sciences, Oncology Biomarker Research Group, Institute of Molecular Life Sciences, Eötvös Loránd Research Network, Magyar Tudósok Körútja 2, 1117 Budapest, Hungary
| | - Matteo Dugo
- Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.
| | - Giampaolo Bianchini
- Università Vita-Salute San Raffaele, Milan, Italy; Department of Medical Oncology, IRCCS Ospedale San Raffaele, Milan, Italy.
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Kabirian R, Franzoi MA, Havas J, Coutant C, Tredan O, Levy C, Cottu P, Dhaini Mérimèche A, Guillermet S, Ferrero JM, Giacchetti S, Petit T, Dalenc F, Rouanet P, Everhard S, Martin AL, Pistilli B, Lambertini M, Vaz-Luis I, Di Meglio A. Chemotherapy-Related Amenorrhea and Quality of Life Among Premenopausal Women With Breast Cancer. JAMA Netw Open 2023; 6:e2343910. [PMID: 37971739 PMCID: PMC10654794 DOI: 10.1001/jamanetworkopen.2023.43910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Accepted: 09/28/2023] [Indexed: 11/19/2023] Open
Abstract
Importance Younger survivors of breast cancer frequently report more treatment-related symptoms, mostly related to the menopausal transition. Objective To assess factors associated with chemotherapy-related amenorrhea (CRA) and to evaluate its association with long-term quality of life (QOL). Design, Setting, and Participants The prospective, longitudinal Cancer Toxicities Study, a multicenter French cohort study, includes women with a diagnosis of stage I to III breast cancer and collects data approximately yearly after diagnosis. The current study reports outcomes up to 4 years after diagnosis for participants enrolled from 2012 to 2017. Participants included premenopausal women younger than 50 years treated with chemotherapy and not receiving adjuvant ovarian function suppression. Data analysis was performed from September 2021 to June 2023. Exposures Clinical, socioeconomic, tumor, and treatment characteristics assessed at diagnosis (for the analysis of factors associated with CRA) and persistent CRA (for the QOL analysis). Main Outcomes and Measures The main outcome of interest was CRA at year 1 (Y1), year 2 (Y2), and year 4 (Y4) after diagnosis. Generalized estimating equations assessed associations of exposure variables with CRA. In the QOL analysis, QOL at Y4 (assessed with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaires C30 and BR23) was the outcome of interest. Multivariable random-effect mixed models assessed the association of persistent CRA (ie, never recovering menses after treatment) with QOL. Results Among 1636 women, the mean (SD) age at diagnosis was 42.2 (5.6) years. Overall, 1242 of 1497 women (83.0%) reported CRA at Y1, 959 of 1323 women (72.5%) reported it at Y2, and 599 of 906 women (66.1%) reported it at Y4. Older age vs 18 to 34 years (adjusted odds ratio [OR] for 35 to 39 years, 1.84 [95% CI, 1.32 to 2.56]; adjusted OR for 40 to 44 years, 5.90 [95% CI, 4.23 to 8.24]; and adjusted OR for ≥45 years, 21.29 [95% CI, 14.34 to 31.61]) and receipt of adjuvant tamoxifen (adjusted OR, 1.97 [95% CI, 1.53 to 2.53]) were associated with higher likelihood of CRA. In the QOL analysis, 416 of 729 women (57.1%) had persistent CRA. However, late menses recovery among women aged 18 to 34 years with no menses at Y2 were reported by 11 of 21 women (52.4%) between Y2 and Y4. Persistent CRA was associated with worse insomnia (mean difference vs recovery at any time, 9.9 points [95% CI, 3.2 to 16.5 points]; P = .004), systemic therapy-related adverse effects (mean difference, 3.0 points [95% CI, 0.2 to 5.8 points]; P = .04), and sexual functioning (mean difference, -9.2 points [95% CI, -14.3 to -4.1 points]; P < .001) at Y4. Conclusions and Relevance In this cohort study of premenopausal women with breast cancer, persistent CRA was common, although some women recovered menses late, and was associated with worse long-term QOL. This study can help inform risk communication, personalized counseling, and early supportive care referrals for such patients.
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Affiliation(s)
- Rayan Kabirian
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Sorbonne Université, Paris, France
| | - Maria Alice Franzoi
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Julie Havas
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | | | | | | | | | - Asma Dhaini Mérimèche
- Institut de Cancérologie de Lorraine–Alexis Vautrin, Vandœuvre-lès-Nancy, France
- Now with Centre Hospitalier de Lunéville-Ghemm, Pôle Mère-Enfant, Lunéville, France
| | | | | | | | - Thierry Petit
- Centre Paul Strauss Centre de Lutte Contre le Cancer, Strasbourg, France
| | | | | | | | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Matteo Lambertini
- Department of Internal Medicine and Medical Specialties, School of Medicine University of Genova, Genova, Italy
- Department of Medical Oncology, UO Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Ines Vaz-Luis
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Département Interdisciplinaire d’Organisation des Parcours Patients, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
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11
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Criscitiello C, Corti C, De Laurentiis M, Bianchini G, Pistilli B, Cinieri S, Castellan L, Arpino G, Conte P, Di Meco F, Gennari A, Guarneri V, Visani L, Livi L, Marchetti P, Puglisi F, Viale G, Del Mastro L, De Placido S, Curigliano G. Tucatinib's journey from clinical development to clinical practice: New horizons for HER2-positive metastatic disease and promising prospects for brain metastatic spread. Cancer Treat Rev 2023; 120:102618. [PMID: 37639757 DOI: 10.1016/j.ctrv.2023.102618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
Approximately 20% of breast cancers (BCs) overexpress human epidermal growth factor receptor 2 (HER2), a transmembrane glycoprotein with tyrosine kinase activity, encoded by ERBB2 gene. Historically, HER2 overexpression has been linked with increased disease recurrence and a worse prognosis. However, the increasing availability of different anti-HER2 compounds and combinations is progressively improving HER2-positive BC outcome, thus requiring expertise to prioritize both overall survival (OS) prolongation and quality of life, without neglecting the accessibility to further treatment lines with a low attrition rate. In this context, tucatinib, an oral tyrosine kinase inhibitor, has recently been granted approval by regulatory agencies based on evidence from the HER2CLIMB, a clinical trial which randomized patients with metastatic BC to receive trastuzumab and capecitabine with either tucatinib or placebo. A distinctive feature of this study was the inclusion of patients with new or active brain metastases (BMs) at study entry, a population traditionally excluded from clinical trials. Thus, HER2CLIMB provides the first solid evidence of an OS benefit in patients with BC and BMs, addressing a long standing unmet medical need, especially given the high incidence of central nervous system metastatic spread in patients with HER2-positive disease. This review provides an overview of the molecular and clinical landscape of tucatinib for the treatment of advanced BC. It focuses on the technological journey that drove the development of this therapeutic innovation, from preclinical data to clinical practice.
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Affiliation(s)
- Carmen Criscitiello
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy.
| | - Chiara Corti
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy
| | - Michelino De Laurentiis
- Department of Breast and Thoracic Oncology, Istituto Nazionale Tumori IRCCS 'Fondazione Pascale', Napoli, Italy
| | - Giampaolo Bianchini
- Department of Medical Oncology, Ospedale San Raffaele, IRCCS, Milan, Italy; Vita-Salute San Raffaele University, Milan, Italy
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Saverio Cinieri
- Medical Oncology Unit, Ospedale di Summa A. Perrino, Brindisi, Italy
| | - Lucio Castellan
- Department of Diagnostic and Interventional Neuroradiology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Grazia Arpino
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Pierfranco Conte
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | | | - Alessandra Gennari
- Medical Oncology, "Maggiore della Carità" University Hospital, Novara, Italy; Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), Novara, Italy
| | - Valentina Guarneri
- Department of Surgery, Oncology and Gastroenterology (DISCOG), University of Padova, Padova, Italy; Medical Oncology 2, Istituto Oncologico Veneto, IRCCS, Padova, Italy
| | - Luca Visani
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Lorenzo Livi
- Department of Experimental and Clinical Biomedical Sciences Mario Serio, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Paolo Marchetti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Fabio Puglisi
- Department of Medical Oncology, National Cancer Institute, IRCCS, Aviano, Italy; Department of Medicine, University of Udine, Udine, Italy
| | - Giuseppe Viale
- Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy; Division of Pathology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Lucia Del Mastro
- Department of Medical Oncology, Breast Unit, IRCCS Ospedale Policlinico San Martino, Genoa, Italy; Department of Internal Medicine and Medical Specialties (DIMI), School of Medicine, University of Genoa, Genoa, Italy
| | - Sabino De Placido
- Department of Translational Medicine (DIMET), University of Eastern Piedmont (UPO), Novara, Italy
| | - Giuseppe Curigliano
- Division of New Drugs and Early Drug Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Oncology and Hematology-Oncology (DIPO), University of Milan, Milan, Italy
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12
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Mosele F, Montagnac G, Pistilli B, André F. Optimizing the potential of antibody-drug conjugates in oncology. Ann Oncol 2023; 34:964-967. [PMID: 37730120 DOI: 10.1016/j.annonc.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 08/24/2023] [Accepted: 08/25/2023] [Indexed: 09/22/2023] Open
Affiliation(s)
- F Mosele
- Department of Medical Oncology, Gustave Roussy, Villejuif; INSERM U981, Gustave Roussy, Villejuif.
| | | | - B Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif
| | - F André
- Department of Medical Oncology, Gustave Roussy, Villejuif; INSERM U981, Gustave Roussy, Villejuif; Faculty of Medicine, Université Paris-Saclay, Kremlin Bicêtre, France
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13
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Le Du F, Carton M, Bachelot T, Saghatchian M, Pistilli B, Brain E, Loirat D, Vanlemmens L, Vermeulin T, Emile G, Gonçalves A, Ung M, Robert M, Jaffre A, Desmoulins I, Jouannaud C, Uwer L, Marc Ferrero J, Mouret-Reynier MA, Jacot W, Chevrot M, Delaloge S, Diéras V. Real-World Impact of Adjuvant Anti-HER2 Treatment on Characteristics and Outcomes of Women With HER2-Positive Metastatic Breast Cancer in the ESME Program. Oncologist 2023; 28:e867-e876. [PMID: 37589218 PMCID: PMC10546827 DOI: 10.1093/oncolo/oyad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Accepted: 04/14/2023] [Indexed: 08/18/2023] Open
Abstract
BACKGROUND Although adjuvant cancer treatments increase cure rates, they may induce clonal selection and tumor resistance. Information still lacks as whether (neo)adjuvant anti-HER2 treatments impact the patterns of recurrence and outcomes of HER2-positive (HER2+) metastatic breast cancer (MBC). We aimed to assess this in the large multicenter ESME real-world database. PATIENTS AND METHODS We examined the characteristics and outcomes (overall survival (OS) and progression-free survival under first-line treatment (PFS1)) of HER2+ patients with MBC from the French ESME program with recurrent disease, as a function of the previous receipt of adjuvant trastuzumab. Multivariable analyses used Cox models adjusted for baseline demographic, prognostic factors, adjuvant treatment received, and disease-free interval. RESULTS Two thousand one hundred and forty-three patients who entered the ESME cohort between 2008 and 2017 had a recurrent HER2+ MBC. Among them, 56% had received (neo)adjuvant trastuzumab and 2.5% another anti-HER2 in this setting. Patients pre-exposed to trastuzumab were younger, had a lower disease-free interval, more HR-negative disease and more metastatic sites. While the crude median OS appeared inferior in patients exposed to adjuvant trastuzumab, as compared to those who did not (37.2 (95%CI 34.4-40.3) versus 53.5 months (95% CI: 47.6-60.1)), this difference disappeared in the multivariable model (HR = 1.05, 95%CI 0.91-1.22). The same figures were observed for PFS1. CONCLUSIONS Among patients with relapsed HER2+ MBC, the receipt of adjuvant trastuzumab did not independently predict for worse outcomes when adjusted to other prognostic factors.
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Affiliation(s)
- Fanny Le Du
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon-Bérard, Lyon, France
| | | | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie/Saint Cloud, Paris, France
| | - Delphine Loirat
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | | | | | - George Emile
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Mony Ung
- Department of Medical Oncology, Institut Claudius Regaud, IUCT-Oncopole, CRCT, Inserm, Toulouse, France
| | - Marie Robert
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest - René Gauducheau, Saint-Herblain, France
| | - Anne Jaffre
- Anne jaffré Department of Medical Information, Institut Bergonié, Bordeaux, France
| | | | | | - Lionel Uwer
- Institut de Cancérologie de Lorraine, Nancy, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | | | - William Jacot
- Department of Medical Oncology, Institut du cancer de Montpellier, Montpellier, France
| | - Michaël Chevrot
- Health Data and Partnership Department, Unicancer, Paris, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
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Giudici F, Pistilli B, Vaz-Luis I, Karimi M, Delaloge S, Bachelot T, Michiels S, Bardet A. Insights adjusting for non-adherence in randomized clinical trials: a reanalysis of an adjuvant trial of tamoxifen duration in early breast cancer. Br J Cancer 2023; 129:1516-1523. [PMID: 37697030 PMCID: PMC10628101 DOI: 10.1038/s41416-023-02420-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 08/23/2023] [Accepted: 08/30/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND Several randomized clinical trials provide evidence of the survival benefit of extended adjuvant tamoxifen in women with estrogen receptor (ER)-positive early breast cancer (BC). However, non-adherence may lead to underestimate treatment effects using intention to treat (ITT) methods. We reanalyzed a randomized trial using contemporary statistical methods adjusting for non-adherence. METHODS The TAM01 study was a phase 3 trial including women with early BC, who had completed 2-3 years of adjuvant tamoxifen between 1986 and 1995. Participants were randomly assigned to continue tamoxifen up to 10 years or to discontinue the treatment at randomization. Invasive disease-free survival (iDFS) and overall survival (OS) were estimated using marginal structural models (MSM) and rank preserving structural failure time model (RPSFTM). RESULTS Of 3830 patients enrolled, 2485 were randomized to extended tamoxifen, and 1345 to treatment discontinuation. The 10-year non-adherence rate in the extended group was 27.2%. Among women with ER-positive BC (n = 2402), extended tamoxifen was associated with a 45% and 21% relative improvement in iDFS by MSM and RPSFTM, respectively (Hazard Ratio (HR), 0.55; 95% Confidence Interval (CI), 0.48-0.64 and HR, 0.79; 95%CI, 0.67-0.95, respectively), a considerable greater benefit than in the ITT analysis (HR, 0.90; 95%CI, 0.81-0.99). The OS reanalysis revealed a substantial benefit of extended tamoxifen (MSM: HR, 0.70; 95%CI, 0.59-0.83; RPSFTM: HR, 0.85; 95%CI, 0.67-1.04), compared to the ITT analyses (HR, 0.94; 95%CI, 0.84-1.07). CONCLUSION This analysis emphasizes both the importance of adherence to hormonotherapy in hormone-receptor positive early BC and the usefulness of more complex statistical analyses.
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Affiliation(s)
- Fabiola Giudici
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
| | - Ines Vaz-Luis
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
- Breast Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy Institute, 114 Rue Edouard Vaillant, Villejuif, France
| | - Maryam Karimi
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, Villejuif, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, 28 Rue Laënnec, Lyon, France
| | - Stefan Michiels
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France.
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France.
| | - Aurelie Bardet
- Bureau de Biostatistique et d'Epidémiologie, Gustave Roussy, Université Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, Université Paris-Saclay, Equipe labellisée Ligue Contre le Cancer, 114 Rue Edouard Vaillant, Villejuif, France
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Grinda T, Pistilli B. Are ERBB2 mutations a 'ready for routine use' target in patients with metastatic breast cancer? ESMO Open 2023; 8:101832. [PMID: 37769401 PMCID: PMC10539925 DOI: 10.1016/j.esmoop.2023.101832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Revised: 09/01/2023] [Accepted: 09/04/2023] [Indexed: 09/30/2023] Open
Affiliation(s)
- T Grinda
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - B Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.
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16
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Balazard F, Bertaut A, Bordet É, Mulard S, Blanc J, Briot N, Paux G, Dhaini Merimeche A, Rigal O, Coutant C, Fournier M, Jouannaud C, Soulie P, Lerebours F, Cottu PH, Tredan O, Vanlemmens L, Levy C, Mouret-Reynier MA, Campone M, Brady KJS, Sasane M, Rice M, Coulouvrat C, Martin AL, Jacquet A, Vaz-Luis I, Herold C, Pistilli B. Adjuvant endocrine therapy uptake, toxicity, quality of life, and prediction of early discontinuation. J Natl Cancer Inst 2023; 115:1099-1108. [PMID: 37434306 PMCID: PMC10483331 DOI: 10.1093/jnci/djad109] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Revised: 03/09/2023] [Accepted: 06/05/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Many patients receiving adjuvant endocrine therapy (ET) for breast cancer experience side effects and reduced quality of life (QoL) and discontinue ET. We sought to describe these issues and develop a prediction model of early discontinuation of ET. METHODS Among patients with hormone receptor-positive and HER2-negative stage I-III breast cancer of the Cancer Toxicities cohort (NCT01993498) who were prescribed adjuvant ET between 2012 and 2017, upon stratification by menopausal status, we evaluated adjuvant ET patterns including treatment change and patient-reported discontinuation and ET-associated toxicities and impact on QoL. Independent variables included clinical and demographic features, toxicities, and patient-reported outcomes. A machine-learning model to predict time to early discontinuation was trained and evaluated on a held-out validation set. RESULTS Patient-reported discontinuation rate of the first prescribed ET at 4 years was 30% and 35% in 4122 postmenopausal and 2087 premenopausal patients, respectively. Switching to a new ET was associated with higher symptom burden, poorer QoL, and higher discontinuation rate. Early discontinuation rate of adjuvant ET before treatment completion was 13% in postmenopausal and 15% in premenopausal patients. The early discontinuation model obtained a C index of 0.62 in the held-out validation set. Many aspects of QoL, most importantly fatigue and insomnia (European Organization for Research and Treatment of Cancer QoL questionnaire 30), were associated with early discontinuation. CONCLUSION Tolerability and adherence to ET remains a challenge for patients who switch to a second ET. An early discontinuation model using patient-reported outcomes identifies patients likely to discontinue their adjuvant ET. Improved management of toxicities and novel more tolerable adjuvant ETs are needed for maintaining patients on treatment.
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Affiliation(s)
| | | | - Élise Bordet
- Sanofi Research and Development, Chilly-Mazarin, France
| | | | - Julie Blanc
- Centre George François Leclerc, Dijon, France
| | | | - Gautier Paux
- Sanofi Research and Development, Cambridge, MA, USA
| | | | | | | | | | | | - Patrick Soulie
- Institut de Cancérologie de L’Ouest—Centre Paul Papin, Angers, France
| | | | | | | | | | | | | | - Mario Campone
- Institut de Cancérologie de l’Ouest—Centre René Gauducheau, Nantes Saint Herblain, France
| | | | - Medha Sasane
- Sanofi Research and Development, Cambridge, MA, USA
| | - Megan Rice
- Sanofi Research and Development, Cambridge, MA, USA
| | | | | | | | - Ines Vaz-Luis
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- Department of Supportive care and pathways (DIOPP) Oncology, Gustave Roussy, Villejuif, France
- INSERM 981, Gustave Roussy, Villejuif, France
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17
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Ruiz de Azua G, Kousignian I, Vaz‐Luis I, Di Meglio A, Caumette E, Havas J, Martin E, Martin A, Querel O, Vanlemmens L, Pistilli B, Coutant C, Cottu PH, Merimeche AD, Lerebours F, Tredan O, Jouannaud C, Levy C, Dumas A, Menvielle G. Sustainable return to work among breast cancer survivors. Cancer Med 2023; 12:19091-19101. [PMID: 37602836 PMCID: PMC10557874 DOI: 10.1002/cam4.6467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/11/2023] [Accepted: 07/14/2023] [Indexed: 08/22/2023] Open
Abstract
PURPOSE This study assessed sustainable return to work (SRTW) of breast cancer survivors (BCS). METHODS We used data from the prospective French cohort, CANTO. We included 1811 stage I-III BCS who were <57 years old and employed at the moment of diagnosis and working 2 years after diagnosis. Using logistic regression, we investigated the role of clinical, health and socio-economic factors, and the work environment on SRTW 3 years after diagnosis. We compared having any sick leave with having worked continuously and being unemployed to having worked continuously between 2 and 3 years after diagnosis. RESULTS Overall, 77% (n = 1395) worked continuously after return to work (RTW). Out of the other 416 BCS, 66% had any sick leave period, 33% had been unemployed, 4% had an early retirement, 2% a disability and 1% another status (multiple situations possible). Being on sick leave was associated with age > 50 (OR = 0.59; 95%CI = 0.43-0.82), stage III (2.56; 1.70-3.85), tumour subtype HR+/HER2+ (0.61; 0.39-0.95), severe fatigue (1.45; 1.06-1.98), workplace accommodations (1.63; 1.14-2.33) and life priorities (0.71; 0.53-0.95). Unemployment was associated with age > 50 (0.45; 0.29-0.72), working in the public sector (0.31; 0.19-0.51), for a small company (3.00; 1.74-5.20) and having a fixed-term contract (7.50; 4.74-11.86). CONCLUSIONS A high number of BCS have periods of sick leave or unemployment after RTW. The determinants differ between sick leave and unemployment. IMPLICATIONS FOR CANCER SURVIVORS BCS need to be supported even after RTW, which should be regarded as a process.
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Affiliation(s)
- Garazi Ruiz de Azua
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie SocialeParisFrance
| | - Isabelle Kousignian
- Université Paris Cité, Unité de Recherche «Biostatistique, Traitement et Modélisation des données bio‐logiques» BioSTM, UR 7537ParisFrance
| | - Ines Vaz‐Luis
- Medical Oncology DepartmentGustave RoussyVillejuifFrance
- INSERM Unit 981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave RoussyVillejuifFrance
| | - Antonio Di Meglio
- INSERM Unit 981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave RoussyVillejuifFrance
| | - Elsa Caumette
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie SocialeParisFrance
- Department of MaieuticsUniversité de MontpellierMontpellierFrance
| | - Julie Havas
- INSERM Unit 981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave RoussyVillejuifFrance
| | - Elise Martin
- INSERM Unit 981—Prédicteurs moléculaires et nouvelles cibles en oncologie, Gustave RoussyVillejuifFrance
| | | | | | | | | | - Charles Coutant
- Department of Medical OncologyCentre Georges‐François LeclercDijonFrance
| | | | | | | | | | | | | | - Agnes Dumas
- Université Paris Cité ECEVE, UMR 1123, InsermParisFrance
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Épidémiologie et de Santé Publique, IPLESP, Équipe de Recherche en Épidémiologie SocialeParisFrance
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18
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Epaillard N, Bassil J, Pistilli B. Current indications and future perspectives for antibody-drug conjugates in brain metastases of breast cancer. Cancer Treat Rev 2023; 119:102597. [PMID: 37454577 DOI: 10.1016/j.ctrv.2023.102597] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 06/29/2023] [Accepted: 07/03/2023] [Indexed: 07/18/2023]
Abstract
Breast cancer is one of the main cause of cerebral and leptomeningeal metastases, the prognosis of which remains poor to this day. Most studies excluded patients with active brain metastases (BM) and particularly with leptomeningeal metastases (LM) explaining the lack of therapeutic innovation in this area. Currently, the standard management of patients with BM of breast cancer is based on the combination of surgery, radiotherapy and systemic treatments. Recently, third-generation of Antibody-Drug Conjugates (ADCs), have revolutionized the management of metastatic breast cancer. Trastuzumab deruxtecan and Sacituzumab govitecan have indeed shown significant improvements of survival outcomes and can now be used in a wide range of breast cancer subtypes. However, few data are available on the efficacy of third-generation ADCs on BM and LM of breast cancer. As the field of ADCs is rapidly evolving, with new constructs entering the late clinical development, in this review we describe the efficacy of approved and novel promising conjugates on patients with BM and LM of breast cancer.
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Affiliation(s)
- N Epaillard
- Breast Cancer Unit, Gustave Roussy Cancer Center, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - J Bassil
- Breast Cancer Unit, Gustave Roussy Cancer Center, 114 Rue Edouard-Vaillant, 94800 Villejuif, France
| | - B Pistilli
- Breast Cancer Unit, Gustave Roussy Cancer Center, 114 Rue Edouard-Vaillant, 94800 Villejuif, France. https://twitter.com/barbara.pistilli@BarbaraPistill2
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19
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Mosele F, Deluche E, Lusque A, Le Bescond L, Filleron T, Pradat Y, Ducoulombier A, Pistilli B, Bachelot T, Viret F, Levy C, Signolle N, Alfaro A, Tran DTN, Garberis IJ, Talbot H, Christodoulidis S, Vakalopoulou M, Droin N, Stourm A, Kobayashi M, Kakegawa T, Lacroix L, Saulnier P, Job B, Deloger M, Jimenez M, Mahier C, Baris V, Laplante P, Kannouche P, Marty V, Lacroix-Triki M, Diéras V, André F. Trastuzumab deruxtecan in metastatic breast cancer with variable HER2 expression: the phase 2 DAISY trial. Nat Med 2023; 29:2110-2120. [PMID: 37488289 PMCID: PMC10427426 DOI: 10.1038/s41591-023-02478-2] [Citation(s) in RCA: 37] [Impact Index Per Article: 37.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 06/28/2023] [Indexed: 07/26/2023]
Abstract
The mechanisms of action of and resistance to trastuzumab deruxtecan (T-DXd), an anti-HER2-drug conjugate for breast cancer treatment, remain unclear. The phase 2 DAISY trial evaluated the efficacy of T-DXd in patients with HER2-overexpressing (n = 72, cohort 1), HER2-low (n = 74, cohort 2) and HER2 non-expressing (n = 40, cohort 3) metastatic breast cancer. In the full analysis set population (n = 177), the confirmed objective response rate (primary endpoint) was 70.6% (95% confidence interval (CI) 58.3-81) in cohort 1, 37.5% (95% CI 26.4-49.7) in cohort 2 and 29.7% (95% CI 15.9-47) in cohort 3. The primary endpoint was met in cohorts 1 and 2. Secondary endpoints included safety. No new safety signals were observed. During treatment, HER2-expressing tumors (n = 4) presented strong T-DXd staining. Conversely, HER2 immunohistochemistry 0 samples (n = 3) presented no or very few T-DXd staining (Pearson correlation coefficient r = 0.75, P = 0.053). Among patients with HER2 immunohistochemistry 0 metastatic breast cancer, 5 of 14 (35.7%, 95% CI 12.8-64.9) with ERBB2 expression below the median presented a confirmed objective response as compared to 3 of 10 (30%, 95% CI 6.7-65.2) with ERBB2 expression above the median. Although HER2 expression is a determinant of T-DXd efficacy, our study suggests that additional mechanisms may also be involved. (ClinicalTrials.gov identifier NCT04132960 .).
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Affiliation(s)
- Fernanda Mosele
- INSERM U981, Gustave Roussy, Villejuif, France
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Elise Deluche
- Department of Medical Oncology, CHU Dupuytren, Limoges, France
| | - Amelie Lusque
- Department of Biostatistics, Institut Claudius-Regaud, IUCT Oncopole, Toulouse, France
| | - Loïc Le Bescond
- INSERM U981, Gustave Roussy, Villejuif, France
- CVN Lab, CentraleSupélec,Université Paris-Saclay, Gif-Sur-Yvette, France
- OPIS, Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Thomas Filleron
- Department of Biostatistics, Institut Claudius-Regaud, IUCT Oncopole, Toulouse, France
| | - Yoann Pradat
- MICS Lab, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | | | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Frederic Viret
- Department of Medical Oncology, Centre Paoli Calmettes, Marseille, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Nicolas Signolle
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | - Alexia Alfaro
- Imaging and Cytometry Platform, Gustave Roussy, UAR 23/3655, Université Paris-Saclay, Villejuif, France
| | | | | | - Hugues Talbot
- CVN Lab, CentraleSupélec,Université Paris-Saclay, Gif-Sur-Yvette, France
- OPIS, Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | | | - Maria Vakalopoulou
- OPIS, Inria, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
- MICS Lab, CentraleSupélec, Université Paris-Saclay, Gif-Sur-Yvette, France
| | - Nathalie Droin
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | - Aurelie Stourm
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | - Maki Kobayashi
- Translational Research Department, Daiichi Sankyo RD Novare, Tokyo, Japan
| | - Tomoya Kakegawa
- Translational Research Department, Daiichi Sankyo RD Novare, Tokyo, Japan
| | - Ludovic Lacroix
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Patrick Saulnier
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
| | - Bastien Job
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | - Marc Deloger
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | | | | | - Vianney Baris
- UMR9019, CNRS, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Pierre Laplante
- UMR9019, CNRS, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Patricia Kannouche
- UMR9019, CNRS, Gustave Roussy, Université Paris-Saclay, Villejuif, France
| | - Virginie Marty
- AMMICa Platform, INSERM US23, CNRS UAR 3655, AMMICa, Villejuif, France
| | | | - Veronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Fabrice André
- INSERM U981, Gustave Roussy, Villejuif, France.
- Department of Medical Oncology, Gustave Roussy, Villejuif, France.
- Faculty of Medicine, Université Paris-Saclay, Kremlin Bicêtre, France.
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20
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Grinda T, Antoine A, Jacot W, Cottu PH, de la Motte Rouge T, Frenel JS, Mailliez A, Dalenc F, Goncalves A, Clatot F, Mouret Reynier MA, Levy C, Ferrero JM, Desmoulins I, Uwer L, Petit T, Jouannaud C, Arnedos M, Chevrot M, Courtinard C, Tredan O, Brain E, Pérol D, Pistilli B, Delaloge S. Real-world clinical and survival outcomes of patients with early relapsed triple-negative breast cancer from the ESME national cohort. Eur J Cancer 2023; 189:112935. [PMID: 37385070 DOI: 10.1016/j.ejca.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/30/2023] [Accepted: 05/31/2023] [Indexed: 07/01/2023]
Abstract
BACKGROUND Early metastatic relapse of triple-negative breast cancer (mTNBC) after anthracyclins and/or taxanes based (A/T) primary treatment represents a highly aggressive cancer situation requiring urgent characterisation and handling. Epidemio-Strategy-Medico-Economical-Metastatic Breast Cancer (ESME-MBC) database, a multicenter, national, observational cohort (NCT03275311) provides recent data on this entity. METHODS All ESME patients diagnosed between 2008 and 2020 with mTNBC occurring as a relapse after a systemic neoadjuvant/adjuvant taxane and/or anthracycline-based chemotherapy were included. Early relapses were defined by a metastatic diagnosis up to 12 months of the end of neo/adjuvant A/T chemotherapy. We assessed overall survival (OS) and progression-free-survival under first-line treatment (PFS1) by early versus late relapse (≥12 months). RESULTS Patients with early relapse (N = 881, 46%) were younger and had a larger tumour burden at primary diagnosis than those with late relapses (N = 1045). Early relapse rates appeared stable over time. Median OS was 10.1 months (95% CI 9.3-10.9) in patients with early relapse versus 17.1 months (95% CI 15.7-18.2) in those with late relapse (adjusted hazard-ratio (aHR): 1.92 (95% CI 1.73-2.13); p < 0.001). The median PFS1 was respectively 3.1 months (95% CI 2.9-3.4) and 5.3 months (95% CI 5.1-5.8); (aHR: 1.66; [95% CI 1.50-1.83]; p < 0.001). Among early relapsed patients, a higher number of metastatic sites, visceral disease but not treatment types, were independently associated with a poorer OS. CONCLUSION These real-world data provide strong evidence on the dismal prognosis, higher treatment resistance and major unmet medical need associated with early relapsed mTNBC. Database registration: clinicaltrials.gov Identifier NCT032753.
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Affiliation(s)
- Thomas Grinda
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France; Sorbonne University, Medicine, 21 rue de l'École de médecine, 75006 Paris, France.
| | - Alison Antoine
- Department of Biostatistics, DRCI, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - William Jacot
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier University, INSERM U1194, 208 Rue des Apothicaires, 34298 Montpellier, France
| | - Paul-Henri Cottu
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - Thibault de la Motte Rouge
- Department of Medical Oncology, Centre Eugène Marquis, Avenue de la Bataille Flandres-Dunkerque, 35000 Rennes, France
| | - Jean-Sébastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest Pays de Loire, 15 rue André Boquel, 49055 Angers, France
| | - Audrey Mailliez
- Medical Oncology Department, Centre Oscar Lambret, 3 Rue Frédéric Combemale, 59000 Lille, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud - IUCT Oncopole, 1 Avenue Irène-Joliot-Curie, 31059 Toulouse, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli-Calmettes, 232 Boulevard de Sainte-Marguerite, 13009 Marseille, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rue d'Amiens, 76000 Rouen, France
| | - Marie-Ange Mouret Reynier
- Department of Medical Oncology, Centre Jean Perrin, 58 Rue Montalembert, 63011 Clermont Ferrand, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, 3 Avenue du Général Harris, 14000 Caen, France
| | - Jean-Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, 06000 Nice, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Institut de Cancérologie de Bourgogne, 21079 Dijon, France
| | - Lionel Uwer
- Medical Oncology Department, Institut de Cancérologie de Lorraine, Vandoeuvre-lès-Nancy, 6 Avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, 3 Rue de la Porte de l'Hôpital, 67000 Strasbourg, France
| | - Christelle Jouannaud
- Department of Medical Oncology, Institut de Cancérologie Jean-Godinot, 1 Rue du Général Koenig, 51100 Reims, France
| | - Monica Arnedos
- Department of Medical Oncology, Institut Bergonié, 229 Cours de l'Argonne, 33000 Bordeaux, France
| | - Michaël Chevrot
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France
| | - Coralie Courtinard
- Department of Research and Development, R&D Unicancer, 101 Rue de Tolbiac, 75654 Paris, France; University of Bordeaux, Inserm, Bordeaux Population Health Research Center, Epicene Team, UMR 1219, 33000 Bordeaux, France
| | - Olivier Tredan
- Department of Medical Oncology, Centre Léon Bérard, 28 Prom. Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Etienne Brain
- Department of Medical Oncology, Institut Curie, 26 Rue d'Ulm, 75005 Paris & Saint-Cloud, France
| | - David Pérol
- Department of Biostatistics, DRCI, Centre Léon Bérard, 28 Promenade Léa et Napoléon Bullukian, 69008 Lyon, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
| | - Suzette Delaloge
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800 Villejuif, France
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21
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Franzoi MA, Degousée L, Martin E, Semedo PM, Aupomerol M, Soldato D, Di Meglio A, Chiodi C, Barbier A, Chaouachi H, Renvoisé N, Boinon D, Fasse L, Ribeiro J, Le-Provost JB, Arvis J, Lazorthes C, di Palma M, de Jesus A, Raynard B, Pagès A, Delaloge S, Pistilli B, Scotté F, Vaz-Luis I. Implementing a PROACTive Care Pathway to Empower and Support Survivors of Breast Cancer. JCO Oncol Pract 2023; 19:353-361. [PMID: 37307673 DOI: 10.1200/op.23.00016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/15/2023] [Accepted: 04/21/2023] [Indexed: 06/14/2023] Open
Abstract
PURPOSE Optimal comprehensive survivorship care is insufficiently delivered. To increase patient empowerment and maximize the uptake of multidisciplinary supportive care strategies to serve all survivorship needs, we implemented a proactive survivorship care pathway for patients with early breast cancer at the end of primary treatment phase. METHODS Pathway components included (1) a personalized survivorship care plan (SCP), (2) face-to-face survivorship education seminars and personalized consultation for supportive care referrals (Transition Day), (3) a mobile app delivering personalized education and self-management advice, and (4) decision aids for physicians focused on supportive care needs. A mixed-methods process evaluation was performed according to the Reach, Effectiveness, Adoption, Implementation and Maintenance framework including administrative data review, pathway experience survey (patient, physician, and organization), and focus group. The primary objective was patient-perceived satisfaction with the pathway (predefined progression criteria for pathway continuation ≥70%). RESULTS Over 6 months, 321 patients were eligible for the pathway and received a SCP and 98 (30%) attended the Transition Day. Among 126 patients surveyed, 77 (66.1%) responded. 70.1% received the SCP, 51.9% attended the Transition Day, and 59.7% accessed the mobile app. 96.1% of patients were very or completely satisfied with the overall pathway, whereas perceived usefulness was 64.8% for the SCP, 90% for the Transition Day, and 65.2% for the mobile app. Pathway implementation seemed to be positively experienced by physicians and the organization. CONCLUSION Patients were satisfied with a proactive survivorship care pathway, and the majority reported that its components were useful in supporting their needs. This study can inform the implementation of survivorship care pathways in other centers.
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Affiliation(s)
- Maria Alice Franzoi
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Lena Degousée
- Breast Oncology Unit, Gustave Roussy, Villejuif, France
| | - Elise Martin
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
- CNRS-UAR3683 MSH Paris-Saclay, Gif sur Yvette, France
| | | | | | - Davide Soldato
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Camila Chiodi
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Aude Barbier
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Hajer Chaouachi
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Nathalie Renvoisé
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Diane Boinon
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Léonor Fasse
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Joana Ribeiro
- Breast Oncology Unit, Gustave Roussy, Villejuif, France
| | | | - Johanna Arvis
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | | | - Mario di Palma
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Anne de Jesus
- Patient Committee, Gustave Roussy, Villejuif, France
| | - Bruno Raynard
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Arnaud Pagès
- Biostatistics and Epidemiology Department, Gustave Roussy, Villejuif, France
| | | | | | - Florian Scotté
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Cancer Survivorship Group, INSERM Unit 981, Gustave Roussy, Villejuif, France
- Breast Oncology Unit, Gustave Roussy, Villejuif, France
- Supportive Care and Patient Pathway Department, Gustave Roussy, Villejuif, France
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22
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Grinda T, Rassy E, Pistilli B. Antibody-Drug Conjugate Revolution in Breast Cancer: The Road Ahead. Curr Treat Options Oncol 2023; 24:442-465. [PMID: 36966267 PMCID: PMC10122624 DOI: 10.1007/s11864-023-01072-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2023] [Indexed: 03/27/2023]
Abstract
OPINION STATEMENT Antibody drug-conjugates (ADCs) have revolutionized the treatment of many types of cancer, including breast cancer. Recently, two new ADCs have been approved, trastuzumab deruxtecan and sacituzumab govitecan; both have demonstrated impressive improvements in overall survival, trastuzumab deruxtecan in all three subtypes of metastatic breast cancer and sacituzumab govitecan in luminal and triple negative metastatic breast cancer. These drugs are the results of significant progress and innovation in the construction of the three components of an ADC, the monoclonal antibody, the payload, and the linker, and of the discovery of new target antigens. ADC engineering has profoundly changed the paradigm of cancer treatment, on one side being effective on tumors considered inherently resistant to the payload class of drugs and on the other side demonstrating activity in tumors with very low target expression. Yet, it is likely that we are just at the beginning of a new era as the identification of new targets and the introduction of new ADC constructs and combinations will expand the field of ADC rapidly over the coming years.
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Affiliation(s)
- Thomas Grinda
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Elie Rassy
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
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23
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Grinda T, Rassy E, Pistilli B. Correction to: Antibody-Drug Conjugate Revolution in Breast Cancer: The Road Ahead. Curr Treat Options Oncol 2023; 24:466-467. [PMID: 37069449 PMCID: PMC10122622 DOI: 10.1007/s11864-023-01092-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Affiliation(s)
- Thomas Grinda
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Elie Rassy
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, 114 Rue Edouard Vaillant, 94800, Villejuif, France.
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24
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Rassy E, Filleron T, Viansone A, Lacroix-Triki M, Rivera S, Desmoulins I, Serin D, Canon JL, Campone M, Gonçalves A, Levy C, Cottu P, Petit T, Eymard JC, Debled M, Bachelot T, Dalenc F, Roca L, Lemonnier J, Delaloge S, Pistilli B. Pattern and risk factors of isolated local relapse among women with hormone receptor-positive and HER2-negative breast cancer and lymph node involvement: 10-year follow-up analysis of the PACS 01 and PACS 04 trials. Breast Cancer Res Treat 2023; 199:371-379. [PMID: 36988749 DOI: 10.1007/s10549-023-06912-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
PURPOSE We aimed to determine the pattern of isolated local recurrences (ILR) in women with stage II-III hormone receptor-positive and human epidermal growth factor receptor 2 breast cancer (HR + /HER2-BC) after 10-year follow-up. METHODS UNICANCER-PACS 01 and PACS 04 trials included 5,008 women with T1-T3 and N1-N3 to evaluate the efficacy of different anthracycline ± taxanes-containing regimens after modified mastectomy or lumpectomy plus axillary lymph node dissection. We analyzed the data from 2,932 women with HR + /HER2- BC to evaluate the cumulative incidence of ILR and describe the factors associated with ILR. RESULTS After a median follow-up of 9.1 years (95% CI 9.0-9.2 years), the cumulative incidence of ILR increased steadily between 1 and 10 years from 0.2% to 2.5%. The multivariable analysis showed that older age (subhazard ratios [sHR] = 0.95, 95% CI 0.92-0.99) and mastectomy (sHR = 0.39, 95% CI 0.17-0.86) were associated with lower risk of ILR, and no adjuvant endocrine therapy (sHR = 2.73, 95% CI 1.32 7-5.67) with increased risk of ILR. CONCLUSION In this population of high-risk patients with localized HR + /HER2- BC, the risk of ILR was low but remained constant over 10 years. Younger age at diagnosis, breast-conserving surgery, and adjuvant endocrine therapy were independent risk factors of ILR.
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Affiliation(s)
- Elie Rassy
- Department of Cancer Medicine, University of Paris Saclay, Gustave Roussy, Villejuif, France
| | - Thomas Filleron
- BiostatisticsDepartment, Institut Claudius Regaud, IUCT-Oncopole, Toulouse, France
| | - Alessandro Viansone
- Department of Cancer Medicine, University of Paris Saclay, Gustave Roussy, Villejuif, France
| | - Magali Lacroix-Triki
- Department of Biopathology, University of Paris Saclay, Roussy, Villejuif, France
| | - Sofia Rivera
- Department of Radiation Therapy, University of Paris Saclay, Gustave Roussy, Villejuif, France
| | | | - Daniel Serin
- Department of Medical Oncology, Institut Sainte-Catherine, Avignon, France
| | - Jean Luc Canon
- Department of Medical Oncology, Grand Hôpital de Charleroi, Charleroi, Belgium
| | - Mario Campone
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Site René Gauducheau, Site Hospitalier Nord, Saint-Herblain, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, Paris, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss, Strasbourg, France
| | | | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Leon Berard, Lyon, France
| | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius Regaud, Institut Universitaire Cancer Toulouse-Oncopole, Toulouse, France
| | - Lise Roca
- Institut Régional du Cancer de Montpellier, Parc Euromédecine, Montpellier, France
| | | | - Suzette Delaloge
- Department of Cancer Medicine, University of Paris Saclay, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- Department of Cancer Medicine, University of Paris Saclay, Gustave Roussy, Villejuif, France.
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25
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Lange M, Lefevre Arbogast S, Hardy-Léger I, Rigal O, Le Fel J, Pistilli B, Petrucci J, Lévy C, Capel A, Coutant C, Médeau L, Lerebours F, Vanlemmens L, Brion M, Bourbouloux E, Blain M, Binarelli G, Vaz-Luis I, Giffard B, Querel O, Everhard S, André F, Charles C, Dauchy S, Joly F. Cognitive change in breast cancer patients up to 2 years after diagnosis. J Natl Cancer Inst 2023; 115:322-331. [PMID: 36571503 PMCID: PMC9996221 DOI: 10.1093/jnci/djac240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/11/2022] [Accepted: 12/19/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Using the large nationwide French, national, multicenter, prospective cancer and toxicities (CANTO) cohort, we assessed cognitive functioning change after cancer treatments in a subgroup of breast cancer (BC) patients. METHODS We included patients with newly diagnosed invasive stage I-III BC enrolled in the CANTO substudy focused on cognitive evaluation and healthy control women matched for age and education. Episodic and working memory, executive functions, processing speed, attention, self-report cognitive difficulties (SRCD), fatigue, anxiety and depression were assessed with neuropsychological tests and self-report questionnaires before treatment (baseline) and approximately 1 (year 1) and 2 years (year 2) after diagnosis. We used linear mixed models to study changes in cognition and tested the effect of adjuvant chemotherapy. RESULTS We studied 276 localized BC patients (62% chemotherapy) compared with 135 healthy controls (HC). After adjustment, patients had lower baseline working memory, processing speed, and attention scores than HC (P ≤ .001), and the difference remained statistically significant over follow-up for working memory and processing speed. Executive function scores were similar between groups at baseline but decreased at year 1 among patients compared with HC (Pchange = .006). This decrease in chemotherapy patients was statistically significant compared with HC scores (Pchange < .001). After adjustment, SRCD were similar between BC patients and HC at baseline but increased in patients after treatment at year 1 (Pchange = .002). CONCLUSIONS Cognitive difficulties are an important concern in BC patients, starting at diagnosis. Cancer treatments induce executive function decline and SRCD, which decrease over follow-up.
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Affiliation(s)
- Marie Lange
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
- Equipe Labellisée LIGUE 2022, 14000 Caen, France
| | - Sophie Lefevre Arbogast
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
| | | | - Olivier Rigal
- Care Support Department, Centre Henri Becquerel, 76000 Rouen, France
- Medical Oncology Department, Centre Henri Becquerel, 76000 Rouen, France
| | - Johan Le Fel
- Care Support Department, Centre Henri Becquerel, 76000 Rouen, France
| | - Barbara Pistilli
- Medical Oncology Department, Gustave Roussy, 94800 Villejuif, France
| | - Jean Petrucci
- Medical Oncology Department, Institut Curie, 92210 Saint Cloud, France
| | - Christelle Lévy
- Institut Normand du Sein, Centre François Baclesse, 14000 Caen, France
| | - Aurélie Capel
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France
| | - Charles Coutant
- Medical Oncology Department, Centre Georges François Leclerc, 21000 Dijon, France
| | - Laure Médeau
- Medical Oncology Department, Centre Georges François Leclerc, 21000 Dijon, France
| | | | | | - Marine Brion
- Medical Oncology Department, Centre Oscar Lambret, 59000 Lille, France
| | - Emmanuelle Bourbouloux
- Medical Oncology Department, Institut de Cancérologie de l’Ouest, 44805/49100 Nantes/Angers, France
| | - Maxime Blain
- Medical Oncology Department, Institut de Cancérologie de l’Ouest, 44805/49100 Nantes/Angers, France
| | - Giulia Binarelli
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
| | | | - Bénédicte Giffard
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
- Normandie Univ, UNICAEN, PSL University, EPHE, INSERM, U1077, CHU de Caen, Neuropsychologie et Imagerie de la Mémoire Humaine, 14000 Caen, France
| | | | | | - Fabrice André
- Medical Oncology Department, Gustave Roussy, 94800 Villejuif, France
| | - Cécile Charles
- Université de Bordeaux, Bordeaux Population Health Research Center, France
| | | | - Florence Joly
- Clinical Research Department, Centre François Baclesse, 14000 Caen, France
- Normandie Univ, UNICAEN, INSERM, ANTICIPE, 14000 Caen, France
- Cancer and Cognition Platform, Ligue Contre le Cancer, 14000 Caen, France
- Equipe Labellisée LIGUE 2022, 14000 Caen, France
- CHU de Caen, Medical Oncology Department, 14000 Caen, France
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26
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Minot-This MS, Grinda T, Epaillard N, Guyon D, Jawiche RE, Garcia G, Pistilli B. Intracranial hypotension in a breast cancer patient treated with epidural blood patches. CNS Oncol 2023; 12:CNS94. [PMID: 36876848 PMCID: PMC9996407 DOI: 10.2217/cns-2022-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
We report the case of a patient with metastatic breast cancer who presented with an orthostatic headache. After a comprehensive diagnostic workup including MRI and lumbar puncture, we maintained the diagnosis of intracranial hypotension (IH). The patient was therefore treated with two consecutive non targeted epidural blood patches, resulting in the remission of IH symptoms for 6 months. IH in cancer patients is a rarer cause of headache than carcinomatous meningitis. As the diagnosis can be made by standard examination and the treatment is relatively simple and effective, IH deserves to be better known by oncologists.
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Affiliation(s)
| | - Thomas Grinda
- Department of Medical Oncology, Gustave Roussy, Villejuif, 94800, France
| | - Nicolas Epaillard
- Department of Medical Oncology, Gustave Roussy, Villejuif, 94800, France
| | - David Guyon
- Department of Medical Oncology, Gustave Roussy, Villejuif, 94800, France
| | - Rita El Jawiche
- Department of Anaesthesia, Gustave Roussy, Villejuif, 94800, France
| | - Gabriel Garcia
- Department of Radiology, Gustave Roussy, Villejuif, 94800, France
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, 94800, France
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27
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Sonigo C, Amsellem N, Mayeur A, Laup L, Pistilli B, Delaloge S, Eustache F, Sifer C, Rakrouki S, Benoit A, Peigné M, Grynberg M. Disease-free survival does not differ according to fertility preservation technique for young women with breast cancer. Fertil Steril 2023; 119:465-473. [PMID: 36473609 DOI: 10.1016/j.fertnstert.2022.11.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2022] [Revised: 11/24/2022] [Accepted: 11/29/2022] [Indexed: 12/07/2022]
Abstract
OBJECTIVE To study whether fertility preservation strategies using ovarian stimulation or without using it impact long-term disease-free survival of patients with breast cancer. DESIGN Retrospective bicentric cohort study. SETTING Two university hospitals. PATIENT(S) In this study, 740 women with breast cancer, aged 18-43 years, who received primary fertility preservation between 2013 and 2019 after a diagnosis of localized breast cancer were included. INTERVENTION(S) Overall, 328 patients underwent at least 1 ovarian stimulation cycle (STIM group) and 412 had a technique without hormonal administration (no STIM group). MAIN OUTCOME MEASURE(S) Disease-free survival and overall survival up to May 2021 were compared between the 2 groups by log-rank test. Cox proportional-hazard regression model was used for multivariable analyses. RESULT(S) Out of the 740 women who underwent fertility preservation, follow-up data were available for 269 women in the STIM group (82%) and 330 (80%) in the no STIM group. Kaplan-Meier estimates of disease-free survival at 4 years were 87.9% (82.8%-92.2%) and 83.1% (78.4%-87.3%) in the STIM and no STIM groups, respectively. After adjustment on prognostic parameters, no significant difference in breast cancer recurrence rate was observed between the STIM and no STIM groups (hazard ratios, 0.83 [0.64-1.08]). Kaplan-Meier estimate of overall survival at 4 years was 97.6% (95.3%-99.2%) and 93.6% (90.9%-95.9%) in the STIM and no STIM groups, respectively. Overall survival was higher in the STIM group than no STIM group (log-rank test). After adjustment on prognostic parameters, the risk of death remained significantly lower in the STIM group (Hazard Ratio, 0.55 [0.35-0.85]). CONCLUSION(S) In our cohort, STIM for fertility preservation in breast cancer did not significantly impact disease-free survival but was associated with higher overall survival. The disease-free survival and overall survival of young patients with breast cancer were not impacted by fertility preservation techniques irrespective of the timing of chemotherapy (neoadjuvant or adjuvant) and the use of ovarian stimulation. Nevertheless, because death and recurrence were rare events, these results should be taken with caution.
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Affiliation(s)
- Charlotte Sonigo
- Department of Reproductive Medicine and Fertility Preservation, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France; Universite Paris-Saclay, Inserm, Physiologie et physiopathologie endocrinienne, Le Kremlin-Bicetre, France.
| | - Noémi Amsellem
- Department of Reproductive Medicine and Fertility Preservation, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France
| | - Anne Mayeur
- Histology-Embryology-Cytogenetic Laboratory, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France
| | - Laetitia Laup
- Department of Reproductive Medicine and Fertility Preservation, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Barbara Pistilli
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Suzette Delaloge
- Department of Medical Oncology, Institut Gustave Roussy, Villejuif, France
| | - Florence Eustache
- Department of Biology of Reproduction and CECOS, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Christophe Sifer
- Department of Biology of Reproduction and CECOS, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Sophia Rakrouki
- Department of Reproductive Medicine and Fertility Preservation, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Alexandra Benoit
- Department of Reproductive Medicine and Fertility Preservation, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France
| | - Maeliss Peigné
- Department of Reproductive Medicine and Fertility Preservation, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Universite Paris-Saclay, Assistance Publique Hopitaux de Paris, Antoine Beclere Hospital, Clamart, France; Department of Reproductive Medicine and Fertility Preservation, Universite Sorbonne Paris Nord, Assistance Publique - Hopitaux de Paris, Jean Verdier Hospital, Bondy, France
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28
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Bailleux C, Bachelot T, Bidard FC, Hardy-Bessard AC, Bièche I, Pradines A, Clatot F, ROUGE TDELAMOTTE, Canon JL, Pistilli B, Chang K, Quinn KJ, Gustafson HL, Dalenc F, Foa C, Ammarguellat H, Bernard-Marty C, Lucas B, Barthier S, Lorchel F, Gisserot O, Arnould L, Mauduit M, Lemonnier J, Berger F, Delaloge S, Andre F. Abstract PD17-02: ctDNA Molecular Response based on breast cancer driver mutations predicts progression in aromatase inhibitor-sensitive first line treatment of oestrogen receptor-positive (ER+) HER2-negative (HER2-) advanced breast cancer. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd17-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: The combination of a CDK4/6 inhibitor and an aromatase inhibitor (AI) is the gold standard for AI-sensitive first line treatment of ER+ HER2- advanced breast cancer. Nevertheless, some patients progress rapidly and may benefit from alternative strategies. Early ctDNA dynamics have been shown to predict disease course in several clinical situations. Here, we use samples from the PADA-1 trial to assess this strategy for patients receiving AI and palbociclib as first line treatment. PADA-1 was designed to assess the clinical utility of sequential analysis of ctDNA for emerging ESR1 mutations to trigger an early switch from AI plus palbociclib to fulvestrant plus palbociclib treatment. The study included 1,017 patients and was positive on its primary end-point. The objective of this translational study was to analyze the predictive value of 4-week molecular response (MR) for patient progression. Material & Method: First, a CLIA-validated targeted next-generation sequencing-based test (Guardant360 Response) was used to characterize changes in ctDNA level via detection of somatic single-nucleotide variants (SNVs), insertion/deletion mutations (indels), and gene fusions in 74 genes frequently mutated in cancer. A second analysis was restricted to cancer-associated mutations in 11 genes commonly mutated in breast cancer (PIK3CA, GATA3, TP53, AKT1, ERBB2, BRCA1, BRCA2, ATM, ESR1, PALB2 and RB1). The threshold for molecular response was defined as ≥ 50% decrease in ctDNA (MR score < 0.5). Subjects with ctDNA levels below the test’s limit of quantitation (ctDNA-low) were considered molecular responders. Results: 372 subjects with matched baseline and 4-weeks samples were available for analysis. Of these, 134 subjects (36%) were ctDNA-low, and 238 subjects (64%) quantifiable. Among the quantifiable subjects, 183 (77%) were molecular responders (MR+, MR < 0.5), and 55 (23%) were not (MR–, MR ≥ 0.5). PFS was moderately improved for both MR+ and ctDNA-low relative to MR– (HR=0.61 (95%CI 0.44-0.85), p< 0.01) over the full 29 months of follow up. Differential PFS event rate was observed only in the first 8 months following ctDNA assessment; during this time MR+ and ctDNA-low were associated with more significantly decreased risk of progression (HR 0.24, 95% CI 0.13 – 0.43, p=0.0001). Limiting ctDNA assessment to genes commonly mutated in breast cancer enhanced the predictive power of MR (HR=0.08, 95% CI 0.04 0.17, p< 0.001, for MR+ and ctDNA-low vs. MR– across 8 months post-assessment); however, fewer samples were quantifiable by this method (169 [45%] quantifiable; 203 [55%] ctDNA-low). Combining MR status with additional molecular features (e.g.tumor mutational burden and maximum mutation allele fraction) did not improve prediction of non-response. Conclusion: Changes in ctDNA fraction during the first weeks of treatment are predictive of long term clinical benefit on an individual patient basis, particularly during the first year of therapy. Adjusting the MR threshold and/or limiting to genes known to be relevant in the specific tumor can tailor the assessment of ctDNA change to specific clinical scenarios where greater sensitivity or specificity may be required. The identification of patients at high risk for early clinical failure at the onset of treatment may allow for therapy escalation and/or change to improve outcome in this population. Funding: Pfizer and Guardant Health
Citation Format: Caroline Bailleux, Thomas Bachelot, Francois-Clement Bidard, Anne-Claire Hardy-Bessard, Ivan Bièche, Anne Pradines, Florian Clatot, thibault DE LA MOTTE ROUGE, Jean-Luc Canon, Barbara Pistilli, Kyle Chang, Katie J. Quinn, Heather L. Gustafson, Florence Dalenc, Cyril Foa, Hanifa Ammarguellat, Chantal Bernard-Marty, Brigitte Lucas, Sophie Barthier, Fabrice Lorchel, Olivier Gisserot, Laurent Arnould, Marjorie Mauduit, Jérôme Lemonnier, Frédérique Berger, Suzette Delaloge, Fabrice Andre. ctDNA Molecular Response based on breast cancer driver mutations predicts progression in aromatase inhibitor-sensitive first line treatment of oestrogen receptor-positive (ER+) HER2-negative (HER2-) advanced breast cancer. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr PD17-02.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Jean-Luc Canon
- 9Grand Hopital de Charleroi - GHdC site Notre Dame, Belgium
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Bardia A, Kalinsky K, Tsurutani J, Hamilton E, Sohn JH, Park KH, Park YH, Im SA, Lee KS, Dastur D, Haddad V, Khan S, Xu B, Pistilli B, Rugo H. Abstract OT1-03-04: Datopotamab deruxtecan (Dato-DXd), a TROP2 antibody-drug conjugate, vs investigators’ choice of chemotherapy in previously-treated, inoperable or metastatic HR+/HER2– breast cancer: TROPION-Breast01. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot1-03-04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Chemotherapy is the main treatment in patients with pre-treated endocrine-resistant HR+/HER2– metastatic breast cancer, but has limited efficacy and substantial toxicities. The antibody-drug conjugate Dato-DXd consists of a humanized IgG1 mAb targeting TROP2 attached via a stable cleavable linker to a topoisomerase I (TopI) inhibitor payload. Heavily pre-treated patients with metastatic triple-negative breast cancer in the TROPION-PanTumor01 (NCT03401385) study of Dato-DXd showed a manageable safety profile and highly encouraging objective response rates (ORR by blinded independent central review [BICR]: 34% in all patients; 52% in patients treatment-naïve to TopI inhibitor-based therapies). The metastatic HR+/HER2– breast cancer cohort of TROPION-PanTumor01 has completed enrollment (n=41); data are currently maturing. Trial design: TROPION-Breast01 (NCT05104866) is an ongoing, global, phase 3, open-label, randomized trial evaluating efficacy and safety of Dato-DXd vs investigators’ choice of chemotherapy (ICC) in patients with inoperable or metastatic HR+/HER2– breast cancer. Patients (n≈700) are randomized 1:1 to Dato-DXd 6 mg/kg IV Q3W or ICC (eribulin, capecitabine, vinorelbine, or gemcitabine) until progression. Adults with an ECOG performance status of 0–1, who experienced progression on or are unsuitable for endocrine therapy, and received 1–2 prior lines of standard-of-care chemotherapy in the inoperable or metastatic setting are eligible. Monotherapy treatment with inhibitors of mTOR, PD-[L]1, CDK4/6 and PARP do not count as prior chemotherapy lines. Patients must have ≥1 measurable lesion per RECIST 1.1 and an archival or fresh formalin-fixed and paraffin-embedded tumor sample. Clinically inactive brain metastases are permitted. Dual primary endpoints are progression-free survival (PFS) by BICR, and overall survival. Secondary endpoints include PFS per investigator, ORR, disease control rate, patient-reported outcomes, and Dato-DXd pharmacokinetics and immunogenicity. Exploratory endpoints include TROP2 expression and exposure–efficacy relationship. Patients are stratified by number of prior chemotherapy lines, prior CDK4/6 inhibitor use, and region. At the time of writing 236 patients have been enrolled across 19 countries.
Citation Format: Aditya Bardia, Kevin Kalinsky, Junji Tsurutani, Erika Hamilton, Joo Hyuk Sohn, Kyong Hwa Park, Yeon Hee Park, Seock-Ah Im, Keun Seok Lee, Daisy Dastur, Vincent Haddad, Sabrina Khan, Binghe Xu, Barbara Pistilli, Hope Rugo. Datopotamab deruxtecan (Dato-DXd), a TROP2 antibody-drug conjugate, vs investigators’ choice of chemotherapy in previously-treated, inoperable or metastatic HR+/HER2– breast cancer: TROPION-Breast01 [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT1-03-04.
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Affiliation(s)
- Aditya Bardia
- 1Massachusetts General Hospital Cancer Center, Boston, Massachusetts
| | - Kevin Kalinsky
- 2Winship Cancer Institute at Emory University, Atlanta, Georgia
| | - Junji Tsurutani
- 3Advanced Cancer Translational Research Institute at Showa University, Shinagawa, Japan
| | | | | | | | | | - Seock-Ah Im
- 8Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Keun Seok Lee
- 9Center for Breast Cancer, National Cancer Center, Goyang, Republic of Korea
| | | | | | | | - Binghe Xu
- 13National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China (People’s Republic)
| | | | - Hope Rugo
- 15University of California San Francisco, San Francisco, CA
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Hurvitz S, Andre F, Cristofanilli M, Curigliano G, Giordano A, Han HS, Martín M, Pistilli B, Rugo H, Wesolowski R, Suzuki S, Mutka SC, Gorbatchevsky I, Loibl S. Abstract OT3-26-02: A Phase 3 study of gedatolisib plus fulvestrant with and without palbociclib in patients with HR+/HER2- advanced breast cancer previously treated with a CDK4/6 inhibitor plus a non-steroidal aromatase inhibitor (VIKTORIA-1). Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-ot3-26-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: Gedatolisib is a potent reversible dual inhibitor that selectively targets all Class I isoforms of phosphoinositide 3-kinase (PI3K) and mechanistic target of rapamycin (mTOR). Two separate pivotal clinical trials demonstrated that PI3K and mTOR inhibitors are active in combination with endocrine therapy and prolong progression-free survival (PFS) among patients with hormone receptor positive (HR+)/HER2-negative (HER2-) advanced breast cancer (ABC) who had previously received endocrine therapy (SOLAR-1, BOLERO-2). CDK4/6 inhibitor (CDK4/6i) therapy has been approved in the front-line setting. However, patients eventually experience disease progression on CDK4/6i based therapy. Available data indicates that resistance to CDK4/6i is a transient adaptive mechanism that may be reversed by adding inhibitors of the PI3K/mTOR pathway (PI3K/mTORi). Thus, combination of PI3K/mTORi and CDK4/6i in patients whose disease progressed on prior CDK4/6i could potentially both restore sensitivity to CDK4/6i and prevent adaptive activation of the PI3K/mTOR pathway. This hypothesis was evaluated in a Phase 1b study (Layman SABCS 2021). Subjects with HR+/HER2- ABC who were CDK4/6i pretreated received gedatolisib (180 mg IV weekly for 3 weeks, then one week off) in combination with standard doses of palbociclib and fulvestrant. Median PFS was 12.9 months, and overall response rate was 63%. Grade 3-4 adverse events (AE) were observed at a low rate, and toxicity was overall easily managed with available standards of care, and few patients discontinued treatment due to treatment-related adverse events (4%). The most common AE was stomatitis; hyperglycemia of any grade occurred in 26% of patients. This preliminary data, dosing schedule, and study population characteristics form the basis for the Phase 3 trial, VIKTORIA-1. Trial design: This Phase 3, open-label, randomized, multinational two-part clinical trial will evaluate the efficacy and safety of gedatolisib and fulvestrant with or without palbociclib in patients with HR+/HER2- ABC previously treated with any CDK4/6i in combination with non-steroidal aromatase inhibitor therapy. Those without tumor PIK3CA mutations will be assigned to Study 1 and those with PIK3CA mutations will be assigned to Study 2. Study 1 will include up to 351 subjects randomized in a 1:1:1 ratio to Arm A (gedatolisib, palbociclib, and fulvestrant), Arm B (gedatolisib plus fulvestrant), or Arm C (fulvestrant). For subjects in Arm C whose disease progresses, crossover to Arm A or B is allowed. Study 2 will include up to 350 subjects randomized in a 3:3:1 ratio to Arm D (gedatolisib, palbociclib, and fulvestrant), Arm E (alpelisib plus fulvestrant), or Arm F (gedatolisib plus fulvestrant). Key eligibility criteria include adults with confirmed metastatic or locally advanced breast cancer, any menopausal status for females, radiologically evaluable disease, and prior CDK4/6i treatment with non-steroidal AI. Prior therapy with SERD, including fulvestrant is allowed. Key exclusion criteria include prior treatment with a PI3K, protein kinase B (Akt), or mTOR inhibitor, prior treatment with chemotherapy for advanced disease, more than two lines of prior endocrine therapy, bone only disease with no soft tissue components, active CNS metastases, and type 1 diabetes or uncontrolled type 2 diabetes. The primary endpoint is PFS assessed by blinded independent central review (BICR) per RECIST v1.1. Secondary endpoints included overall survival (OS), safety and tolerability, ORR, duration of response, time to response, CBR, quality of life, and pharmacokinetics. This trial is open for enrollment.
Citation Format: Sara Hurvitz, Fabrice Andre, Massimo Cristofanilli, Giuseppe Curigliano, Antonio Giordano, Hyo S. Han, Miguel Martín, Barbara Pistilli, Hope Rugo, Robert Wesolowski, Samuel Suzuki, Sarah C. Mutka, Igor Gorbatchevsky, Sibylle Loibl. A Phase 3 study of gedatolisib plus fulvestrant with and without palbociclib in patients with HR+/HER2- advanced breast cancer previously treated with a CDK4/6 inhibitor plus a non-steroidal aromatase inhibitor (VIKTORIA-1) [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr OT3-26-02.
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Affiliation(s)
- Sara Hurvitz
- 1University of California, Los Angeles, Los Angeles, California
| | | | | | | | | | - Hyo S. Han
- 6H. Lee Moffitt Cancer Center, Tampa, FL, USA
| | - Miguel Martín
- 7Hospital General Universitario Gregorio Marañón, Madrid, Spain, Spain
| | | | - Hope Rugo
- 9University of California San Francisco, San Francisco, CA
| | - Robert Wesolowski
- 10James Cancer Hospital and the Ohio State University Comprehensive Cancer Center, Columbus, Ohio
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Rassy E, Garberis I, Tran-Dien A, Job B, Chung-Scott V, Bouakka I, Bassil J, Ferkh R, Lacroix-Triki M, Zanconati F, Giudici F, Generali D, Rouleau E, Lacroix L, Andre F, Pistilli B. Comparative genomic profiling of second breast cancers following first ipislateral hormone receptor-positive breast cancers. Clin Cancer Res 2023; 29:1822-1831. [PMID: 36805183 DOI: 10.1158/1078-0432.ccr-22-2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 12/28/2022] [Accepted: 02/15/2023] [Indexed: 02/22/2023]
Abstract
PURPOSE We compared the mutational profile of second breast cancers (SBC) following first ipislateral hormone receptor-positive breast cancers (FBC) of patient-matched tumors to distinguish new primaries from true recurrences. EXPERIMENTAL DESIGN Targeted next-generation sequencing (tNGS) using the Oncomine Tumor Mutation Load (TML) Assay. Variants were filtered according to their allele frequency ≥ 5%, read count ≥ 5X, and genomic effect and annotation. Whole genome comparative genomic hybridization array (CGH) was also performed to evaluate clonality. RESULTS Among the 131 eligible patients, 96 paired FBC and SBC were successfully sequenced and analyzed. Unshared variants specific to the FBC and SBC were identified in 71.9% and 61.5%, respectively. Paired samples exhibited similar frequency of gene variants, median number of variants per sample and variant allele frequency of the reported variants except for GATA3. Among the 30 most frequent gene alterations, ARIDIA, NSD2 and SETD2 had statistically significant discordance rates in paired samples. Seventeen paired samples (17.7%) exhibited common variants and were considered true recurrences; these patients had a trend for less favorable survival outcomes. Among the 8 patients with available tissue for CGH analysis and considered new primaries by comparison of the mutation profiles, 4 patients had clonally related tumors. CONCLUSION Patient-matched FBC and SBC analysis revealed that only a minority of patients exhibited common gene variants between the first and second tumor. Further analysis using larger cohorts preferably using single cell analyses to account for clonality, might better select patients with true recurrences and thereby better inform the decision-making process.
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Affiliation(s)
- Elie Rassy
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | | | - Bastien Job
- Bioinformatics Platform, Gustave Roussy, Villejuif, France
| | | | | | - Josiane Bassil
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Rachel Ferkh
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | | | - Fabrizio Zanconati
- Breast Unit, Academic Hospital of Trieste, Trieste, Italy
- Department of Medical, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Fabiola Giudici
- Department of Medical, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Department of Biostatistics and Epidemiology, Gustave Roussy, Oncostat U1018, Inserm, Paris-Saclay University, labeled Ligue Contre le Cancer, Villejuif, France
| | - Daniele Generali
- Department of Medical, Surgery and Health Sciences, University of Trieste, Cattinara Hospital, Trieste, Italy
- Breast Cancer Unit, Azienda Socio Sanitaria Territoriale di Cremona, Cremona, Italy
| | - Etienne Rouleau
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
- Genomic Platform and Biobank, CNRS UMS3655-INSERM US23, AMMICA, Gustave Roussy, Villejuif, France
| | - Ludovic Lacroix
- Department of Medical Biology and Pathology, Gustave Roussy, Villejuif, France
- Genomic Platform and Biobank, CNRS UMS3655-INSERM US23, AMMICA, Gustave Roussy, Villejuif, France
| | - Fabrice Andre
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
- INSERM U981, Gustave Roussy, Villejuif, France
- Precision Medicine Group, UNICANCER, Paris, France
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
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François-Martin H, Lardy-Cléaud A, Pistilli B, Levy C, Diéras V, Frenel JS, Guiu S, Mouret-Reynier MA, Mailliez A, Eymard JC, Petit T, Ung M, Desmoulins I, Augereau P, Bachelot T, Uwer L, Debled M, Ferrero JM, Clatot F, Goncalves A, Chevrot M, Chabaud S, Cottu P. Long-Term Results with Everolimus in Advanced Hormone Receptor Positive Breast Cancer in a Multicenter National Real-World Observational Study. Cancers (Basel) 2023; 15:cancers15041191. [PMID: 36831532 PMCID: PMC9954606 DOI: 10.3390/cancers15041191] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Revised: 02/01/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Everolimus is the first oral targeted therapy widely used in advanced HR+/HER2- breast cancer. We sought to evaluate the impact of everolimus-based therapy on overall survival in the ESME-MBC database, a national metastatic breast cancer cohort that collects retrospective data using clinical trial-like methodology including quality assessments. We compared 1693 patients having received everolimus to 5928 patients not exposed to everolimus in the same period. Overall survival was evaluated according to treatment line, and a propensity score with the inverse probability of treatment weighting method was built to adjust for differences between groups. Crude and landmark overall survival analyses were all compatible with a benefit from everolimus-based therapy. Adjusted hazard ratios for overall survival were 0.34 (95% CI: 0.16-0.72, p = 0.0054), 0.34 (95% CI: 0.22-0.52, p < 0.0001), and 0.23 (95% CI: 0.14-0.36, p < 0.0001) for patients treated with everolimus in line 1, 2, and 3 and beyond, respectively. No clinically relevant benefit on progression-free survival was observed. Causes for everolimus discontinuation were progressive disease (56.2%), adverse events (27.7%), and other miscellaneous reasons. Despite the limitations inherent to such retrospective studies, these results suggest that adding everolimus-based therapy to the therapeutic sequences in patients with advanced HR+/HER2- breast cancer may favorably affect overall survival.
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Affiliation(s)
| | | | - Barbara Pistilli
- Gustave Roussy Cancer Campus, Department of Medical Oncology, 94805 Villejuif, France
| | - Christelle Levy
- Centre François Baclesse, Department of Medical Oncology, 14000 Caen, France
| | - Véronique Diéras
- Centre Eugène Marquis, Department of Medical Oncology, 35000 Rennes, France
| | - Jean-Sébastien Frenel
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, 44800 Saint-Herblain, France
| | - Séverine Guiu
- Department of Medical Oncology, Institut de Cancérologie de la Méditerranée, 34090 Montpellier, France
| | | | - Audrey Mailliez
- Centre Oscar Lambret, Department of Medical Oncology, 59000 Lille, France
| | | | - Thierry Petit
- Centre Paul Strauss, Department of Medical Oncology, 67200 Strasbourg, France
| | - Mony Ung
- Department of Medical Oncology, Institut Claudius Regaud, 31100 Toulouse, France
| | - Isabelle Desmoulins
- Centre Georges Francois Leclerc, Department of Medical Oncology, 21000 Dijon, France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancérologie de l’Ouest, 49055 Angers, France
| | - Thomas Bachelot
- Centre Léon Bérard, Department of Medical Oncology, 69008 Lyon, France
| | - Lionel Uwer
- Department of Medical Oncology, Institut de Cancérologie de Lorraine, 54519 Nancy, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, 33076 Bordeaux, France
| | - Jean-Marc Ferrero
- Centre Antoine Lacassagne, Department of Medical Oncology, 06100 Nice, France
| | - Florian Clatot
- Centre Henri Becquerel, Department of Medical Oncology, 76038 Rouen, France
| | - Anthony Goncalves
- Department of Medical Oncology, Institut Paoli Calmettes, 13009 Marseille, France
| | | | - Sylvie Chabaud
- Centre Léon Bérard, Department of Biostatistics, 69008 Lyon, France
| | - Paul Cottu
- Department of Medical Oncology, Institut Curie, 26 rue d’Ulm, 75005 Paris, France
- Correspondence: ; Tel.: +33-172389434; Fax: +33-153104041
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Roche N, Le Provost JB, Borinelli-Franzoi MA, Boinon D, Martin E, Menvielle G, Dumas A, Rivera S, Conversano A, Matias M, Viansone A, Di Meglio A, Delaloge S, Vaz-Duarte-Luis IM, Pistilli B, Fasse L. Facing points of view: Representations on adjuvant endocrine therapy of premenopausal patients after breast cancer and their healthcare providers in France. The FOR-AD study. Eur J Oncol Nurs 2023; 62:102259. [PMID: 36623339 DOI: 10.1016/j.ejon.2022.102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 12/06/2022] [Accepted: 12/14/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Adjuvant endocrine therapy (ET) for 5-10 years is the backbone of the therapeutic strategy in patients with hormone receptor positive (HR+) early breast cancer (BC). However, long-term adherence to adjuvant ET represents a major challenge for most patients. According to prior studies, side effects of adjuvant ET are an important reason for poor adherence. In contrast, better communication and relational bond between patients and healthcare providers (HCPs) may improve adherence. The FOR-AD (Focus on non-adherence) study aimed at better understanding the representation of adjuvant ET by patients and their HCPs, in order to improve the care process. METHODS Three focus groups of premenopausal women (receiving adjuvant ET for variable amount of time) and two focus groups of HCPs (including oncologists, pharmacists, and nurses) were conducted, each including around ten participants. Thematic analyses using a general inductive approach were constructed to report participants' representations. RESULTS Two main themes emerged across groups, and appeared of major importance. Representations on adjuvant ET were often homogenous within each group, but differed between patients and their HCPs. The relationship between both groups was considerably discussed, particularly its importance in facilitating adherence to adjuvant ET. Suggestions on improving the care process were also given, such as systematically including psychologists in follow-up care paths and having a nurse navigator follow patients under treatment with adjuvant ET. CONCLUSION The present qualitative exploration may help buildi future tailored interventions to improve adherence to adjuvant ET, in particular regarding the role of nurse navigators.
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Affiliation(s)
- Nicolas Roche
- Supportive Care Department, Gustave Roussy Hospital, Villejuif, France.
| | | | - Maria-Alice Borinelli-Franzoi
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France; INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Diane Boinon
- Supportive Care Department, Gustave Roussy Hospital, Villejuif, France; Laboratoire de Psychopathologie et Processus de Santé, F 92100, Université de Paris, Boulogne-Billancourt, France
| | - Elise Martin
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Gwenn Menvielle
- Inserm, Institut Pierre Louis d'Epidémiologie et Santé Publique (IPLESP), Sorbonne Université, Paris, France
| | - Agnès Dumas
- Inserm Unit 1123, Unité ECEVE, Université de Paris, France
| | - Sofia Rivera
- Radiotherapy Department, Gustave Roussy Hospital, Villejuif, France
| | - Angelica Conversano
- Oncological and Reconstructive Plastic Surgery Department, Gustave Roussy Hospital, Villejuif, France
| | - Margarida Matias
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France
| | | | - Antonio Di Meglio
- INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Suzette Delaloge
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France
| | - Ines-Maria Vaz-Duarte-Luis
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France; INSERM Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy Hospital, Villejuif, France
| | - Léonor Fasse
- Supportive Care Department, Gustave Roussy Hospital, Villejuif, France; Laboratoire de Psychopathologie et Processus de Santé, F 92100, Université de Paris, Boulogne-Billancourt, France
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Lambertini M, Ceppi M, Anderson RA, Cameron DA, Bruzzone M, Franzoi MA, Massarotti C, El-Abed S, Wang Y, Lecocq C, Nuciforo P, Rolyance R, Pusztai L, Sohn J, Latocca MM, Arecco L, Pistilli B, Ruddy KJ, Ballestrero A, Del Mastro L, Peccatori FA, Partridge AH, Saura C, Untch M, Piccart M, Di Cosimo S, de Azambuja E, Demeestere I. Impact of Anti-HER2 Therapy Alone and With Weekly Paclitaxel on the Ovarian Reserve of Young Women With HER2-Positive Breast Cancer. J Natl Compr Canc Netw 2023; 21:33-41.e16. [PMID: 36634607 DOI: 10.6004/jnccn.2022.7065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 08/09/2022] [Indexed: 01/13/2023]
Abstract
BACKGROUND The potential gonadotoxicity of anti-HER2 agents remains largely unknown, and limited, conflicting evidence exists for taxanes. Antimüllerian hormone (AMH) is an established biomarker of ovarian reserve that may aid in quantifying anticancer treatment-induced gonadotoxicity. PATIENTS AND METHODS The present biomarker analysis of the randomized phase III neoadjuvant NeoALTTO trial included premenopausal women aged ≤45 years at diagnosis of HER2-positive early breast cancer with available frozen serum samples at baseline (ie, before anticancer treatments), at week 2 (ie, the "biological window" of anti-HER2 therapy alone), and/or at the time of surgery (ie, after completing paclitaxel + anti-HER2 therapy, before starting adjuvant chemotherapy). RESULTS The present analysis included 130 patients with a median age of 38 years (interquartile ratio [IQR], age 33-42 years). AMH values at the 3 time points differed significantly (P<.001). At baseline, median AMH levels were 1.29 ng/mL (IQR, 0.56-2.62 ng/mL). At week 2, a small but significant reduction in AMH levels was observed (median, 1.10 ng/mL; IQR, 0.45-2.09 ng/mL; P<.001). At surgery, a larger significant decline in AMH levels was observed (median, 0.01 ng/mL; IQR, 0.01-0.03 ng/mL; P<.001). Although the type of anti-HER2 treatment (trastuzumab and/or lapatinib) did not seem to impact the results, age and pretreatment ovarian reserve had a major influence on treatment-induced gonadotoxicity risk. CONCLUSIONS This NeoALTTO biomarker analysis showed that anti-HER2 therapies alone had limited gonadotoxicity but that the addition of weekly paclitaxel resulted in marked AMH decline with possible negative implications for subsequent ovarian function and fertility.
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Affiliation(s)
- Matteo Lambertini
- School of Medicine, University of Genova, Genova, Italy.,UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Richard A Anderson
- MRC Centre for Reproductive Health, The Queen's Medical Research Institute, The University of Edinburgh, Edinburgh, United Kingdom
| | - David A Cameron
- Institute of Genomics and Cancer, The University of Edinburgh, Edinburgh, United Kingdom
| | | | | | - Claudia Massarotti
- IRCCS Ospedale Policlinico San Martino, Genova, Italy.,University of Genova, Genova, Italy
| | | | | | | | - Paolo Nuciforo
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, SOLTI BC Cooperative Group, Barcelona, Spain
| | | | | | - Joohyuk Sohn
- Yonsei Cancer Center, Yonsei University Health System, Seoul, Korea
| | - Maria Maddalena Latocca
- School of Medicine, University of Genova, Genova, Italy.,UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Luca Arecco
- School of Medicine, University of Genova, Genova, Italy.,UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | | | - Alberto Ballestrero
- School of Medicine, University of Genova, Genova, Italy.,IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Lucia Del Mastro
- School of Medicine, University of Genova, Genova, Italy.,UOC Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | | | - Ann H Partridge
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Cristina Saura
- Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology, SOLTI BC Cooperative Group, Barcelona, Spain
| | | | - Martine Piccart
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | | | - Evandro de Azambuja
- Institut Jules Bordet, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Isabelle Demeestere
- Fertility Clinic, CUB-Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium
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Chan A, Ruiz-Borrego M, Marx G, Chien AJ, Rugo HS, Brufsky A, Thirlwell M, Trudeau M, Bose R, García-Sáenz JA, Egle D, Pistilli B, Wassermann J, Cheong KA, Schnappauf B, Semsek D, Singer CF, Foruzan N, DiPrimeo D, McCulloch L, Hurvitz SA, Barcenas CH. Final findings from the CONTROL trial: Strategies to reduce the incidence and severity of neratinib-associated diarrhea in patients with HER2-positive early-stage breast cancer. Breast 2022; 67:94-101. [PMID: 36702070 PMCID: PMC9982309 DOI: 10.1016/j.breast.2022.12.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Neratinib is an irreversible pan-HER tyrosine kinase inhibitor approved for HER2-positive early-stage and metastatic breast cancer. Diarrhea is the most frequent side effect and the most common reason for early discontinuation. The phase II CONTROL trial investigated antidiarrheal prophylaxis or neratinib dose escalation (DE) for prevention of diarrhea. We present complete study results including final data for two DE strategies. METHODS Patients who completed trastuzumab-based adjuvant therapy received neratinib 240 mg/day for 1 year. Early cohorts investigated mandatory prophylaxis with loperamide, then additional budesonide or colestipol. Final cohorts assessed neratinib DE over the first 2 (DE1) or 4 weeks (DE2). The primary endpoint was incidence of grade ≥3 diarrhea. Health-related quality of life (HRQoL) was assessed using FACT-B and EQ-5D-5L. RESULTS 563 patients were enrolled into six cohorts. All strategies reduced grade ≥3 diarrhea with the lowest incidence in DE1 (DE1 13%; colestipol + loperamide [CL] 21%, DE2 27%; budesonide + loperamide [BL] 28%; loperamide [L] 31%; colestipol + loperamide as needed [CL-PRN] 33%). Diarrhea-related discontinuations occurred early and were lowest in DE1 (DE1 3%; CL 4%; DE2 6%; CL-PRN 8%; BL 11%; L 20%). More patients stayed on neratinib for the prescribed period versus historical controls. Prior pertuzumab use did not affect rates of grade ≥3 diarrhea, diarrhea-related discontinuations, or treatment duration. Early transient reductions in HRQoL scores were observed. CONCLUSIONS These complete results from CONTROL show improved neratinib tolerability with proactive management at the start of therapy. Two-week neratinib DE with loperamide as needed was particularly effective. CLINICALTRIALS GOV REGISTRATION NUMBER NCT02400476.
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Affiliation(s)
- Arlene Chan
- Breast Cancer Research Centre-WA, Perth & Curtin University, Nedlands, Australia.
| | | | - Gavin Marx
- Sydney Adventist Hospital and Australian National University, Sydney, Australia
| | - A. Jo Chien
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Hope S. Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Adam Brufsky
- Magee-Womens Hospital of UPMC, Pittsburgh, PA, USA
| | | | | | - Ron Bose
- Washington University School of Medicine, St. Louis, MO, USA
| | - José A. García-Sáenz
- Hospital Clínico San Carlos, Instituto de Investigación Sanitaria San Carlos (IdISSC), CIBERONC, Madrid, Spain
| | - Daniel Egle
- Medical University Innsbruck, Innsbruck, Austria
| | | | | | | | | | - Dieter Semsek
- Praxis am Diakonie Krankenhaus Onkologische Schwerpunktpraxis, Freiberg, Germany
| | - Christian F. Singer
- Medical University of Vienna and Comprehensive Cancer Center, Vienna, Austria
| | | | | | | | - Sara A. Hurvitz
- University of California Los Angeles, Jonsson Comprehensive Cancer Center, Los Angeles, CA, USA
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Rassy E, Bardet A, Bougacha O, Gantzer L, Lekens B, Delaloge S, André F, Michiels S, Pistilli B. Association of Adherence to Endocrine Therapy Among Patients With Breast Cancer and Potential Drug-Drug Interactions. JAMA Netw Open 2022; 5:e2244849. [PMID: 36459136 PMCID: PMC9719053 DOI: 10.1001/jamanetworkopen.2022.44849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
IMPORTANCE Suboptimal adherence to endocrine therapy (ET) among patients with hormone-receptor-positive breast cancer significantly affects survival outcomes and is associated with higher hospitalization rates and health care costs. Weak adherence to long-term treatments has multiple determinants, including disease characteristics, treatment adverse effects, and patients' attributes, such as age and comorbidities. OBJECTIVE To examine whether potential drug-drug interactions (PDDI) with tamoxifen or aromatase inhibitor were associated with adherence to ET in patients with early and advanced breast cancer. DESIGN, SETTING, AND PARTICIPANTS This cohort study used anonymized health record data of women with breast cancer who received ET in a private observational primary care database. Patients eligible for analysis included women aged 18 years or older who had a reported diagnosis of breast cancer and received ET with tamoxifen or aromatase inhibitor between 1994 and 2021. Data were analyzed 2021. EXPOSURES Adherence to ET during a given year was defined by a medication possession ratio of 80% or greater over 1-year prescription periods. PDDI were categorized into absent, minor (a combination to take into account), moderate (combination requiring precautions for use), major (combination not recommended), and contraindicated according to guidelines in the Claude Bernard Drug Database. MAIN OUTCOMES AND MEASURES We used regression models to estimate odds ratios (ORs) and 95% CIs for the associations between adherence and age, baseline comorbidities, PDDI, and adherence to ET during the previous year. RESULTS A total of 10 863 patients who were prescribed ET for breast cancer were eligible for the analysis (age 70 years or older, 3509 patients [32.3%]). In the tamoxifen cohort (3564 patients), PDDI were reported in 497 of 3670 patients (13.5%) at baseline (moderate, 254 patients [51.1%]; major, 227 patients [45.7%]), 2047 of 4831 patients (42.4%) at year 1, 1127 of 2751 patients (41.0%) at year 2, 761 of 1861 patients (40.9%) at year 3, 376 of 1058 patients (35.5%) at year 4, and 201 of 593 patients (33.9%) at year 5. In the aromatase inhibitor cohort (7299 patients), PDDI were reported in 592 of 7437 patients (8.0%) at baseline (moderate in 588 of 592 patients [99.3%]), which reached 2875 of 9031 patients (31.8%) at year 1 and ranged between 31.4% (1802 of 5730 patients in year 2) and 32.8% (791 of 2411 in year 4) throughout the study period. No association between adherence and PDDI was found in the tamoxifen (OR, 0.99; 95% CI, 0.91-1.08) or aromatase inhibitor (OR, 1.05; 95% CI, 0.95-1.15) cohort. CONCLUSIONS AND RELEVANCE In this cohort of patients with hormone-receptor-positive breast cancer, PDDI with tamoxifen and aromatase inhibitors were not associated with adherence to ET.
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Affiliation(s)
- Elie Rassy
- Department of Medical Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Aurélie Bardet
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, University Paris-Saclay, Ligue Contre le Cancer, Villejuif, France
| | - Omar Bougacha
- Research and Development, Cegedim Healthcare Solutions, Boulogne-Billancourt, Paris, France
| | - Laurène Gantzer
- Research and Development, Cegedim Healthcare Solutions, Boulogne-Billancourt, Paris, France
| | - Béranger Lekens
- Research and Development, Cegedim Healthcare Solutions, Boulogne-Billancourt, Paris, France
| | - Suzette Delaloge
- Department of Medical Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Fabrice André
- Department of Medical Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
| | - Stefan Michiels
- Department of Biostatistics and Epidemiology, Gustave Roussy, University Paris-Saclay, Villejuif, France
- Oncostat U1018, Inserm, University Paris-Saclay, Ligue Contre le Cancer, Villejuif, France
| | - Barbara Pistilli
- Department of Medical Oncology, Gustave Roussy, University Paris-Saclay, Villejuif, France
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Carausu M, Carton M, Diéras V, Petit T, Guiu S, Gonçalves A, Augereau P, Ferrero JM, Levy C, Ung M, Desmoulins I, Debled M, Bachelot T, Pistilli B, Frenel JS, Mailliez A, Chevrot M, Cabel L. Association of Endocrine Therapy for HR+/ERBB2+ Metastatic Breast Cancer With Survival Outcomes. JAMA Netw Open 2022; 5:e2247154. [PMID: 36520434 PMCID: PMC9856509 DOI: 10.1001/jamanetworkopen.2022.47154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
IMPORTANCE Evidence suggests that patients with human epidermal growth factor receptor 2-positive (ERBB2+ [formerly HER2+]) metastatic breast cancer (MBC) have different clinical characteristics and outcomes according to their hormone receptor (HR) status. The place of endocrine therapy (ET) for patients with HR+/ERBB2+ is still not clearly defined in this setting. OBJECTIVE To evaluate the association of HR status and first-line inclusion of ET with outcomes among patients with ERBB2+ MBC. DESIGN, SETTING, AND PARTICIPANTS This cohort study was an analysis of clinical data from the French clinical Epidemiological Strategy and Medical Economics (ESME) cohort, including patients with MBC who started treatment between 2008 and 2017. The last date of follow-up was June 18, 2020. Data were analyzed from May 2021 to May 2022. EXPOSURES Patients were treated with first-line ERBB2-targeted therapy and either chemotherapy (CT) with or without ET or ET alone. For the study of the association of maintenance ET with outcomes, we included patients treated with first-line ERBB2-targeted therapy with CT and with or without maintenance ET. MAIN OUTCOMES AND MEASURES Median overall survival (OS) and median first-line progression-free survival (PFS) were reported using the Kaplan-Meier method. Cox proportional hazards models and a propensity score were constructed to report and adjust for prognostic factors. Multivariable analysis included age at MBC, time to MBC, number of metastatic sites, type of metastases, and Eastern Cooperative Oncology Group performance status. RESULTS Among 4145 women with ERBB2+ MBC, 2696 patients had HR+ (median [IQR] age, 58.0 [47.0-67.0] years) and 1449 patients had HR- (56.0 [47.0-64.0] years) tumors. The median OS for patients with HR+ vs HR- tumors was 55.9 months (95% CI, 53.7-59.4 months) vs 42.0 months (95% CI, 38.8-45.2 months), confirmed in multivariable analysis (hazard ratio, 1.40; 95% CI, 1.26-1.56; P < .001). The median PFS for patients with HR+ vs HR- tumors was 12.2 months (95% CI, 11.5-12.9 months) vs 9.8 months (95% CI, 9.2-11.0 months; P = .01), and the HR was 1.15 (95% CI, 1.06-1.26; P < .001). In multivariable analysis, no significant difference was found in OS or PFS for 1520 patients treated with ERBB2-targeted therapy with CT and with or without ET vs 203 patients receiving ERBB2-targeted therapy with ET, regardless of type of ERBB2-targeted therapy (trastuzumab or trastuzumab with pertuzumab). This result was confirmed by matching patients using a propensity score. Using the time-dependent ET variable among patients with ERBB2-targeted therapy with CT, those with maintenance ET had significantly better PFS (hazard ratio, 0.70; 95% CI, 0.60-0.82; P < .001) and OS (hazard ratio, 0.47; 95% CI, 0.39-0.57; P < .001). CONCLUSIONS AND RELEVANCE These results suggest that ET-containing first-line regimens may be associated with benefits among a subgroup of patients with HR+/ERBB2+ MBC.
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Affiliation(s)
- Marcela Carausu
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
| | - Matthieu Carton
- Department of Biostatistics, Institut Curie, Saint-Cloud, France
| | - Véronique Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - Thierry Petit
- Department of Medical Oncology, Centre Paul Strauss/ICANS, Strasbourg, France
| | - Séverine Guiu
- Department of Medical Oncology, Institut régional du Cancer Montpellier, France
| | - Anthony Gonçalves
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Paule Augereau
- Department of Medical Oncology, Institut de Cancérologie de l'Ouest, Angers, France
| | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | - Mony Ung
- Department of Medical Oncology, Institut Claudius Regaud, Toulouse, France
| | - Isabelle Desmoulins
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Marc Debled
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Barbara Pistilli
- Department of Cancer Medicine, Gustave Roussy, Villejuif, France
| | | | - Audrey Mailliez
- Department of Medical Oncology, Centre Oscar Lambret, Lille, France
| | - Michaël Chevrot
- Health Data and Partnership Department, Unicancer, Paris, France
| | - Luc Cabel
- Department of Medical Oncology, Institut Curie, Saint-Cloud, France
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Bidard FC, Hardy-Bessard AC, Dalenc F, Bachelot T, Pierga JY, de la Motte Rouge T, Sabatier R, Dubot C, Frenel JS, Ferrero JM, Ladoire S, Levy C, Mouret-Reynier MA, Lortholary A, Grenier J, Chakiba C, Stefani L, Plaza JE, Clatot F, Teixeira L, D'Hondt V, Vegas H, Derbel O, Garnier-Tixidre C, Canon JL, Pistilli B, André F, Arnould L, Pradines A, Bièche I, Callens C, Lemonnier J, Berger F, Delaloge S, PISTILLI B, DALENC F, BACHELOT T, DE LA MOTTE ROUGE T, SABATIER R, DUBOT C, FRENEL JS, FERRERO JM, LADOIRE S, LEVY C, MOURET-REYNIER MA, HARDY-BESSARD AC, LORTHOLARY A, GRENIER J, CHAKIBA C, STEFANI L, SOULIE P, JACQUIN JP, PLAZA JE, CLATOT F, TEIXEIRA L, D'HONDT V, VEGAS H, DERBEL O, GARNIER TIXIDRE C, DELBALDO C, MOREAU L, CHENEAU C, PAITEL JF, BERNARD-MARTY C, SPAETH D, GENET D, MOULLET I, BONICHON-LAMICHHANE N, DEIANA L, GREILSAMER C, VENAT-BOUVET L, DELECROIX V, MELIS A, ORFEUVRE H, NGUYEN S, LEGOUFFE E, ZANNETTI A, LE SCODAN R, DOHOLLOU N, DALIVOUST P, ARSENE O, MARQUES N, PETIT T, MOLLON D, DAUBA J, BONNIN N, MORVAN F, GARDNER M, MARTI A, LEVACHE CB, LACHAIER E, ACHILLE M, VALMAR C, BOUAITA R, MEDIONI J, FOA C, BERNARD-MARTY C, DEL PIANO F, GOZY M, ESCANDE A, LEDUC N, LUCAS B, MILLE D, AMMARGUELLAT H, NAJEM A, TROUBOUL F, BARTHELEMY P, DESCLOS H, MAYEUR D, LORCHEL F, GUINET F, LAURENTY AP, BOUDRANT A, GISSEROT O, ALLEAUME C, DE GRAMONT A. Switch to fulvestrant and palbociclib versus no switch in advanced breast cancer with rising ESR1 mutation during aromatase inhibitor and palbociclib therapy (PADA-1): a randomised, open-label, multicentre, phase 3 trial. Lancet Oncol 2022; 23:1367-1377. [PMID: 36183733 DOI: 10.1016/s1470-2045(22)00555-1] [Citation(s) in RCA: 81] [Impact Index Per Article: 40.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 08/25/2022] [Accepted: 08/31/2022] [Indexed: 11/17/2022]
Abstract
BACKGROUND In advanced oestrogen receptor-positive, HER2-negative breast cancer, acquired resistance to aromatase inhibitors frequently stems from ESR1-mutated subclones, which might be sensitive to fulvestrant. The PADA-1 trial aimed to show the efficacy of an early change in therapy on the basis of a rising ESR1 mutation in blood (bESR1mut), while assessing the global safety of combination fulvestrant and palbociclib. METHODS We did a randomised, open-label, phase 3 trial in 83 hospitals in France. Women aged at least 18 years with oestrogen receptor-positive, HER2-negative advanced breast cancer and an Eastern Cooperative Oncology Group performance status of 0-2 were recruited and monitored for rising bESR1mut during first-line aromatase inhibitor (2·5 mg letrozole, 1 mg anastrozole, or 25 mg exemestane, orally once per day, taken continuously) and palbociclib (125 mg orally once per day on days 1-21 of a 28-day cycle) therapy. Patients with newly present or increased bESR1mut in circulating tumour DNA and no synchronous disease progression were randomly assigned (1:1) to continue with the same therapy or to switch to fulvestrant (500 mg intramuscularly on day 1 of each 28-day cycle and on day 15 of cycle 1) and palbociclib (dosing unchanged). The randomisation sequence was generated within an interactive web response system using a minimisation method (with an 80% random factor); patients were stratified according to visceral involvement (present or absent) and the time from inclusion to bESR1mut detection (<12 months or ≥12 months). The co-primary endpoints were investigator-assessed progression-free survival from random assignment, analysed in the intention-to-treat population (ie, all randomly assigned patients), and grade 3 or worse haematological adverse events in all patients. The trial is registered with Clinicaltrials.gov (NCT03079011), and is now complete. FINDINGS From March 22, 2017, to Jan 31, 2019, 1017 patients were included, of whom 279 (27%) developed a rising bESR1mut and 172 (17%) were randomly assigned to treatment: 88 to switching to fulvestrant and palbociclib and 84 patients to continuing aromatase inhibitor and palbociclib. At database lock on July 31, 2021, randomly assigned patients had a median follow-up of 35·3 months (IQR 29·2-41·4) from inclusion and 26·0 months (13·8-34·3) from random assignment. Median progression-free survival from random assignment was 11·9 months (95% CI 9·1-13·6) in the fulvestrant and palbociclib group versus 5·7 months (3·9-7·5) in the aromatase inhibitor and palbociclib group (stratified HR 0·61, 0·43-0·86; p=0·0040). The most frequent grade 3 or worse haematological adverse events were neutropenia (715 [70·3%] of 1017 patients), lymphopenia (66 [6·5%]), and thrombocytopenia (20 [2·0%]). The most common grade 3 or worse adverse events in step 2 were neutropenia (35 [41·7%] of 84 patients in the aromatase inhibitor and palbociclib group vs 39 [44·3%] of 88 patients in the fulvestrant and palbociclib group) and lymphopenia (three [3·6%] vs four [4·5%]). 31 (3·1%) patients had grade 3 or worse serious adverse events related to treatment in the overall population. Three (1·7%) of 172 patients randomly assigned had one serious adverse event in step 2: one (1·2%) grade 4 neutropenia and one (1·2%) grade 3 fatigue among 84 patients in the aromatase inhibitor and palbociclib group, and one (1·1%) grade 4 neutropenia among 88 patients in the fulvestrant and palbociclib group. One death by pulmonary embolism in step 1 was declared as being treatment related. INTERPRETATION PADA-1 is the first prospective randomised trial showing that the early therapeutic targeting of bESR1mut results in significant clinical benefit. Additionally, the original design explored in PADA-1 might help with tackling acquired resistance with new drugs in future trials. FUNDING Pfizer.
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Affiliation(s)
- François-Clément Bidard
- Department of Medical Oncology, Institut Curie, Université Versailles Saint-Quentin, Université Paris-Saclay, Saint-Cloud, France; Circulating Tumour Biomarkers Laboratory, Inserm CIC-BT 1428, Institut Curie, Paris, France.
| | | | - Florence Dalenc
- Department of Medical Oncology, Institut Claudius-Regaud, Institut Universitaire du Cancer de Toulouse-Oncopole, Toulouse, France
| | - Thomas Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - Jean-Yves Pierga
- Circulating Tumour Biomarkers Laboratory, Inserm CIC-BT 1428, Institut Curie, Paris, France; Department of Medical Oncology, Institut Curie and Université de Paris, Paris, France
| | | | - Renaud Sabatier
- Department of Medical Oncology, Institut Paoli Calmettes, Aix-Marseille Université, Marseille, France
| | - Coraline Dubot
- Department of Medical Oncology, Institut Curie, Université Versailles Saint-Quentin, Université Paris-Saclay, Saint-Cloud, France
| | | | - Jean Marc Ferrero
- Department of Medical Oncology, Centre Antoine Lacassagne, Nice, France
| | - Sylvain Ladoire
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Christelle Levy
- Department of Medical Oncology, Centre François Baclesse, Caen, France
| | | | - Alain Lortholary
- Department of Medical Oncology, Hopital Privé du Confluent, Nantes, France
| | - Julien Grenier
- Department of Medical Oncology, Institut Sainte Catherine, Avignon, France
| | - Camille Chakiba
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Laetitia Stefani
- Department of Medical Oncology, Centre Hospitalier Annecy Genvoi, Pringy-Metz-Tessy, France
| | - Jérôme Edouard Plaza
- Department of Medical Oncology, UNEOS Site Hôpital Robert Schuman, Vantoux, France
| | - Florian Clatot
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Luis Teixeira
- Department of Medical Oncology, Hôpital Saint Louis, Paris, France
| | - Véronique D'Hondt
- Department of Medical Oncology, Institut du Cancer de Montpellier Val d'Aurelle, Montpellier, France
| | - Hélène Vegas
- Department of Medical Oncology, Centre Hospitalier de Tours, Hôpital Bretonneau, Tours, France
| | - Olfa Derbel
- Department of Medical Oncology, Hôpital Privé Jean Mermoz, Lyon, France
| | - Claire Garnier-Tixidre
- Department of Medical Oncology, Institut Daniel Hollard, G H Mutualiste de Grenoble, Grenoble, France
| | - Jean-Luc Canon
- Department of Medical Oncology, Grand Hôpital de Charleroi, Charleroi, Belgique
| | | | - Fabrice André
- Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - Laurent Arnould
- Department of Pathology, Centre Georges François Leclerc, Dijon, France
| | - Anne Pradines
- INSERM U1037 CNRS ERL5294 UPS, Cancer Research Center of Toulouse, Toulouse, France; Prospective Biology Unit, Medical Laboratory, Claudius Regaud Institute, Toulouse University Cancer Institute, Toulouse, France
| | - Ivan Bièche
- Pharmacogenomic Unit, Genetics Laboratory, Department of Diagnostic and Theranostic Medicine, Institut Curie, PSL University, Saint-Cloud, Paris, France
| | - Céline Callens
- Pharmacogenomic Unit, Genetics Laboratory, Department of Diagnostic and Theranostic Medicine, Institut Curie, PSL University, Saint-Cloud, Paris, France
| | | | - Frédérique Berger
- Biometry Unit, Institut Curie, PSL University, Saint-Cloud, Paris, France
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Rassy E, Rached L, Pistilli B. Antibody drug conjugates targeting HER2: Clinical development in metastatic breast cancer. Breast 2022; 66:217-226. [PMID: 36334569 PMCID: PMC9636477 DOI: 10.1016/j.breast.2022.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/12/2022] Open
Abstract
The identification of the HER2 alteration as an actionable oncogenic driver in breast cancer has propelled the development of HER-targeting monoclonal antibodies (mAb) such as trastuzumab and pertuzumab, which led to dramatic improvements in survival outcomes. Lately, the great strides made toward developing antibody-conjugation methods have led to the development of a new class of compelling compounds, the antibody-drug conjugates (ADCs) targeting HER2 which have profoundly transformed the treatment landscape of breast cancer. HER2-targeting ADCs, trastuzumab-emtansine and trastuzumab-deruxtecan, have improved the overall survival in the second and third-line settings with manageable adverse events. Other HER2-targeting ADCs using novel technological advances in the antibody, linker and/or payload conception have shown promising activity in preclinical and clinical studies and some of them are now being evaluated in larger clinical trials. Multiple challenges still impede the success of ADCs in breast cancer namely the lack of a comprehensive understanding of resistance mechanisms as well as the mechanisms of action of ADCs in special subgroups of patients such as those with low or ultra-low HER2 expression and patients with brain or leptomeningeal metastases (BM). In this framework, we review the approved indications and ongoing trials for HER2-targeting ADCs, across patient subgroups, including those with BM and discuss the associated potential mechanisms of action and resistance. Last, we provide an overview of the future perspectives involving HER2-targeting ADCs in breast cancer.
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Franzoi MAB, Degousee L, Martin E, Aupomerol M, Soldato D, Di Meglio A, Barbier A, Lazorthes C, Chaouachi H, Renvoise N, Boinon D, Fasse L, Le-Provost JB, Arvis J, De-Jesus A, Raynard B, Delaloge S, Pistilli B, Scotte F, Luis IMVD. PROACT: Implementing a PROACTive care pathway to empower and support breast cancer (BC) survivors. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.28_suppl.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
221 Background: Optimal comprehensive survivorship care, beyond screening of recurrences and new cancers, and including health promotion, management of physical as well as psychosocial needs and chronic conditions is insufficiently delivered. To increase patient (pt) empowerment and maximize the uptake of multidisciplinary strategies serving all survivorship needs, we implemented a proactive survivorship care pathway offered for pts with early BC at the end of their primary treatment phase (surgery, chemotherapy, radiotherapy). Methods: The pathway consisted of the following components: 1) receipt of a personalized survivorship care plan (SCP), 2) invitation to attend face-to-face group seminars focused on specific themes and a comprehensive survivorship consultation for multidisciplinary referrals (”the transition day”) 3) access to a mobile application (app) delivering personalized education according to symptoms reported and 4) decision aids for helping physicians to manage prevalent symptoms and side effects related to BC treatment. Administrative data were collected. A pre-specified post-experience survey was sent to all pts four weeks post pathway delivery to inform program implementation with a minimum requirement of 50 responses. BC physicians and members of the multidisciplinary implementation team (MIT) answered a dedicated survey. For the overall pathway and each of its components we descriptively evaluated the following domains: satisfaction (primary outcome), uptake, perceived usefulness, barriers for delivery, and suggestions for improvement. A 70% satisfaction rate would define a positive experience. Results: From October 2021 to April 2022, 241 SCP were delivered, and 98 pts attended the “transition day”. 62 pts replied to the survey, 42 (67%) had received the SCP, 34 (55%) attended the “transition day”, 36 (57%) accessed the app. Only 21 pts (34%) who answered the survey received the full pathway, 81% of whom were very or completely satisfied with it. Perceived usefulness of individual components and for pts that received the full pathway were, respectively: 64% and 90% for the SCP, 91% and 95% for the “transition day”, 72% and 90% for the app. Among 14 BC physicians, agreement regarding the usefulness of the components was: 93% for the SCP, 86% for the decision aids, 93% for the “transition day”, and 86% for the app. The MIT (n = 13) reported high engagement and satisfaction (100%). Main actionable points for improvement included: automated screening and SCP preparation, virtual “transition day”, increase physicians’ awareness. Conclusions: In this pilot phase, pts were satisfied with receiving a proactive survivorship care pathway and the majority reported that the components were useful for supporting their needs. This study informed improvements on program penetration. Evolution towards sustainability phase is ongoing including dissemination to other cancers and centers.
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Ruiz De Azua G, Vaz-Luis I, Bovagnet T, Di Meglio A, Havas J, Caumette E, Martin E, Pistilli B, Coutant C, Cottu P, Rouanet P, Arnaud A, Arsene O, Ibrahim M, Wassermann J, Rouzier R, Martin AL, Everhard S, Dumas A, Menvielle G. Perceived discrimination at work: examining social, health and work-related factors as determinants among breast cancer survivors – evidence from the prospective CANTO cohort. J Epidemiol Community Health 2022. [DOI: 10.1136/jech-2021-218331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BackgroundWe assessed the prevalence of self-reported perceived discrimination in the workplace after the end of treatment among breast cancer (BC) survivors and studied its association with social, health-related and work-related factors.MethodsWe used data from a French prospective cohort (CANcer TOxicities) including women diagnosed with stage I–III BC. Our analysis included 2130 women who were employed, <57 years old at BC diagnosis and were working 2 years afterwards. We assessed the association between social, health-related and work-related factors and perceived discrimination in the workplace using logistic regression models.ResultsOverall, 26% of women reported perceived discrimination in the workplace after the end of treatment. Women working for a small company, in the public sector or with better overall health status were less likely to report perceived discrimination. Women who benefited from easing dispositions at their workplace, who did not feel supported by their colleagues and those who returned to work because of fear of job loss were more likely to report perceived discrimination.ConclusionsOne in four BC survivors perceives discrimination in the workplace. Health and work-related factors are associated with increased likelihood of reporting perceived discrimination.Trial registration numberNCT01993498.
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Franzoi M, Aupomerol M, Havas J, Hang H, Di Meglio A, Lambertini M, Massarotti C, Coutant C, Tredan O, Joly Lobbedez F, Cottu P, Soldato D, Mouret MA, Tarpin C, Arnaud A, Fasse L, Everhard S, Martin AL, Pistilli B, Luis I. 1558MO Dissecting sexual health after breast cancer (BC) by longitudinal assessment of patient reported outcomes. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Mosele M, Lusque A, Dieras V, Deluche E, Ducoulombier A, Pistilli B, Bachelot T, Viret F, Levy C, Pradat Y, Tran D, Droin N, Kobayashi M, Kakewaga T, Deloger M, Job B, Jimenez M, Lacroix-Triki M, André F. LBA72 Unraveling the mechanism of action and resistance to trastuzumab deruxtecan (T-DXd): Biomarker analyses from patients from DAISY trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.08.078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Lambertini M, Massarotti C, Havas J, Pistilli B, Martin AL, Jacquet A, Coutant C, Coussy F, Mérimèche AD, Lerebours F, Rousset-Jablonski C, Jouannaud C, Rigal O, Fournier M, Soulie P, Franzoi MA, Del Mastro L, Partridge AH, André F, Vaz-Luis I, Di Meglio A. Contraceptive Use in Premenopausal Women With Early Breast Cancer. JAMA Netw Open 2022; 5:e2233137. [PMID: 36149651 PMCID: PMC9508662 DOI: 10.1001/jamanetworkopen.2022.33137] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE As life span has increased among patients with cancer, survivorship has become an important component of breast cancer care. Among survivorship concerns, adequate contraceptive counseling is needed for premenopausal patients who are not seeking to become pregnant. OBJECTIVE To examine contraceptive use and chosen methods and to assess factors associated with contraceptive use over time in patients with early breast cancer. DESIGN, SETTING, AND PARTICIPANTS The Cancer Toxicity (CANTO) study was a multicenter nationwide prospective cohort study that enrolled women diagnosed with stage I to stage III breast cancer in France between March 2012 and December 2017. This analysis included 2900 premenopausal women who were 50 years of age or younger at diagnosis. Data were analyzed from July 2020 to July 2022. EXPOSURES Contraceptive use and method at diagnosis, shortly after the end of primary treatment (year 1), and during follow-up (year 2). MAIN OUTCOMES AND MEASURES Contraceptive use and methods were longitudinally evaluated at diagnosis, year 1, and year 2 after breast cancer diagnosis. Multivariable logistic regression models were used to assess the associations of clinical, socioeconomic, treatment, adverse effect, and patient-reported outcome variables with contraceptive use after diagnosis. RESULTS A total of 2900 patients (mean [SD] age, 43.1 [5.6] years) were included in the analysis; 2050 of 2894 women (70.8%) received chemotherapy, and 2305 of 2880 women (80.0%) received endocrine therapy. After diagnosis, 1182 of 2625 patients (45.0%) at year 1 and 1553 of 2363 patients (65.7%) at year 2 reported consulting with a gynecologist in the previous year. At diagnosis, 1487 of 2744 patients (54.2%) reported contraceptive use, with most patients (921 of 1470 women [62.7%]) using hormonal methods. The use of contraception significantly decreased after diagnosis (911 of 2342 patients [38.9%] at year 1 and 808 of 1961 patients [41.2%] at year 2; P < .001 for trend), when most patients (848 of 900 women [94.2%] at year 1 and 767 of 805 women [95.3%] at year 2) reported use of nonhormonal methods; these methods were primarily reversible mechanical approaches (copper intrauterine devices: 656 of 848 patients [77.4%] at year 1 and 577 of 767 patients [75.2%] at year 2; male condoms: 115 of 848 patients [13.6%] at year 1 and 110 of 767 patients [14.3%] at year 2). In the multivariable model, factors significantly associated with contraceptive use at year 1 included using contraception at diagnosis (adjusted odds ratio [aOR], 4.02; 95% CI, 3.15-5.14), being younger (aOR, 1.09; 95% CI, 1.07-1.13 per decreasing year), having better sexual function (aOR, 1.13; 95% CI, 1.07-1.19 per 10-point increment), having children (aOR, 4.21; 95% CI, 1.80-9.86), reporting the presence of leukorrhea (aOR, 1.32; 95% CI, 1.03-1.70), receiving tamoxifen treatment alone (aOR, 1.39; 95% CI, 1.01-1.92), and consulting with a gynecologist in the previous year (aOR, 1.29; 95% CI, 1.02-1.63). Similar factors were associated with contraceptive use at year 2, with the addition of partnered status (aOR, 1.61; 95% CI, 1.07-2.44). CONCLUSIONS AND RELEVANCE Findings from this study support the importance of raising awareness and improving targeted contraceptive counseling for premenopausal women with early breast cancer.
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Affiliation(s)
- Matteo Lambertini
- Department of Medical Oncology, U.O. 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
| | - Claudia Massarotti
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal, and Child Health, School of Medicine, University of Genova, Genova, Italy
- Academic Unit of Obstetrics and Gynaecology, IRCCS Ospedale Policlinico San Martino, Genova, Italy
| | - Julie Havas
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
| | - Barbara Pistilli
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | | | | | - Charles Coutant
- Department of Medical Oncology, Centre Georges-François Leclerc, Dijon, France
| | - Florence Coussy
- Department of Medical Oncology, Institut Curie, Paris, France
| | | | | | | | | | - Olivier Rigal
- Department of Medical Oncology, Centre Henri Becquerel, Rouen, France
| | - Marion Fournier
- Department of Surgical Oncology, Institut Bergonié, Bordeaux, France
| | - Patrick Soulie
- Department of Medical Oncology, Institut de Cancérologie de L’ouest-Paul Papin, Angers, France
| | - Maria Alice Franzoi
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Lucia Del Mastro
- Department of Medical Oncology, U.O. 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
| | - Ann H. Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Fabrice André
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Institut National de la Sante et de la Recherche Medicale Unit 981, Molecular Predictors and New Targets in Oncology, Gustave Roussy, Villejuif, France
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Villejuif, France
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Kabirian R, Havas J, Franzoi M, Coutant C, Tredan O, Levy C, Cottu P, Dhaini Merimeche A, Guillermet S, Ferrero JM, Giacchetti S, Petit T, Dalenc F, Rouanet P, Querel O, Martin AL, Pistilli B, Lambertini M, Luis I, Di Meglio A. 1551O Factors associated with chemotherapy (CT)-related amenorrhea (CRA) and its relationship with quality of life (QOL) in premenopausal women with early breast cancer (BC): Results from the prospective CANTO cohort study. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Epaillard N, Lusque A, Pistilli B, André F, Bachelot T, Pierga JY, Ducoulombier A, Jouannaud C, Viret F, Salabert L, Johnson A, Deluche E, Durando X, Petit T, Filleron T, Mahier Ait Oukhatar C, Dieras V, Mosele M. 260P Antitumor activity of trastuzumab deruxtecan (T-DXd) in patients with metastatic breast cancer (mBC) and brain metastases (BMs) from DAISY trial. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Verret B, Bottosso M, Hervais S, Pistilli B. The Molecular Predictive and Prognostic Biomarkers in Metastatic Breast Cancer: The Contribution of Molecular Profiling. Cancers (Basel) 2022; 14:4203. [PMID: 36077738 PMCID: PMC9454488 DOI: 10.3390/cancers14174203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 08/16/2022] [Accepted: 08/20/2022] [Indexed: 11/22/2022] Open
Abstract
The past decade was marked by several important studies deciphering the molecular landscape of metastatic breast cancer. Although the initial goal of these studies was to find driver oncogenic events to explain cancer progression and metastatic spreading, they have also permitted the identification of several molecular alterations associated with treatment response or resistance. Herein, we review validated (PI3KCA, ESR1, MSI, NTRK translocation) and emergent molecular biomarkers (ERBB2, AKT, PTEN, HRR gene, CD274 amplification RB1, NF1, mutational process) in metastatic breast cancer, on the bases of the largest molecular profiling studies. These biomarkers will be classed according the level of evidence and, if possible, the ESCAT (ESMO) classification. Finally, we will provide some perspective on development in clinical practice for the main biomarkers.
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Affiliation(s)
- Benjamin Verret
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France
- INSERM Unit U981, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Michele Bottosso
- INSERM Unit U981, Gustave Roussy Cancer Campus, 94805 Villejuif, France
- Department of Surgery, Oncology and Gastroenterology, University of Padova, 35122 Padova, Italy
| | - Sofia Hervais
- INSERM Unit U981, Gustave Roussy Cancer Campus, 94805 Villejuif, France
| | - Barbara Pistilli
- Medical Oncology Department, Gustave Roussy Cancer Campus, 94800 Villejuif, France
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Boni V, Pistilli B, Braña I, Shapiro GI, Trigo J, Moreno V, Castellano D, Fernández C, Kahatt C, Alfaro V, Siguero M, Zeaiter A, Longo F, Zaman K, Antón A, Paredes A, Huidobro G, Subbiah V. Lurbinectedin, a selective inhibitor of oncogenic transcription, in patients with pretreated germline BRCA1/2 metastatic breast cancer: results from a phase II basket study. ESMO Open 2022; 7:100571. [PMID: 36037567 PMCID: PMC9588879 DOI: 10.1016/j.esmoop.2022.100571] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/21/2022] [Accepted: 07/27/2022] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Lurbinectedin, a selective inhibitor of oncogenic transcription, has shown preclinical antitumor activity against homologous recombination repair-deficient models and preliminary clinical activity in BRCA1/2 breast cancer. PATIENTS AND METHODS This phase II basket multitumor trial (NCT02454972) evaluated lurbinectedin 3.2 mg/m2 1-h intravenous infusion every 3 weeks in a cohort of 21 patients with pretreated germline BRCA1/2 breast cancer. Patients with any hormone receptor and human epidermal growth factor receptor 2 status were enrolled. The primary efficacy endpoint was overall response rate (ORR) according to RECIST v1.1. Secondary endpoints included duration of response (DoR), progression-free survival (PFS), overall survival (OS) and safety. RESULTS Confirmed partial response (PR) was observed in six patients [ORR = 28.6%; 95% confidence interval (CI) 11.3% to 52.2%] who had received a median of two prior advanced chemotherapy lines. Lurbinectedin was active in both BRCA mutations: four PRs in 11 patients (36.4%) with BRCA2 and two PRs in 10 patients (20.0%) with BRCA1. Median DoR was 8.6 months, median PFS was 4.1 months and median OS was 16.1 months. Stable disease (SD) was observed in 10 patients (47.6%), including 3 with unconfirmed response in a subsequent tumor assessment [ORR unconfirmed = 42.9% (95% CI 21.8% to 66.0%)]. Clinical benefit rate (PR + SD ≥ 4 months) was 76.2% (95% CI 52.8% to 91.8%). No objective response was observed among patients who had received prior poly (ADP-ribose) polymerase inhibitors. The most common treatment-related adverse events (AEs) were nausea (61.9%), fatigue (38.1%) and vomiting (23.8%). These AEs were mostly grade 1/2. The most common grade 3/4 toxicity was neutropenia (42.9%: grade 4, 23.8%: with no febrile neutropenia). CONCLUSIONS This phase II study met its primary endpoint and showed activity of lurbinectedin in germline BRCA1/2 breast cancer. Lurbinectedin showed a predictable and manageable safety profile. Considering the exploratory aim of this trial as well as previous results in other phase II studies, further development of lurbinectedin in this indication is warranted.
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Affiliation(s)
- V Boni
- START Madrid-CIOCC, Centro Integral Oncológico Clara Campal, Madrid, Spain
| | | | - I Braña
- Hospital Universitario Vall D'Hebron (VHIO), Barcelona, Spain
| | | | - J Trigo
- Hospital Universitario Virgen De La Victoria, IBIMA, Málaga, Spain
| | - V Moreno
- START Madrid-FJD, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - D Castellano
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - C Kahatt
- PharmaMar, Colmenar Viejo, Madrid, Spain
| | - V Alfaro
- PharmaMar, Colmenar Viejo, Madrid, Spain
| | - M Siguero
- PharmaMar, Colmenar Viejo, Madrid, Spain
| | - A Zeaiter
- PharmaMar, Colmenar Viejo, Madrid, Spain
| | - F Longo
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - K Zaman
- University Hospital CHUV, Lausanne, Switzerland
| | - A Antón
- Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - A Paredes
- Hospital Universitario Donostia, Donostia-San Sebastián, Spain
| | - G Huidobro
- Hospital Universitario de Vigo Alvaro Cunqueiro, Pontevedra, Spain
| | - V Subbiah
- The University of Texas MD Anderson Cancer Center, Houston, USA.
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Soldato D, Havas J, Crane TE, Presti D, Lapidari P, Rassy N, Pistilli B, Martin E, Del Mastro L, Martin AL, Jacquet A, Coutant C, Cottu P, Merimeche A, Lerebours F, Tredan O, Vanlemmens L, André F, Vaz-Luis I, Di Meglio A. Coffee and tea consumption, patient-reported, and clinical outcomes in a longitudinal study of patients with breast cancer. Cancer 2022; 128:3552-3563. [PMID: 35913436 PMCID: PMC9541449 DOI: 10.1002/cncr.34401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 03/07/2022] [Accepted: 04/11/2022] [Indexed: 11/12/2022]
Abstract
Background Higher consumption of coffee and tea has been associated with improved health outcomes in the general population and improved breast cancer (BC) prognosis. This study investigated patterns of coffee and tea consumption and association with patient‐reported outcomes (PROs) and clinical outcomes among survivors of BC. Methods The authors included survivors of stage I–III BC enrolled in the CANTO cohort (NCT01993498) that provided post‐treatment assessment of coffee and tea consumption from years 1 to 4 after diagnosis. Group‐based trajectory modeling clustered patients according to daily consumption of coffee and tea. Multivariable mixed models and Cox models examined associations between consumption, PROs and clinical outcomes. Results Among 3788 patients, the authors identified four stable patterns of consumption: “Low” (25.8%), “Moderate” (37.6%), “High” (25.3%), and “Very high” (11.3%), corresponding to <1, 2, 3, and ≥ 4 cups of coffee and/or tea per day. Patients in the “Very high” group (vs. “Low”), were more likely to be younger, smokers, with higher monthly income and education. PROs and survival outcomes were similar across the four groups. Conclusions Over one in three survivors of BC reported high or very high consumption of coffee and/or tea. The authors found no association between higher consumption of coffee and/or tea, worse PROs and clinical outcomes. More than 30% of survivors of breast cancer report high post‐diagnostic consumption of coffee and tea. In this study, the authors did not find any detrimental association between higher consumption of coffee and tea and patient‐reported or clinical outcomes.
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Affiliation(s)
- Davide Soldato
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.,Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy
| | - Julie Havas
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Tracy E Crane
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, Florida, USA
| | - Daniele Presti
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Pietro Lapidari
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | | | | | - Elise Martin
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France
| | - Lucia Del Mastro
- Department of Internal Medicine and Medical Specialties, School of Medicine, University of Genoa, Genoa, Italy.,Academic Unit of Medical Oncology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | - Charles Coutant
- Medical Oncology, Centre Georges Francois Leclerc, Dijon, France
| | - Paul Cottu
- Medical Oncology, Institut Curie, Paris, France
| | - Asma Merimeche
- Medical Oncology, Centre Alexis Vautrin, Vandoeuvre-les-Nancy, France
| | | | | | | | - Fabrice André
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.,Medical Oncology, Gustave Roussy, Villejuif, France
| | - Ines Vaz-Luis
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.,Medical Oncology, Gustave Roussy, Villejuif, France
| | - Antonio Di Meglio
- Molecular Predictors and New Targets in Oncology, INSERM Unit 981, Gustave Roussy, Villejuif, France.,Medical Oncology, Gustave Roussy, Villejuif, France
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Martin E, Di Meglio A, Menvielle G, Arvis J, Bourmaud A, Michiels S, Pistilli B, Vaz-Luis I, Dumas A. Informing the development of multidisciplinary interventions to help breast cancer patients return to work: a qualitative study. Support Care Cancer 2022; 30:8287-8299. [PMID: 35819520 DOI: 10.1007/s00520-022-07262-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 06/27/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE Return to work (RTW) after breast cancer (BC) can be a major challenge for patients. Multidisciplinary interventions seem to be effective but the role of digital solutions is under-developed and therefore not evaluated. We explored the preferences, needs, and barriers regarding RTW interventions, including opinions about the use of digital approaches to deliver such interventions. METHODS We conducted a qualitative study based on interviews with 30 patients with BC and 18 healthcare providers in four French regions. Emergent themes were identified using thematic content analysis. RESULTS Most providers declared that they did not proactively address RTW with patients, mainly due to having other priorities and a lack of knowledge. The following themes emerged: several development and deployment barriers regarding RTW interventions exist, multidisciplinary interventions are preferred, and there is a need to maintain contact between the patient and workplace during sick leave, including pathways and interlocutors that can facilitate RTW. Participants had mostly positive representations of using digital tools to facilitate RTW; however, fear of loss of human contact and the exacerbation of inequalities were identified as possible risks associated with the development of digital-only interventions. CONCLUSIONS Interventions blending the needs and preferences of patients with BC and the healthcare system are warranted. A personalized multimodal approach with mixed digital and in-person features has surfaced as a possible solution to address the weaknesses of existing interventions. IMPLICATIONS FOR CANCER SURVIVORS Since most women work at the time of diagnosis, it is of particular relevance to build interventions promoting RTW.
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Affiliation(s)
- Elise Martin
- Université Paris-Saclay, Gustave Roussy, Inserm, Biomarqueurs Prédictifs Et Nouvelles Stratégies Thérapeutiques en Oncologie, 94800, Villejuif, France.
| | - Antonio Di Meglio
- Université Paris-Saclay, Gustave Roussy, Inserm, Biomarqueurs Prédictifs Et Nouvelles Stratégies Thérapeutiques en Oncologie, 94800, Villejuif, France.,Medical Oncology Department, Gustave Roussy, 94800, Villejuif, France
| | - Gwenn Menvielle
- Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie Et de Sante Publique, Paris, France
| | | | | | - Stefan Michiels
- Office of Biostatistics and Epidemiology, Gustave Roussy, Villejuif, France.,Oncostat U1018, Inserm, University Paris-Saclay, Labeled Ligue Contre Le Cancer, Villejuif, France
| | - Barbara Pistilli
- Medical Oncology Department, Gustave Roussy, 94800, Villejuif, France
| | - Ines Vaz-Luis
- Université Paris-Saclay, Gustave Roussy, Inserm, Biomarqueurs Prédictifs Et Nouvelles Stratégies Thérapeutiques en Oncologie, 94800, Villejuif, France.,Medical Oncology Department, Gustave Roussy, 94800, Villejuif, France
| | - Agnès Dumas
- Université Paris Cité, ECEVE, UMR 1123, INSERM, Paris, France
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