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Leon-Ferre RA, Jonas SF, Salgado R, Loi S, de Jong V, Carter JM, Nielsen TO, Leung S, Riaz N, Chia S, Jules-Clément G, Curigliano G, Criscitiello C, Cockenpot V, Lambertini M, Suman VJ, Linderholm B, Martens JWM, van Deurzen CHM, Timmermans AM, Shimoi T, Yazaki S, Yoshida M, Kim SB, Lee HJ, Dieci MV, Bataillon G, Vincent-Salomon A, André F, Kok M, Linn SC, Goetz MP, Michiels S. Tumor-Infiltrating Lymphocytes in Triple-Negative Breast Cancer. JAMA 2024; 331:1135-1144. [PMID: 38563834 PMCID: PMC10988354 DOI: 10.1001/jama.2024.3056] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 02/20/2024] [Indexed: 04/04/2024]
Abstract
Importance The association of tumor-infiltrating lymphocyte (TIL) abundance in breast cancer tissue with cancer recurrence and death in patients with early-stage triple-negative breast cancer (TNBC) who are not treated with adjuvant or neoadjuvant chemotherapy is unclear. Objective To study the association of TIL abundance in breast cancer tissue with survival among patients with early-stage TNBC who were treated with locoregional therapy but no chemotherapy. Design, Setting, and Participants Retrospective pooled analysis of individual patient-level data from 13 participating centers in North America (Rochester, Minnesota; Vancouver, British Columbia, Canada), Europe (Paris, Lyon, and Villejuif, France; Amsterdam and Rotterdam, the Netherlands; Milan, Padova, and Genova, Italy; Gothenburg, Sweden), and Asia (Tokyo, Japan; Seoul, Korea), including 1966 participants diagnosed with TNBC between 1979 and 2017 (with follow-up until September 27, 2021) who received treatment with surgery with or without radiotherapy but no adjuvant or neoadjuvant chemotherapy. Exposure TIL abundance in breast tissue from resected primary tumors. Main Outcomes and Measures The primary outcome was invasive disease-free survival [iDFS]. Secondary outcomes were recurrence-free survival [RFS], survival free of distant recurrence [distant RFS, DRFS], and overall survival. Associations were assessed using a multivariable Cox model stratified by participating center. Results This study included 1966 patients with TNBC (median age, 56 years [IQR, 39-71]; 55% had stage I TNBC). The median TIL level was 15% (IQR, 5%-40%). Four-hundred seventeen (21%) had a TIL level of 50% or more (median age, 41 years [IQR, 36-63]), and 1300 (66%) had a TIL level of less than 30% (median age, 59 years [IQR, 41-72]). Five-year DRFS for stage I TNBC was 94% (95% CI, 91%-96%) for patients with a TIL level of 50% or more, compared with 78% (95% CI, 75%-80%) for those with a TIL level of less than 30%; 5-year overall survival was 95% (95% CI, 92%-97%) for patients with a TIL level of 50% or more, compared with 82% (95% CI, 79%-84%) for those with a TIL level of less than 30%. At a median follow-up of 18 years, and after adjusting for age, tumor size, nodal status, histological grade, and receipt of radiotherapy, each 10% higher TIL increment was associated independently with improved iDFS (hazard ratio [HR], 0.92 [0.89-0.94]), RFS (HR, 0.90 [0.87-0.92]), DRFS (HR, 0.87 [0.84-0.90]), and overall survival (0.88 [0.85-0.91]) (likelihood ratio test, P < 10e-6). Conclusions and Relevance In patients with early-stage TNBC who did not undergo adjuvant or neoadjuvant chemotherapy, breast cancer tissue with a higher abundance of TIL levels was associated with significantly better survival. These results suggest that breast tissue TIL abundance is a prognostic factor for patients with early-stage TNBC.
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Affiliation(s)
| | - Sarah Flora Jonas
- Office of Biostatistics and Epidemiology, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
| | - Roberto Salgado
- GZA-ZNA-Hospitals, Antwerp, Belgium
- Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Sherene Loi
- Peter Mac Callum Cancer Centre, Melbourne, Victoria, Australia
| | - Vincent de Jong
- Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Jodi M. Carter
- Department of Laboratory Medicine and Pathology, University of Alberta, Edmonton, Alberta, Canada
| | | | - Samuel Leung
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Nazia Riaz
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephen Chia
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Gérôme Jules-Clément
- Bioinformatics Core Facility, Gustave Roussy, Université Paris-Saclay, Inserm US23, CNRS UMS 3655, Villejuif, France
| | - Giuseppe Curigliano
- Division of Early Drug Development for Innovative Therapy, IEO, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Carmen Criscitiello
- Division of Early Drug Development for Innovative Therapy, IEO, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | | | - 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
| | - Vera J. Suman
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota
| | - Barbro Linderholm
- Sahlgrenska University Hospital, and Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | | | | | | | | | - Shu Yazaki
- National Cancer Center Hospital, Tokyo, Japan
| | | | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee Jin Lee
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Maria Vittoria Dieci
- Department of Surgery, Oncology, and Gastroenterology, University of Padova, Padova, Italy
- Oncology 2, Veneto Institute of Oncology IOV—IRCCS, Padova, Italy
| | | | | | - Fabrice André
- Office of Biostatistics and Epidemiology, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
| | - Marleen Kok
- Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Sabine C. Linn
- Department of Medical Oncology, the Netherlands Cancer Institute, Amsterdam, the Netherlands
- Department of Pathology, University Medical Center Utrecht, Utrecht, the Netherlands
| | | | - Stefan Michiels
- Office of Biostatistics and Epidemiology, Gustave Roussy, Oncostat U1018, Inserm, University Paris-Saclay, labeled Ligue Contre le Cancer, Villejuif, France
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Polyzoi M, Ekman M, Reithmeier A, Jacob J, Karlsson E, Bertranou E, Linderholm B, Hettle R. Cost-Effectiveness Analysis of Adjuvant Olaparib Versus Watch and Wait in the Treatment of Germline BRCA1/2-Mutated, High-Risk, HER2-Negative Early Breast Cancer in Sweden. Pharmacoecon Open 2024; 8:277-289. [PMID: 38093030 PMCID: PMC10884392 DOI: 10.1007/s41669-023-00457-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/19/2023] [Indexed: 02/23/2024]
Abstract
INTRODUCTION This study evaluated the cost effectiveness of adjuvant olaparib versus watch and wait (WaW) in patients with germline breast cancer susceptibility gene 1/2 (gBRCA1/2)-mutated, high-risk, human epidermal growth factor receptor 2 (HER2)-negative early breast cancer (eBC), previously treated with neoadjuvant or adjuvant chemotherapy, from a Swedish healthcare perspective. METHODS A five-state (invasive disease-free survival [IDFS], non-metastatic breast cancer [non-mBC], early-onset mBC, late-onset mBC, death) semi-Markov state transition model with a lifetime horizon was developed. Transition probabilities were informed by data from the Phase III OlympiA trial, supplemented with data from additional studies in BRCA-mutated, HER2-negative mBC. Health state utilities were derived via mapping of OlympiA data and supplemented by literature estimates. Treatment, adverse events and other medical costs were extracted from publicly available Swedish sources. Incremental cost per life-year (LY) and quality-adjusted life-year (QALY) gained were estimated. Costs and outcomes were discounted at 3% annually. One-way deterministic and probabilistic sensitivity analyses (PSA) were conducted. RESULTS Over a lifetime horizon, adjuvant olaparib was associated with an additional 1.50 LYs and 1.22 QALYs, and incremental cost of 471,156 Swedish krona (SEK) versus WaW (discounted). The resulting ICER was 385,183SEK per QALY gained for olaparib versus WaW. ICERs remained below 1,000,000SEK across a range of scenarios, and were consistent across subgroups (hormone receptor [HR]-positive/HER2-negative and triple-negative breast cancer [TNBC]). In PSA, the probability of olaparib being cost effective at 1,000,000SEK per QALY was 99.8%. CONCLUSIONS At list price, adjuvant olaparib is a cost-effective alternative to WaW in patients with gBRCA1/2-mutated, high-risk, HER2-negative eBC in Sweden.
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Affiliation(s)
| | | | | | | | | | | | - Barbro Linderholm
- Institution of Clinical Sciences/Department of Oncology, Sahlgrenska University Hospital and Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
| | - Robert Hettle
- AstraZeneca, City House, 130 Hills Rd, Cambridge, CB2 1RY, UK.
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Rodriguez-Wallberg KA, Nilsson HP, Bergh J, Malmros J, Ljungman P, Foukakis T, Stragliotto CL, Friman EI, Linderholm B, Valachis A, Andersson A, Harrysson S, Vennström L, Frisk P, Mörse H, Eloranta S. ProFertil study protocol for the investigation of gonadotropin-releasing hormone agonists (GnRHa) during chemotherapy aiming at fertility protection of young women and teenagers with cancer in Sweden-a phase III randomised double-blinded placebo-controlled study. BMJ Open 2023; 13:e078023. [PMID: 38070906 PMCID: PMC10728964 DOI: 10.1136/bmjopen-2023-078023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 10/31/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Gonadotropin-releasing hormone agonists (GnRHa) cotreatment used to transiently suppress ovarian function during chemotherapy to prevent ovarian damage and preserve female fertility is used globally but efficacy is debated. Most clinical studies investigating a beneficial effect of GnRHa cotreatment on ovarian function have been small, retrospective and uncontrolled. Unblinded randomised studies on women with breast cancer have suggested a beneficial effect, but results are mixed with lack of evidence of improvement in markers of ovarian reserve. Unblinded randomised studies of women with lymphoma have not shown any benefit regarding fertility markers after long-term follow-up and no placebo-controlled study has been conducted so far. The aim of this study is to investigate if administration of GnRHa during cancer treatment can preserve fertility in young female cancer patients in a double-blind, placebo-controlled clinical trial. METHODS AND ANALYSIS A prospective, randomised, double-blinded, placebo-controlled, phase III study including 300 subjects with breast cancer. In addition, 200 subjects with lymphoma, acute leukemias and sarcomas will be recruited. Women aged 14-42 will be randomised 1:1 to treatment with GnRHa (triptorelin) or placebo for the duration of their gonadotoxic chemotherapy. Follow-up until 5 years from end of treatment (EoT). The primary endpoint will be change in anti-Müllerian hormone (AMH) recovery at follow-up 12 months after EoT, relative to AMH levels at EoT, comparing the GnRHa group and the placebo group in women with breast cancer. ETHICS AND DISSEMINATION This study is designed in accordance with the principles of Good Clinical Practice (ICH-GCP E6 (R2)), local regulations (ie, European Directive 2001/20/EC) and the ethical principles of the Declaration of Helsinki. Within 6 months of study completion, the results will be analysed and the study results shall be reported in the EudraCT database. STUDY REGISTRATION The National Institutional review board in Sweden dnr:2021-03379, approval date 12 October 2021 (approved amendments 12 June 2022, dnr:2022-02924-02 and 13 December 2022, dnr:2022-05565-02). The Swedish Medical Product Agency 19 January 2022, Dnr:5.1-2021-98927 (approved amendment 4 February 2022). Manufacturing authorisation for authorised medicinal products approved 6 December 2021, Dnr:6.2.1-2020-079580. Stockholm Medical Biobank approved 22 June 2022, RBC dnr:202 253. TRIAL REGISTRATION NUMBER NCT05328258; EudraCT number:2020-004780-71.
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Affiliation(s)
- Kenny A Rodriguez-Wallberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Department of Reproductive Medicine, Karolinska University Hospital, Stockholm, Sweden
| | | | - Jonas Bergh
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Theme cancer, Karolinska Comprehensive Cancer Center and University Hospital, Stockholm, Sweden
| | - Johan Malmros
- Pediatric Theme Astrid Lindgren's Pediatric Hospital, Stockholm, Sweden
| | - Per Ljungman
- Department of Cellular Therapy and Allogeneic Stem Cell Transplantation, Karolinska University Hospital, Stockholm, Sweden
- Division of Hematology, Department of Medicine Huddinge, Karolinska Institute, Huddinge, Sweden
| | - Theodoros Foukakis
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
- Theme cancer, Karolinska Comprehensive Cancer Center and University Hospital, Stockholm, Sweden
| | | | | | - Barbro Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Antonis Valachis
- Oncology, Örebro universitet Fakulteten för medicin och hälsa, Orebro, Sweden
| | - Anne Andersson
- Department of Oncology, Norrlands University Hospital, Umeå, Sweden
| | - Sara Harrysson
- Department of Hematology, Cancer Theme, Karolinska University Hospital, Stockholm, Sweden
| | - Lovisa Vennström
- Department of Hematology and Coagulation, Sahlgrenska University Hospital, Goteborg, Sweden
| | - Per Frisk
- Akademiska Hospital, Uppsala, Sweden
| | - Helena Mörse
- Center for Pediatric Oncology, Skåne University Hospital, Lund, Sweden
| | - Sandra Eloranta
- Department of Medicine, Karolinska Institute, Solna, Sweden
- Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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4
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Pfeiler G, Hlauschek D, Mayer EL, Deutschmann C, Kacerovsky-Strobl S, Martin M, Meisel JL, Zdenkowski N, Loibl S, Balic M, Park H, Prat A, Isaacs C, Bajetta E, Balko JM, Bellet-Ezquerra M, Bliss J, Burstein H, Cardoso F, Fohler H, Foukakis T, Gelmon KA, Goetz M, Haddad TC, Iwata H, Jassem J, Lee SC, Linderholm B, Los M, Mamounas EP, Miller KD, Morris PG, Munzone E, Gal-Yam EN, Ring A, Shepherd L, Singer C, Thomssen C, Tseng LM, Valagussa P, Winer EP, Wolff AC, Zoppoli G, Machacek-Link J, Schurmans C, Huang X, Gauthier E, Fesl C, Dueck AC, DeMichele A, Gnant M. Impact of BMI in Patients With Early Hormone Receptor-Positive Breast Cancer Receiving Endocrine Therapy With or Without Palbociclib in the PALLAS Trial. J Clin Oncol 2023; 41:5118-5130. [PMID: 37556775 DOI: 10.1200/jco.23.00126] [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: 01/20/2023] [Revised: 05/03/2023] [Accepted: 06/21/2023] [Indexed: 08/11/2023] Open
Abstract
PURPOSE BMI affects breast cancer risk and prognosis. In contrast to cytotoxic chemotherapy, CDK4/6 inhibitors are given at a fixed dose, irrespective of BMI or weight. This preplanned analysis of the global randomized PALLAS trial investigates the impact of BMI on the side-effect profile, treatment adherence, and efficacy of palbociclib. METHODS Patients were categorized at baseline according to WHO BMI categories. Neutropenia rates were assessed with univariable and multivariable logistic regression. Time to early discontinuation of palbociclib was analyzed with Fine and Gray competing risk models. Unstratified Cox models were used to investigate the association between BMI category and time to invasive disease-free survival (iDFS). 95% CIs were derived. RESULTS Of 5,698 patients included in this analysis, 68 (1.2%) were underweight, 2,082 (36.5%) normal weight, 1,818 (31.9%) overweight, and 1,730 (30.4%) obese at baseline. In the palbociclib arm, higher BMI was associated with a significant decrease in neutropenia (unadjusted odds ratio for 1-unit change, 0.93; 95% CI, 0.91 to 0.94; adjusted for age, race ethnicity, region, chemotherapy use, and Eastern Cooperative Oncology Group at baseline, 0.93; 95% CI, 0.92 to 0.95). This translated into a significant decrease in treatment discontinuation rate with higher BMI (adjusted hazard ratio [HR] for 10-unit change, 0.75; 95% CI, 0.67 to 0.83). There was no significant improvement in iDFS with the addition of palbociclib to ET in any weight category (normal weight HR, 0.84; 95% CI, 0.63 to 1.12; overweight HR, 1.10; 95% CI, 0.82 to 1.49; and obese HR, 0.95; 95% CI, 0.69 to 1.30) in this analysis early in follow-up (31 months). CONCLUSION This preplanned analysis of the PALLAS trial demonstrates a significant impact of BMI on side effects, dose reductions, early treatment discontinuation, and relative dose intensity. Additional long-term follow-up will further evaluate whether BMI ultimately affects outcome.
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Affiliation(s)
- Georg Pfeiler
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria
| | | | | | - Christine Deutschmann
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria
| | | | - Miguel Martin
- Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain
| | | | | | - Sibylle Loibl
- German Breast Group, Neu-Isenburg, Germany
- Goethe University Frankfurt/M, Frankfurt/M, Germany
- Centre for Haematology and Oncology/Bethanien, Frankfurt/M, Germany
| | - Marija Balic
- Division of Oncology, Department of Internal Medicine, Medical University Graz, Graz, Austria
| | - Haeseong Park
- Siteman Cancer Center, Washington University, St Louis, MO
| | - Aleix Prat
- Department of Medical Oncology, Hospital Clinic, IDIBAPS, University of Barcelona, Barcelona, Spain
| | | | - Emilio Bajetta
- Gruppo I.T.M.O., Monza, Italy
- Fondazione Policlinico di Monza, Monza, Italy
| | - Justin M Balko
- Vanderbilt-Ingram Cancer Center, Vanderbilt University Medical Center, Nashville, TN
| | | | - Judith Bliss
- The Institute of Cancer Research, London, United Kingdom
| | - Harold Burstein
- Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Hannes Fohler
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Theodoros Foukakis
- Breast Center, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
- Department of Oncology/Pathology, Karolinska Institute, Stockholm, Sweden
| | | | | | - Tufia C Haddad
- Mayo Clinic College of Medicine and Science, Rochester, MN
| | | | - Jacek Jassem
- Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk, Poland
| | - Soo-Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute (NCIS), Singapore, Singapore
- Cancer Science Institute (CSI), Singapore, Singapore
- National University of Singapore (NUS), Singapore, Singapore
| | - Barbro Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
- Department of Oncology, Institution of Clinical Sciences, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden
| | - Maartje Los
- St Antonius Ziekenhuis Nieuwegein, Utrecht, the Netherlands
| | | | - Kathy D Miller
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN
| | - Patrick G Morris
- Cancer Trials Ireland, Dublin, Ireland
- Beaumont RCSI Cancer Centre, Dublin, Ireland
| | | | - Einav Nili Gal-Yam
- The Talpiot Medical Leadership Program, Breast Oncology Institute, Sheba Medical Center, Ramat-Gam, Israel
| | - Alistair Ring
- Royal Marsden Hospital, NHS Foundation Trust, London, United Kingdom
| | - Lois Shepherd
- Canadian Cancer Trials Group, Queen's University, Kingston, ON, Canada
| | - Christian Singer
- Department of Gynecology and Gynecological Oncology, Medical University of Vienna, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | | | - Ling-Ming Tseng
- Taipei-Veterans General Hospital, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | | | - Eric P Winer
- Yale Cancer Center, Smilow Cancer Network, Yale University, New Haven, CT
| | | | - Gabriele Zoppoli
- Gruppo Oncologico Italiano di Ricerca Clinica (GOIRC), Università degli Studi di Genova, Genoa, Italy
- IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | | | | | | | | | - Christian Fesl
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
| | - Amylou C Dueck
- Alliance Statistics and Data Center, Mayo Clinic, Phoenix, AZ
| | | | - Michael Gnant
- Austrian Breast and Colorectal Cancer Study Group, Vienna, Austria
- Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
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5
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Schröder CP, van Leeuwen-Stok E, Cardoso F, Linderholm B, Poncet C, Wolff AC, Bjelic-Radisic V, Werutsky G, Abreu MH, Bozovic-Spasojevic I, den Hoed I, Honkoop AH, Los M, Leone JP, Russell NS, Smilde TJ, van der Velden AWG, Van Poznak C, Vleugel MM, Yung RL, Coens C, Giordano SH, Ruddy KJ. Quality of Life in Male Breast Cancer: Prospective Study of the International Male Breast Cancer Program (EORTC10085/TBCRC029/BIG2-07/NABCG). Oncologist 2023; 28:e877-e883. [PMID: 37310797 PMCID: PMC10546813 DOI: 10.1093/oncolo/oyad152] [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: 08/29/2022] [Accepted: 04/22/2023] [Indexed: 06/15/2023] Open
Abstract
INTRODUCTION Prospective data about quality of life (QoL) in men with breast cancer (BC) are lacking. A prospective registry (EORTC10085) of men with all BC stages, including a QoL correlative study, was performed as part of the International Male Breast Cancer Program. METHODS Questionnaires at BC diagnosis included the EORTC QLQ-C30 and BR23 (BC specific module), adapted for men. High functioning and global health/QoL scores indicate high functioning levels/high QoL; high symptom-focused measures scores indicate high symptoms/problems levels. EORTC reference data for healthy men and women with BC were used for comparisons. RESULTS Of 422 men consenting to participate, 363 were evaluable. Median age was 67 years, and median time between diagnosis and survey was 1.1 months. A total of 114 men (45%) had node-positive early disease, and 28 (8%) had advanced disease. Baseline mean global health status score was 73 (SD: 21), better than in female BC reference data (62, SD: 25). Common symptoms in male BC were fatigue (22, SD: 24), insomnia (21, SD: 28), and pain (16, SD: 23), for which women's mean scores indicated more burdensome symptoms at 33 (SD: 26), 30 (SD: 32), and 29 (SD: 29). Men's mean sexual activity score was 31 (SD: 26), with less sexual activity in older patients or advanced disease. CONCLUSIONS QoL and symptom burden in male BC patients appears no worse (and possibly better) than that in female patients. Future analyses on impact of treatment on symptoms and QoL over time, may support tailoring of male BC management.
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Affiliation(s)
- Carolien P Schröder
- Department Medical Oncology, Netherlands Cancer Institute Amsterdam and University Medical Center Groningen, The Netherlands
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Barbro Linderholm
- Department of Oncologym, Sahlgrenska University Hospital, Gothenburg, Sweden and Swedish Association of Breast Oncologists (SABO), Sweden
| | - Coralie Poncet
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Antonio C Wolff
- Department of Medical Oncology, Johns Hopkins, Baltimore, MD, USA
| | - Vesna Bjelic-Radisic
- Breast Unit, Helios University Clinic, Wuppertal, University Witten/Herdecke, Germany
| | | | - Miguel H Abreu
- Department of Medical Oncology, Portuguese Institute of Oncology of Porto, Porto, Portugal
| | | | - Irma den Hoed
- Department of Medical Oncology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Aafke H Honkoop
- Department of Medical Oncology, Isala, Zwolle, The Netherlands
| | - Maartje Los
- Department of Medical Oncology, St. Antonius Ziekenhuis, Utrecht, The Netherlands
| | - Jose P Leone
- Department of Medical Oncology, Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA, USA
| | - Nicola S Russell
- Department of Radiotherapy, Netherlands Cancer Institute – Antoni van Leeuwenhoek, Amsterdam, The Netherlands
| | - Tineke J Smilde
- Department of Medical Oncology, Jeroen Bosch Ziekenhuis’s Hertogenbosch, The Netherlands
| | | | | | - Marije M Vleugel
- Department of Medical Oncology, Waterlandziekenhuis, Purmerend, The Netherlands
| | - Rachel L Yung
- Department of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Corneel Coens
- European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Sharon H Giordano
- Department of Health Services Research and Department of Breast Medical Oncology, MD Anderson Cancer Center, Houston, TX, USA
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6
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Pasquier D, Bidaut L, Oprea-Lager DE, deSouza NM, Krug D, Collette L, Kunz W, Belkacemi Y, Bau MG, Caramella C, De Geus-Oei LF, De Caluwé A, Deroose C, Gheysens O, Herrmann K, Kindts I, Kontos M, Kümmel S, Linderholm B, Lopci E, Meattini I, Smeets A, Kaidar-Person O, Poortmans P, Tsoutsou P, Hajjaji N, Russell N, Senkus E, Talbot JN, Umutlu L, Vandecaveye V, Verhoeff JJC, van Oordt WMVDH, Zacho HD, Cardoso F, Fournier L, Van Duijnhoven F, Lecouvet FE. Designing clinical trials based on modern imaging and metastasis-directed treatments in patients with oligometastatic breast cancer: a consensus recommendation from the EORTC Imaging and Breast Cancer Groups. Lancet Oncol 2023; 24:e331-e343. [PMID: 37541279 DOI: 10.1016/s1470-2045(23)00286-3] [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: 02/17/2023] [Revised: 06/06/2023] [Accepted: 06/09/2023] [Indexed: 08/06/2023]
Abstract
Breast cancer remains the most common cause of cancer death among women. Despite its considerable histological and molecular heterogeneity, those characteristics are not distinguished in most definitions of oligometastatic disease and clinical trials of oligometastatic breast cancer. After an exhaustive review of the literature covering all aspects of oligometastatic breast cancer, 35 experts from the European Organisation for Research and Treatment of Cancer Imaging and Breast Cancer Groups elaborated a Delphi questionnaire aimed at offering consensus recommendations, including oligometastatic breast cancer definition, optimal diagnostic pathways, and clinical trials required to evaluate the effect of diagnostic imaging strategies and metastasis-directed therapies. The main recommendations are the introduction of modern imaging methods in metastatic screening for an earlier diagnosis of oligometastatic breast cancer and the development of prospective trials also considering the histological and molecular complexity of breast cancer. Strategies for the randomisation of imaging methods and therapeutic approaches in different subsets of patients are also addressed.
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Affiliation(s)
- David Pasquier
- Academic Department of Radiation Oncology, Centre Oscar Lambret, Lille, France; University of Lille and CNRS, Centrale Lille, UMR 9189-CRIStAL, Lille, France.
| | - Luc Bidaut
- College of Science, University of Lincoln, Lincoln, UK
| | - Daniela Elena Oprea-Lager
- Department of Radiology and Nuclear Medicine, Amsterdam University Medical Centers, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Nandita M deSouza
- The Institute of Cancer Research, London, UK; The Royal Marsden NHS Foundation Trust, Sutton, UK
| | - David Krug
- Department of Radiation Oncology, Universitaetsklinikum Schleswig-Holstein-Campus Kiel, Kiel, Germany
| | - Laurence Collette
- Former European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Wolfgang Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - Yazid Belkacemi
- AP-HP, Radiation Oncology Department, Henri Mondor University Hospital, Créteil, France; INSERM Unit 955 (-Bio), IMRB, University of Paris-Est (UPEC), Créteil, France
| | - Maria Grazia Bau
- Azienda Ospedaliera Città della Salute e della Scienza di Torino, Ospedale Sant'Anna, Turin, Italy
| | - Caroline Caramella
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint-Joseph, Paris, France
| | - Lioe-Fee De Geus-Oei
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands; Biomedical Photonic Imaging Group, University of Twente, Enschede, Netherlands; Department of Radiation Science and Technology, Delft University of Technology, Delft, Netherlands
| | - Alex De Caluwé
- Radiotherapy Department, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | | | - Olivier Gheysens
- Department of Nuclear Medicine, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Institut du Cancer Roi Albert II, UCLouvain, Brussels, Belgium
| | - Ken Herrmann
- Department of Nuclear Medicine, University of Duisburg-Essen, Essen, Germany; German Cancer Consortium (DKTK), University Hospital Essen, Essen, Germany
| | - Isabelle Kindts
- Department of Radiation Oncology, Cancer Centre, General Hospital Groeninge, Kortrijk, Belgium
| | - Michalis Kontos
- National and Kapodistrian University of Athens, Athens, Greece
| | - Sherko Kümmel
- Breast Unit, Kliniken Essen-Mitte, Essen, Germany; Charité - Universitätsmedizin Berlin, Department of Gynecology with Breast Center, Berlin, Germany
| | - Barbro Linderholm
- Department of Oncolgy, Sahlgrenska University Hospital, Gothenburg, Sweden; Institution of Clinical Sciences, Department of Oncology, Sahlgrenska Academy at Gothenburg University, Gothenburg , Sweden
| | | | - Icro Meattini
- Department of Experimental and Clinical Biomedical Sciences, University of Florence, Florence, Italy; Radiation Oncology Unit, Oncology Department, Azienda Ospedaliero Universitaria Careggi, Florence, Italy
| | - Ann Smeets
- Department of Surgical Oncology, University Hospitals Leuven, KU Leuven, Leuven, Belgium
| | - Orit Kaidar-Person
- Oncology Institute, Sheba Tel Hashomer, Ramat Gan, Israel; Tel-Aviv University, Tel-Aviv, Israel
| | - Philip Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp, Belgium; University of Antwerp, Antwerp, Belgium
| | - Pelagia Tsoutsou
- Hôpitaux Universitaires de Genève, Site de Cluse-Roseraie, Geneva, Switzerland
| | - Nawale Hajjaji
- Medical Oncology Department, Centre Oscar Lambret, Lille, France; Laboratoire Protéomique, Réponse Inflammatoire, et Spectrométrie De Masse (PRISM), Inserm U1192, Lille, France
| | - Nicola Russell
- Department of Radiotherapy, The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis, Amsterdam, Netherlands
| | | | - Jean-Noël Talbot
- Institut National des Sciences et Techniques Nucléaires, CEA-Saclay, Paris, France
| | - Lale Umutlu
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | | | - Joost J C Verhoeff
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Helle D Zacho
- Department of Nuclear Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Centre, Champalimaud Foundation, Lisbon, Portugal
| | - Laure Fournier
- Université Paris Descartes Sorbonne Paris Cité, Assistance Publique-Hôpitaux de Paris, Hôpital Européen Georges Pompidou, Paris, France
| | - Frederieke Van Duijnhoven
- Department of Surgical Oncology, The Netherlands Cancer Institute-Antoni Van Leeuwenhoekziekenhuis, Amsterdam, Netherlands
| | - Frédéric E Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint-Luc, Institut du Cancer Roi Albert II, UCLouvain, Brussels, Belgium
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Chamalidou C, Nasic S, Linderholm B. Compliance to adjuvant endocrine therapy and survival in breast cancer patients. Cancer Treat Res Commun 2023; 35:100704. [PMID: 37031604 DOI: 10.1016/j.ctarc.2023.100704] [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] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/11/2023]
Abstract
BACKGROUND Data on compliance to adjuvant endocrine treatment (ET) is mainly reported from prospective clinical trials or from smaller retrospective cohorts without correlation to outcome. AIMS To determine compliance to adjuvant ET and the impact on survival in a population-based series of patients with early breast cancer (BC) advised ET. PATIENTS AND METHODS 1090 consecutive patients with hormone receptor positive (HR+) stage I-III BC diagnosed from 1 January 1997 to 31 December 2003 from one health care region of Sweden were included. Data on tumour, type of ET, compliance, reason for termination and outcome were collected. Statistical analyses were calculated with patients in three groups. RESULTS 72 patients were excluded leaving 1018 patients with a HR+ stage I to III BC for analyses. The most common ET was tamoxifen (n = 751, 73.8%). At the last follow up (31 Dec 2019) with a median follow-up of 18 years (interquartile range 16-22) 228 (22.4%) patients had a relapse. 71.1% of the included patients were compliant to endocrine therapy. Older patients ≥74 years had lower compliance, 61% compared with 75% in the other age groups (≤50 years and 51-73 years) (p < 0001), other parameters including type of ET were not associated with compliance. Low compliance remained as an independent risk factor in multivariate analyses for lower relapse-free survival, HR=1.83, 95% Confidence Interval (CI) 1.52-2.19, p < 0.001 and for time to BC death, HR=2.69, 95%CI 1.82-3.98, p < 0.001. CONCLUSIONS Patients compliant to adjuvant ET have an improved survival.
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Affiliation(s)
- Chaido Chamalidou
- Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy at Gothenburg University, Sweden; Skaraborg Hospital, Department of Oncology, Skövde, Sweden.
| | - Salmir Nasic
- Research and Development Centre, Skaraborgs Hospital, Skövde, Sweden; Department of Molecular and Clinical Medicine, Institute of Medicine, the Sahlgrenska Academy at University of Gothenburg, Sweden
| | - Barbro Linderholm
- Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy at Gothenburg University, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
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Leon-Ferre RA, Jonas SF, Salgado R, Loi S, De Jong V, Carter JM, Nielson T, Leung S, Riaz N, Curigliano G, Criscitiello C, Cockenpot V, Lambertini M, Suman V, Linderholm B, Martens JWM, van Deurzen CHM, Timmermans M, Shimoi T, Yazaki S, Yoshida M, Kim SB, Lee HJ, Dieci MV, Bataillon G, Salomon A, Andre F, Kok M, Linn S, Goetz MP, Michiels S. Abstract PD9-05: Stromal tumor-infiltrating lymphocytes identify early-stage triple-negative breast cancer patients with favorable outcomes at 10-year follow-up in the absence of systemic therapy: a pooled analysis of 1835 patients. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd9-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
Abstract
Abstract
Background: The prognostic value of stromal tumor-infiltrating lymphocytes (TILs) as a biomarker for triple-negative breast cancer (TNBC) has been extensively demonstrated in patients (pts) receiving (neo)adjuvant systemic therapy. In addition, several small studies suggest that a subset of pts with early-stage TNBC and high TILs have excellent long-term outcomes, even in the absence of systemic therapy [1-3]. However, data on the absolute risk of TNBC recurrence according to TIL levels in the absence of systemic therapy are limited and critical to inform the design of future systemic therapy de-escalation clinical trials.
Methods: We conducted an individual patient data pooled analysis of 12 international cohorts of pts with TNBC treated with locoregional therapy but no systemic therapy. TNBC was defined as tumors with estrogen and progesterone receptor of < 1% and HER2 negative (IHC 0, 1+ or IHC 2+ and FISH negative) per local evaluation. TILs were locally assessed in hematoxylin & eosin-stained slides according to the International Immuno-Oncology Biomarker Working Group guidelines (www.tilsinbreastcancer.org). We used the Kaplan-Meier method to assess survival outcomes according to prespecified TIL thresholds: 30% and 50%. Confidence intervals (CI) for survival probabilities were calculated using a percentile bootstrap method. The primary endpoint was invasive disease-free survival (iDFS, STEEP 2.0 definition). Key secondary outcomes included recurrence-free survival (RFS), distant disease-free survival (DDFS) and overall survival (OS).
Results: 1,835 pts diagnosed with TNBC between 1982 and 2017 who did not receive systemic therapy were included. The median age at diagnosis was 56 (IQR 38-71). Menopausal status was known in 1,184 women, of whom 78% were post-menopausal. The median tumor size was 2.0 cm (IQR 1.2-2.6). Most pts (87%) had no axillary lymph node involvement (N0). Most tumors were invasive ductal carcinoma (74%) and grade 3 (70%). The median level of TILs was 15% (IQR 5-40). The median duration of follow-up was 30.4 years (95% CI 29.9, 31.1). A total of 950 (52%) iDFS, 828 (45%) RFS, 767 (42%) DDFS events, and 604 (33%) deaths were observed. In multivariable analyses, higher TILs were independently associated with improved iDFS, RFS, DDFS, and OS beyond clinicopathological factors (likelihood ratio p< 10e-6). Each 10% increment in stromal TILs was associated with an 8% (95% CI: 6-11), 10% (95% CI: 7-13), and 13% (95% CI: 10-15) reduction in the risk of experiencing an iDFS, RFS or DDFS event, and with a 12% (95% CI: 9-15) reduction in the risk of death. iDFS, RFS, DDFS and OS rates according to different TIL thresholds and nodal status are shown in the Table. Of note, the RFS estimates (which exclude second non-breast primaries and contralateral breast cancers) were consistently higher than the iDFS counterparts (which include both), consistent with a high rate of contralateral breast cancers and second primary tumors in this cohort. Notably, patients with node-negative—and especially stage I—TNBC with high TILs had excellent survival rates at 10-year follow-up.
Conclusion: TILs are highly prognostic in pts with systemically untreated early-stage TNBC. Pts with pN0 (and especially stage I) TNBC with high TILs exhibited very favorable long-term outcomes even in the absence of systemic therapy. These data define the natural history of TIL-rich TNBC pts and are crucial to identifying the optimal patient population for future chemotherapy and immunotherapy de-escalation clinical trials.
References:
[1] Leon-Ferre et al, 2017, PMID: 28913760
[2] Park et al, 2019, PMID: 31566659
[3] de Jong et al, 2022, PMID: 35353548
Table 5 and 10-year survival endpoints according TIL level, nodal status, and stage
Citation Format: Roberto A. Leon-Ferre, Sarah Flora Jonas, Roberto Salgado, Sherene Loi, Vincent De Jong, Jodi M. Carter, Torsten Nielson, Samuel Leung, Nazia Riaz, Giuseppe Curigliano, Carmen Criscitiello, Vincent Cockenpot, Matteo Lambertini, Vera Suman, Barbro Linderholm, John WM Martens, Carolien HM van Deurzen, Mieke Timmermans, Tatsunori Shimoi, Shu Yazaki, Masayuki Yoshida, Sung-Bae Kim, Hee Jin Lee, Maria Vittoria Dieci, Guillaume Bataillon, Anne Salomon, Fabrice Andre, Marleen Kok, Sabine Linn, Matthew P. Goetz, Stefan Michiels. Stromal tumor-infiltrating lymphocytes identify early-stage triple-negative breast cancer patients with favorable outcomes at 10-year follow-up in the absence of systemic therapy: a pooled analysis of 1835 patients [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 PD9-05.
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Affiliation(s)
| | | | - Roberto Salgado
- 3GZA-ZNA-Hospitals, Antwerp, Belgium; Peter Mac Callum Cancer Centre, Melbourne, Australia
| | - Sherene Loi
- 4Peter MacCallum Cancer Centre, Melbourne, Australia, Australia
| | - Vincent De Jong
- 5Netherlands Cancer Institute, Amsterdam, Netherlands, Netherlands
| | | | | | - Samuel Leung
- 8University of British Columbia, Vancouver, BC, Canada, Vancouver, British Columbia, Canada
| | - Nazia Riaz
- 9University of British Columbia, British Columbia, Canada
| | | | | | | | | | | | | | - John WM Martens
- 16Erasmus MC Cancer Institute, Rotterdam, The Netherlands, Rotterdam, Zuid-Holland, Netherlands
| | | | - Mieke Timmermans
- 18ErasmusMC Rotterdam, the Netherlands, Rotterdam, Zuid-Holland, Netherlands
| | | | - Shu Yazaki
- 20National Cancer Center Hospital–, Tokyo, Japan
| | - Masayuki Yoshida
- 21Department of Diagnostic Pathology, National Cancer Center Hospital, Tokyo, Japan
| | | | - Hee Jin Lee
- 23University of Ulsan College of Medicine, Asan Medical Center
| | | | | | | | | | - Marleen Kok
- 28Netherlands Cancer Institute, Amsterdam, Netherlands
| | - Sabine Linn
- 29Netherlands Cancer Institute, Amsterdam, Netherlands, Netherlands
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Zakon DB, Poncet C, Cardoso F, Anouk N, Valero V, Aebi S, Benstead K, Bogler O, Lago LD, Fraser J, Caballero C, Hedenfalk IA, Korde LA, Linderholm B, Martens JWM, Middleton LP, Murray M, Kelly CM, Nilsson C, Nowaczyk M, Peeters S, Beauvois M, Porter P, Schroder CP, Rubio IT, Ruddy K, van Asperen C, Weyngaert DVD, van Deurzen CHM, van Leeuwen-Stok E, Vermeij JM, Bartlett JMS, Wolff AC, Giordano SH, Symmans WF. Abstract PD6-11: PD6-11 Evaluation of the Sensitivity to Endocrine Therapy Index (SET2,3) in Early Male Breast Cancer: Results from an analysis in the EORTC 10085/TBCRC/BIG/NCTN International Male Breast Cancer Program. Cancer Res 2023. [DOI: 10.1158/1538-7445.sabcs22-pd6-11] [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
Introduction Breast cancer is uncommon in men. Almost all male breast cancers are hormone receptor-positive, HER2-negative, although the pathogenesis is not always attributable to an endocrine condition. A few studies have compared biological characteristics or molecular signatures with breast cancers in women. We sought to evaluate whether hormone receptor-related gene expression is different in cancers from men compared to equivalent cancers from women. SET2,3 index measures non-proliferative hormone receptor-related transcriptional activity in the cancer (SET-ER/PR index) and adjusts this for a Baseline Prognosis Index (BPI) that combines the measurements of tumor and nodal stage with a 4-gene molecular subtype (ESR1, PGR, ERBB2, and AURKA). Methods We received aliquots of total RNA from male patients with breast cancer included in the retrospective cohort study of the EORTC 10085/BCG/TBCRC/BIG/NCTN International Male Breast Cancer Program (NCT01101425). SET2,3 assay was performed using the QuantiGene assay (Thermo Fisher) using bead-based hybridization and laser spectroscopy (Luminex). The statistical analyses were performed by the EORTC statistician. The primary objective of the study was the assessment of the prognostic value of the SET2,3 index score in patients with early-stage hormone receptor-positive, HER2-negative male breast cancer, treated with endocrine therapy. Clinical outcomes (recurrence-free survival – RFS; overall survival – OS) were estimated by Kaplan-Meier curves and secondarily compared using multivariable Cox models adjusted for continuous SET2,3 index, tumor size, nodal status, age, and chemotherapy and radiotherapy use. An exploratory analysis to compare the SET2,3 index scores distribution in female and male breast cancer patients was also performed using results from the same assay performed on cancers from women selected on the same inclusion criteria. Due to the low numbers of male patients treated with neoadjuvant treatment (N=6), this analysis was restricted to patients treated with adjuvant treatment (n=315 male and 660 female). Results Of the 321 male patients with breast cancer analyzed, treated between 1990 and 2010, 211 (65.7%) were categorized as high SET2,3 index score, reflecting a high endocrine activity in the cancer and low risk of recurrence, and 110 patients (34.3%) categorized as being low score, reflecting low endocrine activity and high risk of recurrence. At 5 years, the RFS was 75.0% (95% CI, 67.4-81.1) in the high SET2,3 group versus 60.7% (95% CI, 49.1-70.5) in the low SET2,3 group (HR univariate, 0.49; 95% CI, 0.34-0.70; P< 0.0001). The 5-year OS rate among patients with a high SET2,3 index was 84.3% (95% CI, 45.5-73.8), in contrast of 67.8% (95% CI, 56.6-76.7) in the low SET2,3 group (HR univariate, 0.44; 95% CI, 0.30-0.65; P< 0.0001). SET2,3 was independently prognostic for OS, but not RFS in multivariable Cox models. In patients classified as low SET2,3, the addition of neo/adjuvant chemotherapy to adjuvant endocrine therapy was associated with 5-year OS of 76.0% (95% CI, 59.5-86.4) and in patients who received endocrine therapy alone the 5-year OS was 61.3% (95% CI, 45.5-73.8), an absolute difference of 14.7 percentage points. Overall, we did not observe a difference in the distributions (median, interquartile range) of SET2,3 index between men (2.4, 1.9–2.6) and women (2.3, 2.0–2.7). Conclusion SET2,3 index measurements of endocrine-related transcriptional activity in male patients with breast cancer were not different from measurements in female patients with breast cancer. SET2,3 was prognostic in male breast cancer and our exploratory analysis suggests that chemotherapy might improve the poor prognosis for men with breast cancer that has low SET2,3 index. This study was funded by the Breast Cancer Research Foundation (BCRF).
Citation Format: Danielle B. Zakon, Coralie Poncet, Fatima Cardoso, Neven Anouk, Vicente Valero, Stefan Aebi, Kim Benstead, Oliver Bogler, Lissandra Dal Lago, Judith Fraser, Carmela Caballero, Ingrid A. Hedenfalk, Larissa A. Korde, Barbro Linderholm, John WM Martens, Lavinia P. Middleton, Melissa Murray, Catherine M. Kelly, Cecilia Nilsson, Monika Nowaczyk, Stephanie Peeters, Melanie Beauvois, Peggy Porter, Carolien P. Schroder, Isabel T. Rubio, Kathryn Ruddy, Christi van Asperen, Danielle Van Den Weyngaert, Carolien HM van Deurzen, Elise van Leeuwen-Stok, Joanna M. Vermeij, John MS Bartlett, Antonio C. Wolff, Sharon H. Giordano, W. Fraser Symmans. PD6-11 Evaluation of the Sensitivity to Endocrine Therapy Index (SET2,3) in Early Male Breast Cancer: Results from an analysis in the EORTC 10085/TBCRC/BIG/NCTN International Male Breast Cancer Program [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 PD6-11.
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Affiliation(s)
- Danielle B. Zakon
- 1Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
| | - Coralie Poncet
- 2European Organisation for Research and Treatment of Cancer (EORTC), Brussels, Belgium
| | - Fatima Cardoso
- 3Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Neven Anouk
- 4Luxembourg Institute of Health, Strassen, Luxembourg
| | - Vicente Valero
- 5Department of Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Stefan Aebi
- 6Swiss Group for Clinical Cancer Research (SAKK), Bern, Luzern, Luzern, Switzerland
| | - Kim Benstead
- 7Cheltenham General Hospital, Gloucestershire, United Kingdom
| | - Oliver Bogler
- 8Center for Cancer Training, National Cancer Institute, Bethesda, USA
| | | | - Judith Fraser
- 10Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | | | | | | | | | - John WM Martens
- 15Erasmus MC Cancer Institute, Rotterdam, Zuid-Holland, The Netherlands
| | | | | | | | - Cecilia Nilsson
- 19Department of Oncology, Västmanlands Hospital, Västerås, Sweden
| | | | | | - Melanie Beauvois
- 22European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Peggy Porter
- 23Fred Hutchinson Cancer Research Center & Department of Pathology, University of Washington, Seattle, USA
| | | | | | | | - Christi van Asperen
- 27Department of Clinical Genetics, Leiden University Medical Center, Leiden, the Netherlands
| | | | | | | | | | | | | | - Sharon H. Giordano
- 34Department of Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, USA
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Geyer C, Garber J, Gelber R, Yothers G, Taboada M, Ross L, Rastogi P, Cui K, Arahmani A, Aktan G, Armstrong A, Arnedos M, Balmaña J, Bergh J, Bliss J, Delaloge S, Domchek S, Eisen A, Elsafy F, Fein L, Fielding A, Ford J, Friedman S, Gelmon K, Gianni L, Gnant M, Hollingsworth S, Im SA, Jager A, Jóhannsson Ó, Lakhani S, Janni W, Linderholm B, Liu TW, Loman N, Korde L, Loibl S, Lucas P, Marmé F, Martinez de Dueñas E, McConnell R, Phillips KA, Piccart M, Rossi G, Schmutzler R, Senkus E, Shao Z, Sharma P, Singer C, Španić T, Stickeler E, Toi M, Traina T, Viale G, Zoppoli G, Park Y, Yerushalmi R, Yang H, Pang D, Jung K, Mailliez A, Fan Z, Tennevet I, Zhang J, Nagy T, Sonke G, Sun Q, Parton M, Colleoni M, Schmidt M, Brufsky A, Razaq W, Kaufman B, Cameron D, Campbell C, Tutt A. Overall survival in the OlympiA phase III trial of adjuvant olaparib in patients with germline pathogenic variants in BRCA1/2 and high risk, early breast cancer. Ann Oncol 2022; 33:1250-1268. [PMID: 36228963 DOI: 10.1016/j.annonc.2022.09.159] [Citation(s) in RCA: 108] [Impact Index Per Article: 54.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 09/22/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND The randomized, double-blind OlympiA trial compared 1 year of the oral poly(adenosine diphosphate-ribose) polymerase inhibitor, olaparib, to matching placebo as adjuvant therapy for patients with pathogenic or likely pathogenic variants in germline BRCA1 or BRCA2 (gBRCA1/2pv) and high-risk, human epidermal growth factor receptor 2-negative, early breast cancer (EBC). The first pre-specified interim analysis (IA) previously demonstrated statistically significant improvement in invasive disease-free survival (IDFS) and distant disease-free survival (DDFS). The olaparib group had fewer deaths than the placebo group, but the difference did not reach statistical significance for overall survival (OS). We now report the pre-specified second IA of OS with updates of IDFS, DDFS, and safety. PATIENTS AND METHODS One thousand eight hundred and thirty-six patients were randomly assigned to olaparib or placebo following (neo)adjuvant chemotherapy, surgery, and radiation therapy if indicated. Endocrine therapy was given concurrently with study medication for hormone receptor-positive cancers. Statistical significance for OS at this IA required P < 0.015. RESULTS With a median follow-up of 3.5 years, the second IA of OS demonstrated significant improvement in the olaparib group relative to the placebo group [hazard ratio 0.68; 98.5% confidence interval (CI) 0.47-0.97; P = 0.009]. Four-year OS was 89.8% in the olaparib group and 86.4% in the placebo group (Δ 3.4%, 95% CI -0.1% to 6.8%). Four-year IDFS for the olaparib group versus placebo group was 82.7% versus 75.4% (Δ 7.3%, 95% CI 3.0% to 11.5%) and 4-year DDFS was 86.5% versus 79.1% (Δ 7.4%, 95% CI 3.6% to 11.3%), respectively. Subset analyses for OS, IDFS, and DDFS demonstrated benefit across major subgroups. No new safety signals were identified including no new cases of acute myeloid leukemia or myelodysplastic syndrome. CONCLUSION With 3.5 years of median follow-up, OlympiA demonstrates statistically significant improvement in OS with adjuvant olaparib compared with placebo for gBRCA1/2pv-associated EBC and maintained improvements in the previously reported, statistically significant endpoints of IDFS and DDFS with no new safety signals.
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Loman N, Linderholm B, Ahlgren J, Kimbung S, Zander L, Magnusson HG, Kjellman EC, Raaberg AJ, Jensen MBR, Borg Å, Staaf J, Ståhlberg A, Bendahl PO, Laenkholm AV, Tanner M, Bjarnadóttir O, Johannsson O, Ejlertsen B, Lindman H. Abstract OT2-30-01: Nordictrip, a translational randomized phase-3study exploring the effect of the addition of capecitabine to carboplatinum-based chemotherapy in early “triple negative” breast cancer, ClinicalTrials.gov Identifier: NCT04335669. Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-ot2-30-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: A striking heterogeneity combined with an absence of highly efficient targeted treatments necessitates a continued effort to optimize the choice of chemotherapy for patients with triple negative breast cancer (TNBC). Neoadjuvant therapy has become the standard of care for high risk TNBC in order to potentially reduce breast and axillary surgery, start medical treatment early, allow genomic screening and guide post neoadjuvant therapy. Much attention is drawn to the use of immunotherapy in early TNBC, but there is also interesting data suggesting a potential to optimize the use of conventional chemotherapy. According to one meta-analysis including data from nine randomized controlled trials, the addition of platinum salts in the preoperative setting increases the pathologic complete response (pCR) rate in TNBC (Poggio 2018). A second meta-analysis, evaluating the effect of capecitabine in early breast cancer indicates an additional benefit from adding capecitabine to conventional chemotherapy in terms of an increased recurrence-free survival in the subset of TNBC (Mackelenbergh SABCS 2019). An adjuvant trial in TNBC suggests that the beneficial effect of capecitabine may be confined to patients with a non-basal like phenotype of TNBC (Lluch 2020), a subset that correlates with the homologous repair non-deficient subset which constitutes 41 % of TNBC in a mainly south Swedish population based cohort (Staaf 2019). The effect of capecitabine in platinum treated early TNBC is unknown. Objectives: We are conducting a multi-center randomized controlled trial evaluating the effect on the pCR rate by the addition of capecitabine to optimal platinum based and dose dense preoperative chemotherapy in early TNBC. Method: 820 patients (pts) with early TNBC stage 1 (≥20 mm) - 3 will be randomized 1:1 between two treatment arms A and B. A: Epirubicine Cyclophosphamide (EC) q2w x 4 followed by Carboplatin AUC 5 q3w with weekly paclitaxel x 12. B: Epirubicine Cyclophosphamide with capecitabine daily for two weeks (CEX) q3w x 4 followed by Carboplatin AUC 5 q3w with weekly paclitaxel x 12 The primary endpoint is pCR rate in the different treatment strata, and the primary translational endpoint will be the potential difference of treatment effect stratified for HRD-status in the primary tumor. Secondary endpoints include IDFS in subsets of TNBC, eg according to gene-expression-based subtypes of TNBC (Lehmann 2011, Burstein 2015), and germline mutation status of hereditary breast cancer genes. Tumor material for genotypig is collected at baseline, at surgery and optionally after two treatment cycles. Sequential blood samples are collected for tsDNA analysis during and after treatment termination. Results: The trial, which is a collaborative effort between the national breast cancer groups in the participating countries, has been postponed by the pandemic but is now recruiting according to plan. So far 56 patients out of 820 have been recruited at 15 sites in Sweden and Denmark. Additional Sites in Sweden, Denmark, Iceland and Finland are preparing to join the study. For update please see: www.NordicTrip.se; E-mail address: Nordictrip.onkologi@skane.se
Citation Format: Niklas Loman, Barbro Linderholm, Johan Ahlgren, Siker Kimbung, Lina Zander, Heidi Grill Magnusson, Eva-Christin Kjellman, Ann Julia Raaberg, Maj-Britt Raaby Jensen, Åke Borg, Johan Staaf, Anders Ståhlberg, Pär-Ola Bendahl, Anne-Vibeke Laenkholm, Minna Tanner, Olöf Bjarnadóttir, Oskar Johannsson, Bent Ejlertsen, Henrik Lindman. Nordictrip, a translational randomized phase-3study exploring the effect of the addition of capecitabine to carboplatinum-based chemotherapy in early “triple negative” breast cancer, ClinicalTrials.gov Identifier: NCT04335669 [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr OT2-30-01.
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Affiliation(s)
- Niklas Loman
- Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Barbro Linderholm
- Dept of Oncology, Jubileumskliniken, Sahlgrenska University Hospital, Sweden
| | - Johan Ahlgren
- Regional Cancer Center, Central Sweden, Uppsala, Sweden
| | - Siker Kimbung
- Division of Oncology, Dept of Clinical Sciences Lund, Lund University, Sweden
| | - Lina Zander
- Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Heidi Grill Magnusson
- Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | - Eva-Christin Kjellman
- Dept of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Sweden
| | | | | | - Åke Borg
- Division of Oncology, Dept of Clinical Sciences Lund, Lund University, Sweden
| | - Johan Staaf
- Division of Oncology, Dept of Clinical Sciences Lund, Lund University, Sweden
| | | | - Pär-Ola Bendahl
- Division of Oncology, Dept of Clinical Sciences Lund, Lund University, Sweden
| | | | - Minna Tanner
- Dept of Oncology, Tampere University Hospital, Finland
| | | | | | - Bent Ejlertsen
- Danish Breast Cancer Group, Rigshospitalet, Copenhagen, Denmark
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Naughton MJ, Zahrieh D, Gnant M, Zdenkowski N, Lemieux J, Mao JJ, Bjelic-Radisic V, Shinn E, Balic M, Thomssen C, Neisel J, Ruiz-Echarri M, Loibl S, Isaacs C, Cameron D, Carrasco FMH, Goetz M, Wette V, Werutsky G, Rugo H, Vetter M, Tseng LM, Miller K, Fitzal F, Gil JMG, Park H, Linderholm B, Bajetta E, Dayao Z, Prat A, Ehrhardt K, Metzger O, Arahmani A, Law E, Partridge A, Carey L, Zoroufy A, Dueck A, Hlauschek D, DeMichele A, Mayer E. Abstract P4-10-01: Quality of life and symptom severity in the PALLAS randomized trial of palbociclib with adjuvant endocrine therapy in early breast cancer (AFT-05). Cancer Res 2022. [DOI: 10.1158/1538-7445.sabcs21-p4-10-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Quality of life (QOL) in breast cancer patients (pts) can be greatly impacted by initial treatment and ongoing therapy, particularly if side effects and symptoms are not well tolerated. The PALLAS trial investigated whether the addition of 2 years of palbociclib (palbo) to adjuvant endocrine therapy (ET) improved invasive disease-free survival (iDFS) over adjuvant ET alone. We report on the main patient-reported outcome (PRO) quality of life (QOL) and symptom severity results of this trial by treatment arm. Methods: PALLAS is an ongoing multicenter, open label phase 3 trial that enrolled hormone receptor positive, HER2-negative, stage II-III breast cancer patients at 406 cancer centers across 21 countries. Patients were randomly assigned (1:1) to either 2 years of palbo (125mg/day, 3 weeks on 1 week off) plus ongoing provider or patient-choice adjuvant ET (palbo+ET) versus ongoing ET alone. The primary study endpoint was iDFS. Treatment with palbo in all pts stopped at the time of the second interim analysis (5/2020) due to futility; all pts then moved to follow up. The PRO analyses were triggered for completion after awareness of the pre-specified 469 iDFS cases in November 2020. Eight PRO endpoints were measured serially (i.e., day 1 of each monthly cycle for the first 3 months, then every 3 months for the first 2 years, and once at year 3). The endpoints were the EORTC QLQ-C30 global health status/QOL score, the Brief Fatigue Inventory score, the modified Brief Pain Inventory severity and pain interference scores, the EORTC QLQ-BR23 alopecia score, and the Breast Cancer Prevention Trial hot flash symptoms, vaginal problems, and musculoskeletal pain scores. Linear mixed models compared the average difference between arms across time points during the initial 2-year treatment period adjusting for cycle 1 day 1 (C1D1) PRO scores, demographic and clinical variables. The average differences between arms (palbo+ET vs ET alone) and the two-sided (1-[0.05/8]) x 100% confidence intervals, adjusted for multiple comparisons, were calculated. Analysis of covariance compared the average between-arm differences by endpoint at 3 years. Results: The PRO intention to collect population included 4688 (81%) of the overall trial pts, and was clinically and demographically representative of the remaining 1073 pts. Each analysis population, with measures at C1D1 and at least 1 post-C1D1 assessment for each PRO endpoint, comprised ≥ 89% of the 4688 pts and the proportions were similar between arms. After adjustment for baseline covariates, on average, no clinically important differences between arms were observed for any of the eight endpoints over the 2 year treatment period (Table 1). All effect sizes were below the pre-specified 0.2 threshold. These PRO results were similar at the 3 year time point. Conclusions: No clinically significant differences in either patient-reported QOL or symptom severity were found, on average, between participants in the two PALLAS treatment arms while either taking palbo+ET or ET alone, or after study-wide termination of palbo. In general, the addition of palbociclib in the adjuvant breast cancer setting did not contribute to increased symptom burden within this survivorship population. Further analyses will examine the relationship between PROs and treatment discontinuation by arm and study time point. Support: AFT, Pfizer, https://acknowledgments.alliancefound.org
Table 1.Results of the Patient-Reported QOL and Symptom Severity Analyses Between the Two Treatment Arms During the First 2 Years of PALLASPRO Endpoint *Palbo + ET Adjusted average score (95% CI)ET alone Adjusted average score (95% CI)Average Difference + (Palbo + ET vs ET alone)[99.38% CI] Clinically ++ Important DifferenceEORTC QLQ-C30 Global Health Status/QOL71.7 (71.2, 72.2)74.0 (73.5, 74.5)-2.3 (-3.3, -1.4)**NoBrief Fatigue Inventory Score2.3 (2.2, 2.3)2.1 (2.0, 2.1)0.2 (0.1, 0.3)NoModified Brief Pain Inventory - Severity Score2.3 (2.2, 2.3)2.4 (2.4, 2.5)-0.2 (-0.3, -0.1)NoModified Brief Pain Inventory - Interference Score1.7 (1.6, 1.7)1.7 (1.6, 1.7)0.0 (-0.1, 0.1)NoEORTC QLQ-BR23 Alopecia1.4 (1.4, 1.4)1.3 (1.3, 1.3)0.1 (0.1, 0.1)NoBreast Cancer Prevention Trial - Hot Flash Symptoms1.2 (1.2, 1.3)1.2 (1.2, 1.3)0.0 (-0.1, 0.1)NoBreast Cancer Prevention Trial - Vaginal Problems0.8 (0.8, 0.8)0.8 (0.7, 0.8)0.0 (0.0, 0.1)NoBreast Cancer Prevention Trial - Musculoskeletal Pain1.2 (1.2, 1.2)1.3 (1.3, 1.3)-0.1 (-0.2, 0.0)No* For the EORTC QLQ-C30 Global Health Status/QOL subscale, higher scores indicate better QOL. For all other PRO endpoints, higher scores indicate worse symptom levels. ** The lower bound of the one-sided CI (adjusted for multiple comparisons) was -3.3. Because the lower limit is greater than the pre-specified non-inferiority margin of -3.44, non-inferiority of palbo+ET relative to ET-alone was concluded. The non-inferiority margin corresponds to a 0.2 SD in the EORTC QLQ-C30 global health/QOL score. +The average difference was adjusted for the following baseline covariates: Cycle 1 day 1 score, region (if applicable), age category, first adjuvant ET, race, ethnicity, N-stage, T-stage, histological grade, PgR, prior chemotherapy, ECOG Performance Status. ++Based on each instrument’s published clinically relevant cut-offs, if available. After calculating Cohen’s d treatment effect sizes, (i.e. by dividing the average difference by the ET-alone arm standard deviation from cycle 1 day 1), all effect sizes were below the pre-specified 0.2 threshold, and would not be considered clinically important.
Citation Format: Michelle Joy Naughton, David Zahrieh, Michael Gnant, Nicholas Zdenkowski, Julie Lemieux, Jun J Mao, Vesna Bjelic-Radisic, Eileen Shinn, Marija Balic, Christoph Thomssen, Jane Neisel, Manuel Ruiz-Echarri, Sibylle Loibl, Claudine Isaacs, David Cameron, Fernando Manuel Henao Carrasco, Matthew Goetz, Viktor Wette, Gustavo Werutsky, Hope Rugo, Marcus Vetter, Ling-Ming Tseng, Kathy Miller, Florian Fitzal, Juan Miguel Gil Gil, Haeseong Park, Barbro Linderholm, Emilio Bajetta, Zoneddy Dayao, Aleix Prat, Karin Ehrhardt, Otto Metzger, Amal Arahmani, Ernest Law, Ann Partridge, Lisa Carey, Alex Zoroufy, Amylou Dueck, Dominik Hlauschek, Angela DeMichele, Erica Mayer. Quality of life and symptom severity in the PALLAS randomized trial of palbociclib with adjuvant endocrine therapy in early breast cancer (AFT-05) [abstract]. In: Proceedings of the 2021 San Antonio Breast Cancer Symposium; 2021 Dec 7-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2022;82(4 Suppl):Abstract nr P4-10-01.
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Affiliation(s)
| | | | | | | | - Julie Lemieux
- Center Hospitalier Universitaire de Quebec, Universite Laval, Quebec City, QC, Canada
| | - Jun J Mao
- Memorial Sloan Kettering Cancer Center, New York City, NY
| | | | | | | | | | | | | | | | | | - David Cameron
- Cancer Research UK Edinburgh Center, Edinburgh, United Kingdom
| | | | | | | | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Hope Rugo
- University of California, San Francisco, CA
| | | | | | - Kathy Miller
- Indiana University Simon Cancer Center, Indianapolis, IN
| | | | | | | | | | - Emilio Bajetta
- Institute of Oncology, Polyclinic Hospital, di Monza, Italy
| | | | | | - Karin Ehrhardt
- Austrian Breast and Colorectal Cancer Study Group (ABCSG), Vienna, Austria
| | - Otto Metzger
- Dana Farber Cancer Institute/Alliance, Boston, MA
| | | | | | | | - Lisa Carey
- University of North Carolina, Chapel Hill, NC
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Aftimos P, Oliveira M, Irrthum A, Fumagalli D, Sotiriou C, Gal-Yam EN, Robson ME, Ndozeng J, Di Leo A, Ciruelos EM, de Azambuja E, Viale G, Scheepers ED, Curigliano G, Bliss JM, Reis-Filho JS, Colleoni M, Balic M, Cardoso F, Albanell J, Duhem C, Marreaud S, Romagnoli D, Rojas B, Gombos A, Wildiers H, Guerrero-Zotano A, Hall P, Bonetti A, Larsson KF, Degiorgis M, Khodaverdi S, Greil R, Sverrisdóttir Á, Paoli M, Seyll E, Loibl S, Linderholm B, Zoppoli G, Davidson NE, Johannsson OT, Bedard PL, Loi S, Knox S, Cameron DA, Harbeck N, Montoya ML, Brandão M, Vingiani A, Caballero C, Hilbers FS, Yates LR, Benelli M, Venet D, Piccart MJ. Genomic and Transcriptomic Analyses of Breast Cancer Primaries and Matched Metastases in AURORA, the Breast International Group (BIG) Molecular Screening Initiative. Cancer Discov 2021; 11:2796-2811. [PMID: 34183353 PMCID: PMC9414283 DOI: 10.1158/2159-8290.cd-20-1647] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/05/2021] [Accepted: 06/11/2021] [Indexed: 02/01/2023]
Abstract
AURORA aims to study the processes of relapse in metastatic breast cancer (MBC) by performing multi-omics profiling on paired primary tumors and early-course metastases. Among 381 patients (primary tumor and metastasis pairs: 252 targeted gene sequencing, 152 RNA sequencing, 67 single nucleotide polymorphism arrays), we found a driver role for GATA1 and MEN1 somatic mutations. Metastases were enriched in ESR1, PTEN, CDH1, PIK3CA, and RB1 mutations; MDM4 and MYC amplifications; and ARID1A deletions. An increase in clonality was observed in driver genes such as ERBB2 and RB1. Intrinsic subtype switching occurred in 36% of cases. Luminal A/B to HER2-enriched switching was associated with TP53 and/or PIK3CA mutations. Metastases had lower immune score and increased immune-permissive cells. High tumor mutational burden correlated to shorter time to relapse in HR+/HER2- cancers. ESCAT tier I/II alterations were detected in 51% of patients and matched therapy was used in 7%. Integration of multi-omics analyses in clinical practice could affect treatment strategies in MBC. SIGNIFICANCE: The AURORA program, through the genomic and transcriptomic analyses of matched primary and metastatic samples from 381 patients with breast cancer, coupled with prospectively collected clinical data, identified genomic alterations enriched in metastases and prognostic biomarkers. ESCAT tier I/II alterations were detected in more than half of the patients.This article is highlighted in the In This Issue feature, p. 2659.
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Affiliation(s)
- Philippe Aftimos
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Mafalda Oliveira
- Medical Oncology Department, Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Christos Sotiriou
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | | | - Mark E Robson
- Memorial Sloan Kettering Cancer Center, New York, New York
| | - Justin Ndozeng
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | | | | | | | - Giuseppe Viale
- IEO, Istituto Europeo di Oncologia, IRCCS, and University of Milan, Milan, Italy
| | | | - Giuseppe Curigliano
- IEO, Istituto Europeo di Oncologia, IRCCS, and University of Milan, Milan, Italy
| | - Judith M Bliss
- The Institute of Cancer Research, London, United Kingdom
| | | | - Marco Colleoni
- IEO, Istituto Europeo di Oncologia, IRCCS, and University of Milan, Milan, Italy
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Joan Albanell
- Hospital del Mar - CIBERONC; IMIM, Barcelona; Pompeu Fabra University, Barcelona, Spain
| | - Caroline Duhem
- Centre Hospitalier Luxembourg, Luxembourg City, Luxembourg
| | | | | | - Beatriz Rojas
- CIOCC (Centro Integral Oncologico "Clara Campal"), Madrid, Spain
| | - Andrea Gombos
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Peter Hall
- University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Andrea Bonetti
- Department of Oncology AZIENDA ULSS 9 Verona, Verona, Italy
| | | | | | - Silvia Khodaverdi
- Sana Klinikum Offenbach, Klinik für Gynaekologie und Geburtshilfe, Offenbach, Germany
| | - Richard Greil
- Paracelsus Medical University Salzburg, Salzburg Cancer Research Institute-CCCIT and Cancer Cluster Salzburg, Salzburg, Austria
| | | | | | - Ethel Seyll
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | | | | | - Gabriele Zoppoli
- Università degli Studi di Genova and IRCCS Ospedale Policlinico San Martino, San Martino, Italy
| | - Nancy E Davidson
- Fred Hutchinson Cancer Research Center and University of Washington, Seattle, Washington
| | | | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Susan Knox
- Europa Donna- The European Breast Cancer Coalition, Milan, Italy
| | - David A Cameron
- University of Edinburgh Cancer Research Centre, Edinburgh, United Kingdom
| | - Nadia Harbeck
- Breast Center, LMU University Hospital, Munich, Germany, and West German Study Group, Moenchengladbach, Germany
| | | | - Mariana Brandão
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Andrea Vingiani
- Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | | | - Lucy R Yates
- Wellcome Trust Sanger Institute, London, United Kingdom
| | | | - David Venet
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium
| | - Martine J Piccart
- Institut Jules Bordet - Université Libre de Bruxelles, Brussels, Belgium.
- Breast International Group, Brussels, Belgium
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Abraha Woldemariam A, Andersson R, Munthe C, Linderholm B, Berbyuk Lindström N. Breaking Bad News in Cancer Care: Ethiopian Patients Want More Information Than What Family and the Public Want Them to Have. JCO Glob Oncol 2021; 7:1341-1348. [PMID: 34491813 PMCID: PMC8423395 DOI: 10.1200/go.21.00190] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE This study explores the preferences of patients with cancer, family caregivers, and the general public regarding breaking bad news in an Ethiopian oncology setting. METHODS The study was conducted at Tikur Anbessa (Black Lion) Specialized Hospital. The sample consists of patients with a confirmed cancer diagnosis, their family caregivers, and representatives from the general public with 150 subjects per cohort. The study used a comparative cross-sectional design and multivariable data analysis. RESULTS The patients would like to be informed, which contradicts the preferences of family caregivers. This creates an ethical dilemma for staff in terms of how much they involve their patients in clinical decision making. The patients also indicate that information should not be withheld from them. By contrast, the general public prefers information about poor life expectancy to be communicated to family only, which may reflect a widespread public perception of cancer as a deadly disease. CONCLUSION The findings indicate the complexity of communication-related preferences concerning breaking bad news in oncology care in Ethiopia. It requires oncologists to probe patient attitudes before information disclosure to find a balance between involving patients in communication at the same time as keeping a constructive alliance with family caregivers.
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Affiliation(s)
- Aynalem Abraha Woldemariam
- Department of Surgery, School of Medicine, Health Science College, Addis Ababa University, Addis Ababa, Ethiopia.,Deceased
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Christian Munthe
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
| | - Barbro Linderholm
- Institute of Clinical Sciences, Department of Oncology, The Sahlgrenska Academy, University of Gothenburg and the Sahlgrenska University Hospital, Gothenburg, Sweden
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Bayani J, Poncet C, Crozier C, Neven A, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Dal Lago L, Fraser J, Hilbers F, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Van Den Weyngaert D, van Deurzen C, van Leeuwen-Stok E, Vermeij J, Winer E, Giordano SH, Cardoso F, Bartlett JMS. Evaluation of multiple transcriptomic gene risk signatures in male breast cancer. NPJ Breast Cancer 2021; 7:98. [PMID: 34312396 PMCID: PMC8313692 DOI: 10.1038/s41523-021-00301-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 06/24/2021] [Indexed: 12/12/2022] Open
Abstract
Male breast cancer (BCa) is a rare disease accounting for less than 1% of all breast cancers and 1% of all cancers in males. The clinical management is largely extrapolated from female BCa. Several multigene assays are increasingly used to guide clinical treatment decisions in female BCa, however, there are limited data on the utility of these tests in male BCa. Here we present the gene expression results of 381 M0, ER+ve, HER2-ve male BCa patients enrolled in the Part 1 (retrospective analysis) of the International Male Breast Cancer Program. Using a custom NanoString™ panel comprised of the genes from the commercial risk tests Prosigna®, OncotypeDX®, and MammaPrint®, risk scores and intrinsic subtyping data were generated to recapitulate the commercial tests as described by us previously. We also examined the prognostic value of other risk scores such as the Genomic Grade Index (GGI), IHC4-mRNA and our prognostic 95-gene signature. In this sample set of male BCa, we demonstrated prognostic utility on univariate analysis. Across all signatures, patients whose samples were identified as low-risk experienced better outcomes than intermediate-risk, with those classed as high risk experiencing the poorest outcomes. As seen with female BCa, the concordance between tests was poor, with C-index values ranging from 40.3% to 78.2% and Kappa values ranging from 0.17 to 0.58. To our knowledge, this is the largest study of male breast cancers assayed to generate risk scores of the current commercial and academic risk tests demonstrating comparable clinical utility to female BCa.
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Affiliation(s)
- Jane Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada
| | - Coralie Poncet
- Department of Statistics, European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Cheryl Crozier
- Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Anouk Neven
- Department of Statistics, European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | | | | | | | - Stefan Aebi
- Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland
| | - Kim Benstead
- Department of Oncology, Cheltenham General Hospital, Cheltenham, UK
| | - Oliver Bogler
- Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Lissandra Dal Lago
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
| | - Judith Fraser
- Beatson West of Scotland Cancer Centre, Glasgow, Scotland, UK
| | | | - Ingrid Hedenfalk
- Division of Oncology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | | | - Barbro Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - John Martens
- Medical Oncology, Erasmus Medical Center Rotterdam; BOOG, Rotterdam, The Netherlands
| | - Lavinia Middleton
- Department Pathology, University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Melissa Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Catherine Kelly
- All Ireland Cooperative Oncology Research Group (ICORG), Dublin, Ireland
| | - Cecilia Nilsson
- Department of Oncology, Västmanlands Hospital, Västerås, Sweden
| | | | - Stephanie Peeters
- Department of Radiation Oncology Maastro, Masstricht, The Netherlands
| | - Aleksandra Peric
- Department of Statistics, European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Peggy Porter
- Divisions of Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center & Department of Pathology, University of Washington, Seattle, WA, USA
| | - Carolien Schröder
- Department Medical Oncology, University Medical Center Groningen; BOOG, Groningen, The Netherlands
| | - Isabel T Rubio
- Breast Surgical Unit. Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | | | - Christi van Asperen
- Department of Clinical Genetics, Leiden University Medical Center; BOOG, Leiden, The Netherlands
| | | | | | | | - Joanna Vermeij
- Department of Medical Oncology, ZNA Jan Palfijn, Merksem, Belgium
| | - Eric Winer
- Dana-Farber Cancer Institute, Boston, MA, USA
| | | | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation; EORTC, Lisbon, Portugal
| | - John M S Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada.
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada.
- University of Edinburgh, Scotland, UK.
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Klint L, Kovács A, Rönnerman E, Linderholm B. Real world data on adjuvant treatment of older HER2-positive breast cancer patients - A single institution experience through 8 years. Cancer Treat Res Commun 2021; 28:100430. [PMID: 34273877 DOI: 10.1016/j.ctarc.2021.100430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 06/18/2021] [Accepted: 07/03/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND The large randomized trials on trastuzumab for primary breast cancer (BC) included few old patients. With exception of endocrine treatment, trials on adjuvant therapy for the old group specifically are scarce. AIMS To compare adjuvant treatment, recurrences and survival in old and older-old patients with primary HER2 positive BC. MATERIAL AND METHODS Patients ≥ 70 years with diagnose of primary HER2 positive BC from 2008 through 2015 were included in this retrospective non-randomized investigation. Standard clinical and biological data (age, surgery, tumor size, nodal status, histopathological grade, vascular invasion, expression of hormone receptors, recurrences and death) were extracted from patient's charts. Comparisons were performed according to age (old; 70-74 years vs older old; ≥ 75 years) and treatment with trastuzumab or not. Patients that initiated adjuvant trastuzumab but did not complete one year (n = 8) were included in the trastuzumab group in survival analyzes. Recurrence-free survival (RFS) and overall survival (OS) were calculated in uni- and multivariate analyses. RESULTS A total of 115 patients were registered, eleven patients had distant metastasis and seven were omitted from all treatment including primary surgery due to serious concomitant illness and a poor general condition leaving 97 patients for analysis. There were no differences between the groups (70-74; n = 40), (≥75; n = 57) in tumor size (p = 0.86), nodal status (p = 0.10), ER (p = 0.25), PgR (p = 1.0) or vascular invasion (p = 1.0). A lower proportion of patients ≥ 75 years received adjuvant trastuzumab (21% versus 70%, p < 0.001). Adjuvant trastuzumab improved RFS (p = 0.027) and OS (p = 0.002) in univariate analyses. The corresponding figures in multivariate analysis adjusted for tumor size, nodal status and grade were RFS (p = 0.0052) and OS (p = 0.0003) respectively. Brain was the most common site of distant metastasis (15% of patients at first recurrence). CONCLUSIONS We show a large difference in delivered adjuvant treatment between old and older old patients with a small proportion of patients aged 75 years or more receiving HER2 directed therapy that resulted in a worse survival. The vast majority can complete the planned treatment. Our results indicate that brain metastases is common also among older patients.
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Affiliation(s)
- L Klint
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
| | - A Kovács
- Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - E Rönnerman
- Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - B Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden
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Tutt ANJ, Garber JE, Kaufman B, Viale G, Fumagalli D, Rastogi P, Gelber RD, de Azambuja E, Fielding A, Balmaña J, Domchek SM, Gelmon KA, Hollingsworth SJ, Korde LA, Linderholm B, Bandos H, Senkus E, Suga JM, Shao Z, Pippas AW, Nowecki Z, Huzarski T, Ganz PA, Lucas PC, Baker N, Loibl S, McConnell R, Piccart M, Schmutzler R, Steger GG, Costantino JP, Arahmani A, Wolmark N, McFadden E, Karantza V, Lakhani SR, Yothers G, Campbell C, Geyer CE. Adjuvant Olaparib for Patients with BRCA1- or BRCA2-Mutated Breast Cancer. N Engl J Med 2021; 384:2394-2405. [PMID: 34081848 PMCID: PMC9126186 DOI: 10.1056/nejmoa2105215] [Citation(s) in RCA: 660] [Impact Index Per Article: 220.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Poly(adenosine diphosphate-ribose) polymerase inhibitors target cancers with defects in homologous recombination repair by synthetic lethality. New therapies are needed to reduce recurrence in patients with BRCA1 or BRCA2 germline mutation-associated early breast cancer. METHODS We conducted a phase 3, double-blind, randomized trial involving patients with human epidermal growth factor receptor 2 (HER2)-negative early breast cancer with BRCA1 or BRCA2 germline pathogenic or likely pathogenic variants and high-risk clinicopathological factors who had received local treatment and neoadjuvant or adjuvant chemotherapy. Patients were randomly assigned (in a 1:1 ratio) to 1 year of oral olaparib or placebo. The primary end point was invasive disease-free survival. RESULTS A total of 1836 patients underwent randomization. At a prespecified event-driven interim analysis with a median follow-up of 2.5 years, the 3-year invasive disease-free survival was 85.9% in the olaparib group and 77.1% in the placebo group (difference, 8.8 percentage points; 95% confidence interval [CI], 4.5 to 13.0; hazard ratio for invasive disease or death, 0.58; 99.5% CI, 0.41 to 0.82; P<0.001). The 3-year distant disease-free survival was 87.5% in the olaparib group and 80.4% in the placebo group (difference, 7.1 percentage points; 95% CI, 3.0 to 11.1; hazard ratio for distant disease or death, 0.57; 99.5% CI, 0.39 to 0.83; P<0.001). Olaparib was associated with fewer deaths than placebo (59 and 86, respectively) (hazard ratio, 0.68; 99% CI, 0.44 to 1.05; P = 0.02); however, the between-group difference was not significant at an interim-analysis boundary of a P value of less than 0.01. Safety data were consistent with known side effects of olaparib, with no excess serious adverse events or adverse events of special interest. CONCLUSIONS Among patients with high-risk, HER2-negative early breast cancer and germline BRCA1 or BRCA2 pathogenic or likely pathogenic variants, adjuvant olaparib after completion of local treatment and neoadjuvant or adjuvant chemotherapy was associated with significantly longer survival free of invasive or distant disease than was placebo. Olaparib had limited effects on global patient-reported quality of life. (Funded by the National Cancer Institute and AstraZeneca; OlympiA ClinicalTrials.gov number, NCT02032823.).
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Affiliation(s)
- Andrew N J Tutt
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Judy E Garber
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Bella Kaufman
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Giuseppe Viale
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Debora Fumagalli
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Priya Rastogi
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Richard D Gelber
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Evandro de Azambuja
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Anitra Fielding
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Judith Balmaña
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Susan M Domchek
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Karen A Gelmon
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Simon J Hollingsworth
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Larissa A Korde
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Barbro Linderholm
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Hanna Bandos
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Elżbieta Senkus
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Jennifer M Suga
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Zhimin Shao
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Andrew W Pippas
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Zbigniew Nowecki
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Tomasz Huzarski
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Patricia A Ganz
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Peter C Lucas
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Nigel Baker
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Sibylle Loibl
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Robin McConnell
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Martine Piccart
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Rita Schmutzler
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Guenther G Steger
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Joseph P Costantino
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Amal Arahmani
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Norman Wolmark
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Eleanor McFadden
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Vassiliki Karantza
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Sunil R Lakhani
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Greg Yothers
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Christine Campbell
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
| | - Charles E Geyer
- From the Breast Cancer Now Toby Robins Research Centre, the Institute of Cancer Research (A.N.J.T.), and the Breast Cancer Now Unit, Guy's Hospital Cancer Centre, King's College London (A.N.J.T.), London, AstraZeneca, Cambridge (S.J.H., N.B.), and Frontier Science (Scotland), Kincraig (R.M.C., E.M.F., C.C.) - all in the United Kingdom; Dana-Farber Cancer Institute, Harvard Medical School (J.E.G., R.D.G.), Frontier Science Foundation (R.D.G.), and Harvard T.H. Chan School of Public Health (R.D.G.) - all in Boston; the Breast Oncology Institute, Chaim Sheba Medical Center, Tel Aviv University, Tel Aviv, Israel (B.K.); the University of Milan, European Institute of Oncology IRCCS, Milan (G.V.); Breast International Group (D.F., A.A.) and Institut Jules Bordet, l'Université Libre de Bruxelles (E.A., M.P.), Brussels; NRG Oncology (P.R., H.B., P.C.L., N.W., G.Y., C.E.G.) and the Basser Center for BRCA, Abramson Cancer Center, University of Pennsylvania (S.M.D.), Philadelphia, and the UPMC Hillman Cancer Center (P.R., P.C.L., N.W.) and the Department of Biostatistics (H.B., J.P.C., G.Y.), University of Pittsburgh, and the NSABP Foundation (N.W.), Pittsburgh - all in Pennsylvania; AstraZeneca, Gaithersburg (A.F.), and the National Cancer Institute, Rockville (L.A.K.) - both in Maryland; Vall d'Hebron Institute of Oncology and Vall d'Hebron University Hospital (J.B.) - both in Barcelona; BC Cancer, Vancouver, BC, Canada (K.A.G.); Sahlgrenska University Hospital (B.L.) and the Institute of Clinical Sciences, Department of Oncology, Sahlgrenska Academy, Gothenburg University (B.L.) - both in Gothenburg, Sweden; the Department of Oncology and Radiotherapy, Medical University of Gdańsk, Gdańsk (E.S.), the Maria Skłodowska-Curie National Research Institute of Oncology, Warsaw (Z.N.), the International Hereditary Cancer Center, Pomeranian Medical University, Szczecin (T.H.), and Read-Gene, Grzepnica (T.H.) - all in Poland; Kaiser Permanente Vallejo Medical Center, Vallejo (J.M.S.), and the UCLA Fielding School of Public Health, David Geffen School of Medicine at UCLA (P.A.G.), and the UCLA Jonsson Comprehensive Cancer Center (P.A.G.), Los Angeles - all in California; Fudan University Shanghai Cancer Center, Shanghai, China, (Z.S.); Georgia NCORP, Northside Hospital Cancer Institute (A.W.P.), and Piedmont Healthcare (A.W.P.) - both in Atlanta; German Breast Group, Neu-Isenburg (S.L.), the Center for Hematology and Oncology Bethanien and Goethe University, Frankfurt (S.L.), and the Center for Familial Breast and Ovarian Cancer and the Center for Integrated Oncology, Faculty of Medicine, University Hospital Cologne, Cologne (R.S.) - all in Germany; the Department of Internal Medicine I and Gaston H. Glock Research Center, Medical University of Vienna, Vienna (G.G.S.); Merck, Kenilworth, NJ (V.K.); the University of Queensland Centre for Clinical Research and Pathology Queensland (S.R.L.) - both in Brisbane, QLD, Australia; and Houston Methodist Cancer Center (C.E.G.) and Weill Cornell Medical College (C.E.G.) - both in Houston
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Abstract
BACKGROUND Overall survival has improved significantly in patients with human epidermal growth receptor 2 (HER2)-positive breast cancer due to the use of the monoclonal antibody trastuzumab blocking HER2. However, patients may develop trastuzumab-induced cardiotoxicity (TIC) leading to congestive heart failure. Here we assessed whether analysing NT-proBNP and assessment of electrocardiography (ECG) could detect TIC during trastuzumab therapy. METHODS One hundred thirty-six patients undergoing adjuvant, neoadjuvant or palliative chemotherapy and HER2 blockade for HER2-positive breast cancer were prospectively assessed with echocardiography, ECG and N-terminal - pro hormone B-type natriuretic peptide (NT-proBNP) testing at baseline and at 6 and 12 months of trastuzumab therapy. TIC was defined as a left ventricular ejection fraction (LVEF) of less than 50% and a decline from baseline of ≥10 units. RESULTS Six patients developed TIC under 12 months of trastuzumab therapy (incidence 4.4%). NT-proBNP increased from 198.8 ± 64.0 pg/ml to 678.7 ± 132.4 pg/ml (p < .05) in TIC patients. With a cut-off point of 276.5 pg/ml for NTproBNP and increase in NT-proBNP by 75.8 pg/ml from baseline the sensitivity was 100% and the specificity 95% to detect TIC. Compared with controls, TIC patients were older (68.3 ± 1.1 years and 56.2 ± 1.4 years, respectively; p < .01), had more often diabetes mellitus (OR = 63.5, 95% CI: 5.63-915, p < .01) and atrial fibrillation (OR = 12.3; 95% CI: 1.89-74.62; p < .05) and had lower baseline LVEF (57.1 ± 1.4% and 61.4 ± 0.3%, respectively; p < .001). Abnormal ECGs were common in patients developing TIC. CONCLUSIONS Measuring changes in NTproBNP may be used to monitor patients for TIC under trastuzumab therapy. Patients with a cardiovascular risk profile are more at risk of developing TIC.
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Affiliation(s)
- Anton E. Andersson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
| | - Barbro Linderholm
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Daniel Giglio
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden
- Department of Oncology, Halland Hospital Varberg, Region Halland, Sweden
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Janeva S, Zhang C, Kovács A, Parris TZ, Crozier JA, Pezzi CM, Linderholm B, Audisio RA, Olofsson Bagge R. Adjuvant chemotherapy and survival in women aged 70 years and older with triple-negative breast cancer: a Swedish population-based propensity score-matched analysis. The Lancet Healthy Longevity 2020; 1:e117-e124. [DOI: 10.1016/s2666-7568(20)30018-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/24/2020] [Accepted: 09/25/2020] [Indexed: 02/06/2023] Open
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Thulin A, Rönnerman E, De Lara S, Chamalidou C, Schoenfeldt A, Kovács A, Linderholm B. Compared expression of Tumour Infiltrating Lymphocytes and FOXA1 in matched pairs of brain metastasis and primary breast cancer and prognostic implications – a pilot study. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30697-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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21
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Chamalidou C, Nasic S, Linderholm B. Compliance to adjuvant endocrine treatment – real world data from 1019 consecutive luminal breast cancer patients with long follow-up. Eur J Cancer 2020. [DOI: 10.1016/s0959-8049(20)30683-3] [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: 11/27/2022]
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22
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Wallerstedt SM, Nilsson Ek A, Olofsson Bagge R, Kovács A, Strandell A, Linderholm B. Personalised medicine and the decision to withhold chemotherapy in early breast cancer with intermediate risk of recurrence - a systematic review and meta-analysis. Eur J Clin Pharmacol 2020; 76:1199-1211. [PMID: 32504183 PMCID: PMC7419442 DOI: 10.1007/s00228-020-02914-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 05/25/2020] [Indexed: 02/06/2023]
Abstract
Purpose To assess the evidence for decision making, at the health care and the patient levels, regarding the use of gene expression assays to inform chemotherapy decisions in breast cancer patients with intermediate clinical risk of recurrence. Methods Systematic literature searches were performed (January 2002–April 2020) in Medline, Embase, PubMed, Cochrane Library, PsycINFO and HTA databases. Inclusion criteria: patients (P) were individuals with post-surgical breast cancer at intermediate clinical risk of recurrence; intervention (I)/comparison (C) was (i) use of, versus no use of, a gene expression assay and (ii) withholding versus providing chemotherapy; outcomes (O) were overall survival (OS), health-related quality of life (HRQL), and recurrence. Randomised controlled trials (RCTs) and non-RCTs were included. Random-effects meta-analyses were performed where possible. Results Three inconclusive non-RCTs, respectively, compared OS and recurrence with and without a gene expression assay. No studies investigated HRQL. Regarding the comparison withholding versus providing chemotherapy based on a gene expression assay, one RCT and four non-RCTs evaluated OS. In the RCT, 93.9% (I) versus 93.8% (C) were alive at 9 years. Three RCTs and seven non-RCTs evaluated recurrence. Three RCTs could be pooled regarding distant recurrence; 4.29% versus 3.88% had such an event (risk ratio: 1.12 (95% confidence interval: 0.90 to 1.39). Conclusion Regarding the use of gene expression assays in breast cancer, evidence on patient effects, informing patient-level chemotherapy decision making, is available. However, evidence for prioritisation at the overall health care level, i.e. use of, versus no use of, such assays, is largely lacking. Electronic supplementary material The online version of this article (10.1007/s00228-020-02914-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Susanna M Wallerstedt
- HTA-centrum, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden. .,Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 431, SE-405 30, Gothenburg, Sweden.
| | - Astrid Nilsson Ek
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Roger Olofsson Bagge
- Sahlgrenska Cancer Center, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Surgery, Sahlgrenska University Hospital, Gothenburg, Sweden.,Wallenberg Centre for Molecular and Translational Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Annika Strandell
- HTA-centrum, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Barbro Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Oncology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Oncology and Pathology, Karolinska Institutet, Stockholm, Sweden
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Filges S, Andersson D, Kristiansson H, Vannas C, Johansson G, Li J, Godfrey TE, Levin M, Linderholm B, Ståhlberg A. Abstract A23: Ultrasensitive mutation detection in FFPE tissues and circulating tumor DNA using SiMSen-Seq. Clin Cancer Res 2020. [DOI: 10.1158/1557-3265.liqbiop20-a23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Novel diagnostic tools in oncology, prenatal diagnostics, and transplantation medicine depend on the detection of ultrarare variants. The analysis of cell-free DNA has the potential to revolutionize diagnosis, treatment monitoring, and recurrence and resistance of cancer. Yet these analysis remains challenging due to limited amounts of material and low allele frequencies of targeted variants. Simple, Multiplexed, PCR-based barcoding of DNA for Sensitive mutation detection using Sequencing (SiMSen-Seq) enables easy generation of libraries containing unique molecular identifiers (UMI) with minimal DNA input across several kilobases of DNA using two rounds of PCR and allows the detection of rare variants below 0.1% allele frequency. Clinical applications of ctDNA require highly optimized workflows to ensure high sensitivity and reproducibility. Here we present our state-of-the-art liquid biopsy workflow using SiMSen-Seq and simple quality control steps, applicable to almost any liquid biopsy protocol. In a series of case studies with melanoma patients we find that ctDNA mirrors the time-course of established protein markers such as S-100 and in some cases detects minimal residual months in advance of standard clinical diagnostics. SiMSen-Seq efficiently determined even rare mutations across multiple tumor forms in challenging sample types, such as FFPE tissue or cfDNA. We identified mutations in highly degraded FFPE tissue using a 60-plex SiMSen-Seq panel and then analyzed longitudinal cfDNA samples using patient-specific panels in a cohort of metastatic breast cancer patients. Our data indicate that ctDNA might be used as a biomarker for early detection of recurrence in these patients. We were able to detect treatment resistance variants as well as observe tumor recurrence well in advance of the onset of clinical symptoms. Thus, SiMSen-Seq offers an affordable, minimally invasive method for monitoring treatment efficiency and determination of drug resistance development in cancer.
Citation Format: Stefan Filges, Daniel Andersson, Helena Kristiansson, Christoffer Vannas, Gustav Johansson, Junrui Li, Tony E. Godfrey, Max Levin, Barbro Linderholm, Anders Ståhlberg. Ultrasensitive mutation detection in FFPE tissues and circulating tumor DNA using SiMSen-Seq [abstract]. In: Proceedings of the AACR Special Conference on Advances in Liquid Biopsies; Jan 13-16, 2020; Miami, FL. Philadelphia (PA): AACR; Clin Cancer Res 2020;26(11_Suppl):Abstract nr A23.
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Affiliation(s)
- Stefan Filges
- 1Department of Laboratory Medicine, Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden,
| | - Daniel Andersson
- 1Department of Laboratory Medicine, Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden,
| | - Helena Kristiansson
- 2Wallenberg Centre for Molecular and Translational Medicine, Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden,
| | - Christoffer Vannas
- 1Department of Laboratory Medicine, Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden,
| | - Gustav Johansson
- 3Department of Laboratory Medicine, Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Wallenberg Centre for Molecular and Translational Medicine, Translational Science & Experimental Medicine, Early RIA, BioPharmaceuticals R&D, AstraZeneca, Gothenburg, Sweden,
| | - Junrui Li
- 1Department of Laboratory Medicine, Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden,
| | - Tony E. Godfrey
- 4Department of Surgery, Boston University School of Medicine, Boston, MA,
| | - Max Levin
- 5Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden,
| | - Barbro Linderholm
- 6Department of Oncology, Sahlgrenska University Hospital, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden,
| | - Anders Ståhlberg
- 7Department of Laboratory Medicine, Sahlgrenska Cancer Center, Institute of Biomedicine, Sahlgrenska Academy at University of Gothenburg, Wallenberg Centre for Molecular and Translational Medicine, Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
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24
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Berbyuk Lindström N, Woldemariam AA, Bekele A, Munthe C, Andersson R, Girma Kebede B, Linderholm B, Tigeneh W. Person and Family Centeredness in Ethiopian Cancer Care: Proposal for a Project for Improving Communication, Ethics, Decision Making, and Health. JMIR Res Protoc 2020; 9:e16493. [PMID: 32427112 PMCID: PMC7267985 DOI: 10.2196/16493] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 03/04/2020] [Accepted: 03/10/2020] [Indexed: 11/13/2022] Open
Abstract
Background Cancer is a major burden in Ethiopia. The Oncology Department of Tikur Anbessa (Black Lion) Specialized Hospital in Addis Ababa is the sole specialist unit for cancer care in the country. With only a handful of oncologists, a lack of resources, and a huge patient load, the work is challenging, especially in terms of achieving effective and ethical patient consultations. Patients, usually accompanied by family members, often wait for a long time to receive medical attention and frequently depart without treatment. Handling consultations effectively is essential to help patients as much as possible within such limitations. Objective The project has the following three main aims: (1) to enhance and expand the understanding of communicative and associated ethical challenges in Ethiopian cancer care; (2) to enhance and expand the understanding of the implications and use of person- and family-centered solutions to address such communicative challenges in practice; and (3) to plan and evaluate interventions in this area. Methods This project develops and consolidates a research collaboration to better understand and mitigate the communicative challenges in Ethiopian cancer care, with a focus on the handling and sharing of decision making and ethical tension among patients, staff, and family. Using theoretical models from linguistics, health communication, and health care ethics, multiple sources of data will be analyzed. Data sources currently include semistructured interviews with Ethiopian staff (n= 16), patients (n= 54), and family caregivers (n= 22); survey data on cancer awareness (n=150) and attitudes toward breaking bad news (n=450); and video recordings of medical consultations (n=45). In addition, we will develop clinical and methodological solutions to formulate educational interventions. Results The project was awarded funding by the Swedish Research Council in December 2017 for the period 2018 to 2021. The research ethics boards in Sweden and Ethiopia approved the project in May 2018. The results of the studies will be published in 2020 and 2021. Conclusions The project is the first step toward providing unique and seminal knowledge for the specific context of Ethiopia in the areas of physician-patient communication research and ethics. It contributes to the understanding of the complexity of the role of family and ethical challenges in relation to patient involvement and decision making in Ethiopia. Improved knowledge in this area can provide a fundamental model for ways to improve cancer care in many other low-resource settings in Africa and the Middle East, which share central cultural prerequisites, such as a strong patriarchal family structure, along with strong and devout religiosity. The project will also serve to develop greater understanding about the current challenges in Western health systems associated with greater family and patient participation in decision making. In addition, the project will contribute to improving the education of Ethiopian health professionals working in cancer care by developing a training program to help them better understand and respond to identified challenges associated with communication. International Registered Report Identifier (IRRID) DERR1-10.2196/16493
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Affiliation(s)
| | - Aynalem Abraha Woldemariam
- Department of Oncology and Radiotherapy, School of Medicine, Health Science College, Addis Ababa University, Addis Ababa, Ethiopia
| | - Abebe Bekele
- Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia
| | - Christian Munthe
- Department of Philosophy, Linguistics and Theory of Science, University of Gothenburg, Gothenburg, Sweden
| | - Rune Andersson
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Bethlehem Girma Kebede
- Department of Applied Information Technology, University of Gothenburg, Gothenburg, Sweden
| | - Barbro Linderholm
- Department of Oncology, Institute of Clinical Sciences, University of Gothenburg and Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Wondemagegnhu Tigeneh
- Department of Oncology and Radiotherapy, School of Medicine, Health Science College, Addis Ababa University, Addis Ababa, Ethiopia
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Thulin A, Rönnerman E, Zhang C, De Lara S, Chamalidou C, Schoenfeldt A, Andersson C, Kovács A, Enlund F, Linderholm B. Clinical outcome of patients with brain metastases from breast cancer - A population based study over 21 years. Breast 2020; 50:113-124. [PMID: 32145571 PMCID: PMC7375610 DOI: 10.1016/j.breast.2020.02.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 05/06/2019] [Revised: 01/14/2020] [Accepted: 02/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background Brain metastases (BM) are a feared progression of breast cancer (BC) with impact on quality of life and survival. Despite improved treatments, it is believed patients suffering from BM are increasing. Aims To study potential changes in the number of BM, the possible links between BC subgroup and extent of BM with prognosis. To investigate the interval between primary BC/extra cranial recurrence, and diagnosis of BM in the years 1994–2014. Patients and methods Clinical data from 191 patients with BM diagnosed 1994–2014, was retrieved from charts. Primary tumours where re-evaluated histologically. Results There was an increase of BM in 5 years cohorts (1994-99 (n = 9); 2000-04 (n = 36); 2005-09 (n = 60); 2010-14 (n = 86)). We found no difference in the time interval from primary BC to BM but an insignificant increase in time from extra cranial relapse to development of BM in the time periods 1994–2004 and 2005–2014 of 15.5 and 25.0 months (p = 0.0612). Survival after BM was 7 months (95% CI 6–10) with a statistically significant difference between HER2 positive and TNBC with an inferior outcome for the latter (p = 0.018) whilst no differences were present when Luminal BC were compared with HER2 positive BC (p = 0.073). Conclusions We show an increase of BM over time whilst the time span from primary BC to BM is unchanged supports earlier findings that adjuvant treatments have little preventive function. Time from extra cranial recurrence to BM was prolonged with one year. Patients with TNBC or more advance extent of BM had the shortest survival with BM. Increase in number of brain metastases diagnosed from breast cancer over a 21 year period. Increased survival in HER2+ breast cancer with brain metastases. We confirm that TNBC has a consistently poor prognosis across the time period. Despite improvement in overall survival in breast cancer, interval to brain metastasis remains unchanged.
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Affiliation(s)
- Anna Thulin
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | - Elisabeth Rönnerman
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | - Shahin De Lara
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Chaido Chamalidou
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden; Department of Oncology, SKAS, Sweden
| | - Arnd Schoenfeldt
- Department of Pathology, Norra Älvsborgs Hospital, Trollhättan, Sweden
| | - Carola Andersson
- Diagnostic Center, Kalmar, Regional Hospital of Kalmar County, Sweden
| | - Anikó Kovács
- Department of Clinical Pathology and Genetics, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Fredrik Enlund
- Diagnostic Center, Kalmar, Regional Hospital of Kalmar County, Sweden
| | - Barbro Linderholm
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden.
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Bayani J, Poncet C, Crozier C, Trinh QM, Hopkins M, Uwimana AL, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Lago LD, Hilbers F, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Weyngaert DVD, van Deurzen CHM, van Leeuwen-Stok E, Vermeij J, Winer E, Stein LD, Giordano SH, Cardoso F, Bartlett JMS. Abstract P4-10-03: The genomic landscape of male breast cancers using the oncomine comprehensive assay for actionable mutations. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-10-03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Male breast cancer (BCa) is a rare disease accounting for less than 1% of all breast cancers (BC) and 1% of all cancers in males. The clinical management is largely extrapolated from female BCa. Few studies have examined the genomic landscape of male BCas, with six male BCas included in The Cancer Genome Atlas (TCGA). Familial studies of male BCas have shown genomic changes similar to female BCa, while a larger targeted sequencing study of 59 male breast cancers identified recurrent mutations affecting PIK3CA and GATA3. To date, there is still limited information regarding the genomic landscape of male BCas; particularly in the context of identifying targeted treatments. To reveal genomic changes that characterize male BCas in the context of known cancer driver genes linked to prognosis and targeted agents, we performed a targeted sequencing study on 248 male BCas from the International Male Breast Cancer Program. Methods: 248 primary M0, ER+ve, HER2-ve male BCas enrolled in the Part 1 (retrospective joint analysis) International Male Breast Cancer Program of 1483 patients diagnosed between 1990-2010 (Cardoso et al. Annals of Oncology, 2018) were processed for nucleic acid extraction from formalin-fixed paraffin embedded (FFPE) tissues. Using the Thermo Fisher Scientific Oncomine Comprehensive Assay v3 (OCAv3), a validated targeted sequencing panel currently used in the NCI-MATCH trial (NCT02465060), we evaluated mutational and copy number variations (CNVs) of genes that are prognostic or predictive to targeted therapies currently in use in the clinic or late-stage clinical trials. The OCAv3 DNA pan-cancer panel assays 115 genes for determining mutational status (48 full coding and 67 hotspot) as well as copy-number assessment in 43 genes. The OCAv3 uses Ampliseq-based technology linked to the Oncomine NGS workflow to identify actionable mutations and CNVs Results: Of the 248 samples assayed, 216 passed strict quality control parameters (87.1%). Using the Oncomine NGS workflow, actionable mutations at ≥5% variant allele frequency (VAF) were most frequently identified in PIK3CA (29.2%), BRCA2 (11.1%), NF1 (11.6%), indels in TP53 (10.6%), ATR (5.6%), ATRX (5.1%), indel BRCA2 (5.1%), TP53 point mutations (4.6%), MET (4.6%), ATM (4.6%), NOTCH2 (4.6%), CHEK1 (4.2%), FANCI (4.2%), PTEN (3.2%) with a number of additional genes identified at lower frequencies. Gene amplifications were most frequently detected in MYC (24.5%), FGFR1 (14.8%), CCND1 (12%), FGF3 (9.7%), FGF19 (9.7%), MDM2 (6.5%), CDK4 (1.4%), FGFR3, MDM4, ERBB2 (0.9% each), and FLT3, AR, MYCL, CDK6, IGF1R, FGFR4, KRAS, AKT3 and ESR1 (0.5% each). Although the results here describe the mutations and copy-number changes deemed to be actionable, further analysis of all non-actionable somatic mutations and CNVs will be presented and compared to female BCas previously assayed using the same panel. Conclusion: In this targeted sequencing study of the largest series of male BCas to our knowledge, we have revealed that PIK3CA continues to be a frequently altered gene in both male and female BCas. However, there is an enrichment of mutations in genes related to DNA repair in male BCs. Interestingly, while MYC is commonly amplified in female BCa, a higher frequency of amplified cases were seen in male BCas, in contrast to female BCas. Together with our previously generated transcriptional profiling data in this data set, we believe that both common and unique biological processes comprising male and female BCas will ultimately improve their clinical management and move towards the goal of precision medicine.
This work has been funded by the Breast Cancer Research Foundation (BCRF).
Citation Format: Jane Bayani, Coralie Poncet, Cheryl Crozier, Quang M Trinh, Megan Hopkins, Aime Lambert Uwimana, Tammy Piper, Carrie Cunningham, Monika Sobol, Stefan Aebi, Kim Benstead, Oliver Bogler, Lissandra Dal Lago, Florentine Hilbers, Ingrid Hedenfalk, Larissa Korde, Barbro Linderholm, John Martens, Lavinia Middleton, Melissa Murray, Catherine Kelly, Cecilia Nilsson, Monika Nowaczyk, Stephanie Peeters, Aleksandra Peric, Peggy Porter, Carolien Schröder, Isabel T Rubio, Kathryn J Ruddy, Christi van Asperen, Danielle Van Den Weyngaert, Carolien HM van Deurzen, Elise van Leeuwen-Stok, Joanna Vermeij, Eric Winer, Lincoln D Stein, Sharon H Giordano, Fatima Cardoso, John MS Bartlett. The genomic landscape of male breast cancers using the oncomine comprehensive assay for actionable mutations [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-10-03.
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Affiliation(s)
- Jane Bayani
- 1Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Coralie Poncet
- 2European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Cheryl Crozier
- 1Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Quang M Trinh
- 1Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Megan Hopkins
- 1Ontario Institute for Cancer Research, Toronto, ON, Canada
| | - Aime Lambert Uwimana
- 2European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Tammy Piper
- 3University of Edinburgh, Edinburgh, United Kingdom
| | | | - Monika Sobol
- 3University of Edinburgh, Edinburgh, United Kingdom
| | - Stefan Aebi
- 4Swiss Group for Clinical Cancer Research (SAKK), Bern, Swaziland
| | - Kim Benstead
- 5Cheltenham General Hospital, Gloucestershire, United Kingdom
| | - Oliver Bogler
- 6University of Texas MD Anderson Cancer Center, Houston, TX
| | | | | | | | | | | | - John Martens
- 12Erasmus Medical Center Rotterdam, Rotterdam, Netherlands
| | | | | | - Catherine Kelly
- 14All Ireland Cooperative Oncology Research Group (ICORG), Dublin, Ireland
| | | | | | | | - Aleksandra Peric
- 2European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - Peggy Porter
- 18Fred Hutchinson Cancer Research Center, Seattle, WA
| | | | - Isabel T Rubio
- 20Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | | | | | | | | | | | - Joanna Vermeij
- 25Department of Medical Oncology, ZNA, Jan Palfijn, Belgium
| | - Eric Winer
- 26Dana-Farber Cancer Institute,, Boston, MA
| | | | | | - Fatima Cardoso
- 27Champalimaud Clinical Center/Champalimaud Foundation, Lisbond, Portugal
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Larsson K, Linderholm B. EFFICACY AND TOLERABILITY OF LOW DOSE METRONOMIC CHEMOTHERAPY (LDMC) IN PATIENTS WITH METASTATIC BREAST CANCER (MBC): A SINGLE CENTER EXPERIENCE IN WEST SWEDEN. Breast 2019. [DOI: 10.1016/s0960-9776(19)30684-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Cardoso F, Bartlett JMS, Slaets L, van Deurzen CHM, van Leeuwen-Stok E, Porter P, Linderholm B, Hedenfalk I, Schröder C, Martens J, Bayani J, van Asperen C, Murray M, Hudis C, Middleton L, Vermeij J, Punie K, Fraser J, Nowaczyk M, Rubio IT, Aebi S, Kelly C, Ruddy KJ, Winer E, Nilsson C, Lago LD, Korde L, Benstead K, Bogler O, Goulioti T, Peric A, Litière S, Aalders KC, Poncet C, Tryfonidis K, Giordano SH. Characterization of male breast cancer: results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Ann Oncol 2019; 29:405-417. [PMID: 29092024 DOI: 10.1093/annonc/mdx651] [Citation(s) in RCA: 202] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background Male breast cancer (BC) is rare, managed by extrapolation from female BC. The International Male BC Program aims to better characterize and manage this disease. We report the results of part I, a retrospective joint analysis of cases diagnosed during a 20-year period. Methods Patients with follow-up and tumor samples, treated between 1990 and 2010, in 93 centers/9 countries. Samples were centrally analyzed in three laboratories (the United Kingdom, the Netherlands and the United States). Results Of 1822 patients enrolled, 1483 were analyzed; 63.5% were diagnosed between 2001 and 2010, 57 (5.1%) had metastatic disease (M1). Median age at diagnosis: 68.4 years. Of 1054 M0 cases, 56.2% were node-negative (N0) and 48.5% had T1 tumors; 4% had breast conserving surgery (BCS), 18% sentinel lymph-node biopsy; half received adjuvant radiotherapy; 29.8% (neo)adjuvant chemotherapy and 76.8% adjuvant endocrine therapy (ET), mostly tamoxifen (88.4%). Per central pathology, for M0 tumors: 84.8% ductal invasive carcinomas, 51.5% grade 2; 99.3% estrogen receptor (ER)-positive; 81.9% progesterone receptor (PR)-positive; 96.9% androgen receptor (AR)-positive [ER, PR or AR Allred score ≥3]; 61.1% Ki67 expression low (<14% positive cells); using immunohistochemistry (IHC) surrogates, 41.9% were Luminal-A-like, 48.6% Luminal-B-like/HER-2-negative, 8.7% HER-2-positive, 0.3% triple negative. Median follow-up: 8.2 years (0.0-23.8) for all, 7.2 years (0.0-23.2), for M0, 2.6 years (0.0-12.7) for M1 patients. A significant improvement over time was observed in age-corrected BC mortality. BC-specific-mortality was higher for men younger than 50 years. Better overall (OS) and recurrence-free survival (RFS) were observed for highly ER+ (P = 0.001), highly PR+ (P = 0.002), highly AR+ disease (P = 0.019). There was no association between OS/RFS and HER-2 status, Ki67, IHC subtypes nor grade. Conclusions Male BC is usually ER, PR and AR-positive, Luminal B-like/HER2-negative. Of note, 56% patients had T1 tumors but only 4% had BCS. ER was highly positive in >90% of cases but only 77% received adjuvant ET. ER, PR and AR were associated with OS and RFS, whereas grade, Ki67 and IHC surrogates were not. Significant improvement in survival over time was observed.
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Affiliation(s)
- F Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal; European Organisation for Research and Treatment of Cancer-Breast Cancer Group, Toronto, Canada.
| | - J M S Bartlett
- Transformative Pathology, Ontario Institute for Cancer Research, Toronto, Canada; University of Edinburgh, Edinburgh, UK
| | - L Slaets
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - C H M van Deurzen
- Department of Pathology, Erasmus Medical Center, Rotterdam, The Netherlands; Dutch Breast Cancer Research Group (BOOG), The Netherlands
| | | | - P Porter
- Divisions of Human Biology and Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, USA; Department of Pathology, University of Washington, Seattle, USA
| | - B Linderholm
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden; Swedish Association of Breast Oncologists (SABO), Lund University, Lund, Sweden
| | - I Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - C Schröder
- Dutch Breast Cancer Research Group (BOOG), The Netherlands; Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands
| | - J Martens
- Dutch Breast Cancer Research Group (BOOG), The Netherlands; Breast Cancer Genomics and Proteomics Lab, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - J Bayani
- Transformative Pathology, Ontario Institute for Cancer Research, Toronto, Canada
| | - C van Asperen
- Dutch Breast Cancer Research Group (BOOG), The Netherlands; Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands
| | - M Murray
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York
| | - C Hudis
- Breast Medicine Service, Memorial Sloan Kettering Cancer Center, New York; Weill Cornell Medical College, New York
| | - L Middleton
- Department of Pathology, University of Texas MD Anderson Cancer Center, Houston, USA
| | - J Vermeij
- Department of Medical Oncology, Hospital Network Antwerp (ZNA), Antwerp, Belgium
| | - K Punie
- Department of General Medical Oncology, UZ Leuven, Leuven, Belgium
| | - J Fraser
- Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - M Nowaczyk
- Specialist Hospital, St. Wojciech, Gdansk, Poland
| | - I T Rubio
- Breast Surgical Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain
| | - S Aebi
- Swiss Group for Clinical Cancer Research (SAKK), Switzerland
| | - C Kelly
- All Ireland Cooperative Oncology Research Group (ICORG), Ireland
| | - K J Ruddy
- Department of Oncology, Mayo Clinic, Rochester, USA
| | - E Winer
- Dana-Farber Cancer Institute, Boston, USA
| | - C Nilsson
- Department of Oncology, Västmanlands Hospital, Västerås, Sweden; Swedish Association of Breast Oncologists (SABO), Sweden
| | - L Dal Lago
- Department of Medical Oncology, Jules Bordet Institute, Brussels, Belgium
| | - L Korde
- University of Washington, Seattle, USA
| | - K Benstead
- Department of Oncology, Cheltenham General Hospital, UK
| | - O Bogler
- Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, USA
| | - T Goulioti
- Breast International Group, Brussels, Belgium
| | - A Peric
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - S Litière
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - K C Aalders
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - C Poncet
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - K Tryfonidis
- European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium
| | - S H Giordano
- Departments of Health Services Research and Breast Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, USA
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Bayani J, Poncet C, Yao CQ, Crozier C, Anouk N, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Dal Lago L, Fraser J, Hilbers FH, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Van Den Weyngaert D, van Deurzen C, van Leeuwen-Stok E, Vermeij J, Winer E, Boutros PC, Giordano SH, Cardoso F, Bartlett JM. Abstract P6-19-01: Evaluation of multiple transcriptomic gene risk signatures in male breast cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.sabcs18-p6-19-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Male breast cancer (MBC) is a rare disease accounting for less than 1% of all breast cancers (BC) and 1% of all cancers in males. The clinical management is largely extrapolated from female BC. Several multigene assays are increasingly used to guide clinical treatment decisions in female BC, however there is little data on the utility of these tests in MBC.
Methods: Here we present the gene expression results of 380 M0, ER+ve, HER2-ve MBCs enrolled in the Part 1 (retrospective joint analysis) International Male Breast Cancer Program of 1483 patients diagnosed between 1990-2010 (Cardoso et al. Annals of Oncology, 2018). Using a custom Nanostring™ panel comprised of the genes from the commercial risk tests Prosigna®, OncotypeDx® and Mammaprint®, risk scores and intrinsic subtyping data were generated to recapitulate the commercial tests as described by Bayani and Yao et al (npjBreast Cancer, 2017). Survival outcomes by risk classification were analyzed using Cox models with time-dependent covariates when the proportional hazard assumption was not met and adjusted for clinical and treatment variables.
Results: Prosigna-like risk scores identified 99 (26.1%) as low-risk, 159 (41.8%) as intermediate-risk, and 122 (32.1%) as high-risk. Using the TAILORx cut-off (25) for OncotypeDx-like risk of recurrence scoring, 158 (41.6%) were identified as low-risk, while 222 (58.4%) were identified as high-risk. MammaPrint-like results identified 175 (46.1%) as low-risk and 205 (53.9%) as high-risk. Overall, patients classified as high-risk had higher grade, more nodal involvement, larger tumors, and more frequently treated with chemotherapy than low-risk patients. Survival analyses demonstrated clear clinical utility for each test, showing patients at high-risk with poor relapse-free survival (RFS) as compared to patients classified as low-risk: Prosigna-like RFS at 3-years (HR=2.20, 95% CI, 1.28-3.80); Oncotype-like RFS at 3-years (HR=1.92, 95% CI, 1.17-3.17); MammaPrint-like RFS (HR=1.51, 95% CI, 1.00-2.27); with similar findings for distant relapse-free survival (DRFS) and overall survival (OS). Across outcomes and all gene signatures, patients with concordant Low/Low risk classification had better prognosis than those with concordant High/High risk classification. PAM50 intrinsic subtyping identified 147 (38.7%) as Luminal A, 57 (15.0%) as Luminal B, 80 (21.1%) as Her2-enriched and 96 (25.3%) as Basal-like; showing overall 34.5% concordance to clinic-pathological subtyping by central pathology (95% CI, 29.7%-39.5%). Comparison between the tests in the MBC cohort and a comparable cohort of female BC from the Tamoxifen Exemestane Adjuvant Multinational (TEAM) trial processed in the same way will be presented.
Conclusion: Common transcriptomic assays designed to assess residual risk, validated in female BC, provide similar information in male BC patients. Not surprisingly, disagreement between test results at the individual patient level was observed. To our knowledge, this is the largest study of MBC assayed to generate risk scores of the current commercial BC tests to demonstrate their clinical utility and their differences and similarity to female BC.
This work has been funded by the Breast Cancer Research Foundation (BCRF).
Citation Format: Bayani J, Poncet C, Yao CQ, Crozier C, Anouk N, Piper T, Cunningham C, Sobol M, Aebi S, Benstead K, Bogler O, Dal Lago L, Fraser J, Hilbers FH, Hedenfalk I, Korde L, Linderholm B, Martens J, Middleton L, Murray M, Kelly C, Nilsson C, Nowaczyk M, Peeters S, Peric A, Porter P, Schröder C, Rubio IT, Ruddy KJ, van Asperen C, Van Den Weyngaert D, van Deurzen C, van Leeuwen-Stok E, Vermeij J, Winer E, Boutros PC, Giordano SH, Cardoso F, Bartlett JM. Evaluation of multiple transcriptomic gene risk signatures in male breast cancer [abstract]. In: Proceedings of the 2018 San Antonio Breast Cancer Symposium; 2018 Dec 4-8; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2019;79(4 Suppl):Abstract nr P6-19-01.
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Affiliation(s)
- J Bayani
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Poncet
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - CQ Yao
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Crozier
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - N Anouk
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - T Piper
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Cunningham
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - M Sobol
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - S Aebi
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - K Benstead
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - O Bogler
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - L Dal Lago
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - J Fraser
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - FH Hilbers
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - I Hedenfalk
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - L Korde
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - B Linderholm
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - J Martens
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - L Middleton
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - M Murray
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Kelly
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Nilsson
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - M Nowaczyk
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - S Peeters
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - A Peric
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - P Porter
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C Schröder
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - IT Rubio
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - KJ Ruddy
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C van Asperen
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - D Van Den Weyngaert
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - C van Deurzen
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - E van Leeuwen-Stok
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - J Vermeij
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - E Winer
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - PC Boutros
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - SH Giordano
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - F Cardoso
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
| | - JM Bartlett
- Ontario Institute for Cancer Research, Toronto, ON, Canada; European Organization for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; University of Edinburgh, Edinburgh, United Kingdom; Swiss Group for Clinical Cancer Research (SAKK), Bern, Switzerland; Cheltenham General Hospital, Gloucestershire, United Kingdom; Global Academic Programs, University of Texas MD Anderson Cancer Center, Houston, TX; Jules Bordet Institute, Brussels, Belgium; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom; Breast International Group, Brussels, Belgium; Lund University, Lund, Sweden; University of Washington, Seattle, WA; Sahlgrenska University Hospital, Gothenburg, Sweden; Medical Oncology, Erasmus Medical Center Rotterdam, Rotterdam, Netherlands; University of Texas MD Anderson Cancer Center, Houston, TX; Memorial Sloan Kettering Cancer Center, New York, NY; All Ireland Cooperative Oncology Research Group (ICORG), Dublin, United Kingdom; Västmanlands Hospital, Västerås, Sweden; Speci
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Martens JWM, Sieuwerts A, Ponchet C, Smid M, de Weerd V, Slaets L, Piper T, van Deurzen CHM, Schroder CP, Stangle C, Kloosterman W, van Leeuwen-Stok E, Nilsson C, Vermeij J, Peeters S, Goulioti T, Nowaczyk M, Aebi S, Rubio IT, Kelly C, Bayani J, Porter P, Murray M, Hudis C, Middleton L, Korde L, Ruddy K, Winer E, Bogler O, van den Weyngaert D, dal Lago L, Fraser J, Benstead K, van Asperen C, Linderholm B, Hedenfalk I, Tryfonidis K, Giordano S, Bartlett J, Cardoso F. Abstract PD7-12: Molecular subtyping of male breast cancer by the International male breast cancer program (IMBC): EORTC 10085/TBCRC 0-29/BIG 2-07/NABCG/BOOG 2009-04. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-pd7-12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction. Male breast cancer (male BC) is a rare disease for which disease management is extrapolated from females. IMBC, an international consortium, which previously reported on clinico-pathological aspects, now reports on molecular subgroups revealed by RNA sequencing and their relation to patient outcome.
Methods. Tumor samples from the retrospective MALE BC registry diagnosed between 1990-2010 and with pathology and outcome data (relapse-free- (RFS) and overall survival (OS)) were included (n=699). To allow the discovery of prognostic features, we selected, stratified for known risk factors (TN stage, grade, age at diagnose and adjuvant endocrine treatment), from the cohort 152 cases with poor (RFS <= 4 yrs) and good outcome (RFS > 7yrs) evenly distributed. Here, we report RNA sequencing results of the first 73 cases, 38 with poor and 35 with good outcome. RNA sequencing reads were used to generate gene expression values and to report transcripts carrying driver mutations. Unsupervised clustering identified subgroups and within subgroups differentially expressed genes were identified. The reported prognostic male BC subgroups M1 and M2 (Johansson BCR 2012(14):R31) were also annotated. All identified subgroups were related to outcome using logistic regression (p-value using Wald test).
Results. Unsupervised clustering revealed 2 main subgroups of which group 1 was enriched for expression of ER target genes, WNT3 and genes from amplicons known for female BC, e.g. 19p13 (CCNE1), 8q24 (MYC), and 11q13 (CCND1). The biology of the smaller group 2 was less defined but TGFβ2 expression was high as were various kallikreins (KLK) including interestingly KLK3 (prostate specific antigen). Other known amplified regions [(8p11 (FGFR1), 20q13 (ZNF217) and 12q15 (MDM2)] and mutated transcripts [PIK3CA (H1047R/L/Q; E542K, E545K, N345K; 16% of cases), TP53 and SF3B1 (K700E) (2% of cases)] were identified. Profound tumor infiltrate gene expression was present in 5% of cases and one third of cases expressed proliferation markers. Except for TP53, none of these latter characteristics were unevenly distributed among the 2 main subgroups. ER and AR were highly correlated, particularly in group 1. The two main groups could be further subdivided. Group 1 comprised 3 subgroups of which subgroup 1a expressed TFF1/3 and NAT1, well-known ER targets, while subgroups 1b and 1c expressed other ER targets,respectively BEX1 and PITX1. HOXC cluster expression differentiated subgroup 1b from 1a and 1c. None of these intrinsic subgroups were, however, related to RFS. The previously reported M2 subgroup, which largely segregated with subclusters 1a and 1b, was associated with a better RFS than the M1 subgroup (OR=2.9; 95%CI 1.1-7.5; p-value=0.03).
Conclusions. 1) Intrinsic subtypes of male BC were revealed and their subgrouping is defined by ER associated subsets of genes. 2) The association of the reported M2 subgroup of male BC with longer RFS was validated; 3) Currently identified biological characteristics of male BC may improve future treatments. The full report on 152 cases including a comparison to female BC will be presented at the conference.
This research was funded by Breast Cancer Research Foundation
Citation Format: Martens JWM, Sieuwerts A, Ponchet C, Smid M, de Weerd V, Slaets L, Piper T, van Deurzen CHM, Schroder CP, Stangle C, Kloosterman W, van Leeuwen-Stok E, Nilsson C, Vermeij J, Peeters S, Goulioti T, Nowaczyk M, Aebi S, Rubio IT, Kelly C, Bayani J, Porter P, Murray M, Hudis C, Middleton L, Korde L, Ruddy K, Winer E, Bogler O, van den Weyngaert D, dal Lago L, Fraser J, Benstead K, van Asperen C, Linderholm B, Hedenfalk I, Tryfonidis K, Giordano S, Bartlett J, Cardoso F. Molecular subtyping of male breast cancer by the International male breast cancer program (IMBC): EORTC 10085/TBCRC 0-29/BIG 2-07/NABCG/BOOG 2009-04 [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr PD7-12.
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Affiliation(s)
- JWM Martens
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - A Sieuwerts
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Ponchet
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - M Smid
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - V de Weerd
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L Slaets
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - T Piper
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - CHM van Deurzen
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - CP Schroder
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Stangle
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - W Kloosterman
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - E van Leeuwen-Stok
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Nilsson
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Vermeij
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - S Peeters
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - T Goulioti
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - M Nowaczyk
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - S Aebi
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - IT Rubio
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Kelly
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Bayani
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - P Porter
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - M Murray
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C Hudis
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L Middleton
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L Korde
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - K Ruddy
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - E Winer
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - O Bogler
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - D van den Weyngaert
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - L dal Lago
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Fraser
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - K Benstead
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - C van Asperen
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - B Linderholm
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - I Hedenfalk
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - K Tryfonidis
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - S Giordano
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - J Bartlett
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
| | - F Cardoso
- Erasmus Medical Center, Rotterdam, ZH, Netherlands; European Organization for Research and Treatment of Cancer, Brussels, Belgium; Ontario Institute for Cancer Research, Toronto, Canada; Erasmus Medical Center, Rotterdam, Netherlands; University Medical Center, Groningen, Netherlands; University Medical Center, Utrecht, Netherlands; Dutch Breast Cancer Research Group (BOOG), Netherlands; Västmanlands Hospital, Vateras, Sweden; ZNA Jan Palfijn, Belgium; UZ Leuven, Leuven, Belgium; Breast International Group, Brussels, Belgium; Specialist Hospital. St. Wojciech, Gdansk, Poland; Swiss Group for Clinical Cancer Research, Switzerland; Hospital Universitario Vall d´Hebron, Barcelona, Spain; All Ireland Cooperative Oncology Research Group, Ireland; University of Washington, Seattle; Memorial Sloan Kettering Cancer Center, New York; Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York; University of Texas MD Anderson Cancer Center, Houston; Mayo Clinic, Rochester; Dana-Farber Cancer Ins
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Schroder C, Cardoso F, Dijkstra N, van Leeuwen-Stok E, Linderholm B, Morgenstern D, Van Poznak C, Wolff AC, Poncet C, Gomez HL, Aalders K, Bjelic-Radisic V, Werutsky G, Tryfonidis K, Coens C, Giordano SH, Ruddy KJ. Abstract P5-23-02: Quality of life (QoL) in male breast cancer (BC): Prospective study of the EORTC10085/TBCRC029/BIG2-07/NABCG International male BC program. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-23-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction: Male BC is a rare disease (dx) for which management is extrapolated from trials in female BC. Comprehensive prospective data about QoL in men with BC could inform treatment. The international Male BC Consortium conducted a prospective registry of male BC patients of all stages who newly presented to a participating center between October 2013 and February 2017. A QoL substudy was conducted as part of this registry at most participating sites.
Methods: Informed consent for participation in the QoL substudy was requested from new enrollees. Those who consented were asked to complete a survey including the EORTC QLQ-C30 and BR23 (breast cancer specific module), adapted by replacing female-specific items with male-specific sexual activity/function items from the prostate module (PR25). Outcomes were scored according to standard EORTC QLQ procedures on a 0-100 scale (with higher scores on QoL/functioning scales representing better QoL and functioning, and higher scores on symptom scales representing worse symptoms). Forms were analyzed centrally by EORTC. In order to compare to female BC, we used reference data from 2782 mixed age (62% under age 60) women with BC (of whom 1,147 had recurrent or metastatic dx, and 464 had stage 1-2 dx) reported in the EORTC QLQ-C30 Reference Values manual (2008).
Results: A total of 557 men were enrolled in EORTC10085, 445 at sites participating in the QoL substudy. Consent forms were received from 422/445 (95%) for the substudy. Baseline survey (required to be completed within 30 days of enrollment) compliance was 85% (359/422). Median age at diagnosis was 67 years. There were 111 men (45%) with node-positive M0/MX dx and 27 men (8%) with M1 dx. Their median global health status score at baseline was 75 (IQR 67-83), higher than that documented historically in female BC (67, with IQR 50-83, in both the 2782 women with mixed stage and the subgroup of 464 with stage 1-2 tumors). The participating men's median social functioning score was 100 (IQR 67-100), also higher than the 83.3 (IQR 67-100) reported in mixed stage female BC patients, though no different than the 100 (IQR 67-100) found in women with stage 1-2 dx. Men's most commonly reported symptoms included fatigue (median score 13.9, IQR 0-33), insomnia (median score 0, IQR 0-33), and pain (median score 0, IQR 0-33), for which women's median scores were 33 (IQR 11-44), 33 (IQR 0-33), and 17 (IQR 0-50) with mixed stage dx, and 22 (IQR 0-33), 33 (IQR 0-33), and 17 (IQR 0-33) with stage 1-2 dx. Men's median sexual activity score was 33.3 (IQR 0-50), with less sexual activity reported by older patients and men with M1 dx. In those who were sexually active, median sexual function score was 83 (IQR 75-92), with no difference by age or stage.
Conclusions: QoL and symptom burden in male BC patients appears no worse (and possibly better) than that in female patients. Future analyses of 1- and 5-year surveys from this study will assess the impact of specific treatments on changes in symptoms and QoL over time. These data will be useful in future efforts to tailor treatments and target interventions for male BC.
Funding: Breast Cancer Research Foundation, Dutch Pink Ribbon Foundation, Swedish BRO, and EBCC Council.
Citation Format: Schroder C, Cardoso F, Dijkstra N, van Leeuwen-Stok E, Linderholm B, Morgenstern D, Van Poznak C, Wolff AC, Poncet C, Gomez HL, Aalders K, Bjelic-Radisic V, Werutsky G, Tryfonidis K, Coens C, Giordano SH, Ruddy KJ. Quality of life (QoL) in male breast cancer (BC): Prospective study of the EORTC10085/TBCRC029/BIG2-07/NABCG International male BC program [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-23-02.
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Affiliation(s)
- C Schroder
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - F Cardoso
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - N Dijkstra
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - E van Leeuwen-Stok
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - B Linderholm
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - D Morgenstern
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - C Van Poznak
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - AC Wolff
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - C Poncet
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - HL Gomez
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - K Aalders
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - V Bjelic-Radisic
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - G Werutsky
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - K Tryfonidis
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - C Coens
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - SH Giordano
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
| | - KJ Ruddy
- University Medical Center Groningen, Groningen, Netherlands; Champalimaud Clinical Center, Lisbon, Portugal; Dutch Breast Cancer Trialists' Research Group (BOOG), Amsterdam, Netherlands; Sahlgrenska University Hospital & Swedish Association of Breast Oncologists (SABO), Gothenburg, Sweden; Dana-Farber Cancer Institute, Boston, MA; Unversity of Michigan, Ann Arbor, MI; Johns Hopkins Medicine, Lutherville, MD; European Organisation for Research and Treatment of Cancer (EORTC) Headquarters, Brussels, Belgium; Instituto Nacional de Enfermedades Neoplásicas, Lima, Peru; Medical University of Graz, Graz, Austria; Latin American Cooperative Oncology Group, Porto Alegre, Brazil; MD Anderson Cancer Center, Houston, TX; Mayo Clinic, Rochester, MN
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Giordano SH, Schröder CP, Poncet C, van Leeuwen-Stok E, Linderholm B, Abreu MH, Rubio I, Van Poznak C, Morganstern D, Cameron D, Vleugel MM, Smilde TJ, Bozovic-Spasojevic I, Korde L, Russell NS, den Hoed IDM, Honkoop AH, van der Velden AWG, van 't Riet M, Dijkstra N, Bogler O, Goulioti T, Hilsenbeck S, Ruddy KJ, Wolff A, van Deurzen CHM, Martens J, Bartlett JMS, Aalders K, Tryfonidis K, Cardoso F. Abstract P5-23-01: Clinical and biological characterization of male breast cancer (BC) EORTC 10085/TBCRC 029/BOOG 2013-02/BIG 2-07: Baseline results from the prospective registry. Cancer Res 2018. [DOI: 10.1158/1538-7445.sabcs17-p5-23-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
BACKGROUND: Through the International Male Breast Cancer Program, a prospective registry for male BC was created with the goals of evaluating 1) the clinical and biological features of this disease and 2) assessing feasibility of a prospective therapeutic clinical trial.
METHODS: All men, with any stage histologically proven invasive breast cancer, age 3 18 years, and newly presenting at the participating institutions (within 3 months prior) were eligible. Patients were enrolled for 30 months after activation of the first center, through February 2017. Per the study design, if <100 men enrolled, the study would be considered a failure and therapeutic trials would not be pursued through this network. Epidemiologic data, staging, pathologic features, and BRCA status were collected. Treatment and outcome data collection is ongoing. Optional collection of FFPE tumor samples, blood, and QOL were performed in the US, the Netherlands, and Latin America. Clinical database lock for this report was May 30, 2017. We currently report patient and disease characteristics and will update with patterns of treatment for the presentation. Outcomes and biological samples will be analyzed in the future.
RESULTS: 557 patients were enrolled: 75% in Europe, 20% in United States, 5% in other countries. 6.3% of patients had missing forms. Median age was 67 years (range 26-92). 93% were diagnosed 2010-2017. Among patients with complete data, 79% presented with a breast mass. 88% were M0 and 12% M1. Among M0 patients: 47%, 39%, 2%, and 11% had T1, T2, T3, and T4 disease respectively; 52% were N0. Overall, 98% had ER+ disease and 11% had HER2+ cancer. 14% had grade 1, 56% had grade 2, and 30% had grade 3 tumors. Among 112 men who underwent BRCA1 testing, 1 was positive. Among 118 men who had BRCA2 testing, 18 (15%) were positive. 21% of men had prior or concurrent malignancies, with the following most common sites: prostate, non-melanoma skin, colorectal, and melanoma. The prevalence of previously identified possible risk factors for male breast cancer were: overweight/obesity (72%), former/current smoker (51%), current alcohol 31 drink daily (41%), family history of breast cancer (35%), gynecomastia (16%), history radiation exposure (8%), use of anti-androgens (1%), and use of estrogens (1%).
CONCLUSION: Through an international collaborative effort, we were able to prospectively accrue 557 patients to a male breast cancer registry. These results demonstrate feasibility of pursuing a therapeutic clinical trial in men with breast cancer. In addition, this study shows the relatively low uptake of BRCA testing, high rates of concurrent/prior malignancy, and the rates of potentially modifiable risk factors in this patient population.
Funding from Breast Cancer Research Foundation, Susan G. Komen, Dutch Pink Ribbon Foundation, Swedish Breast Cancer Association (BRO) and EBCC Council.
Citation Format: Giordano SH, Schröder CP, Poncet C, van Leeuwen-Stok E, Linderholm B, Abreu MH, Rubio I, Van Poznak C, Morganstern D, Cameron D, Vleugel MM, Smilde TJ, Bozovic-Spasojevic I, Korde L, Russell NS, den Hoed IDM, Honkoop AH, van der Velden AWG, van 't Riet M, Dijkstra N, Bogler O, Goulioti T, Hilsenbeck S, Ruddy KJ, Wolff A, van Deurzen CHM, Martens J, Bartlett JMS, Aalders K, Tryfonidis K, Cardoso F. Clinical and biological characterization of male breast cancer (BC) EORTC 10085/TBCRC 029/BOOG 2013-02/BIG 2-07: Baseline results from the prospective registry [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P5-23-01.
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Affiliation(s)
- SH Giordano
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - CP Schröder
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - C Poncet
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - E van Leeuwen-Stok
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - B Linderholm
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - MH Abreu
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - I Rubio
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - C Van Poznak
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - D Morganstern
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - D Cameron
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - MM Vleugel
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - TJ Smilde
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - I Bozovic-Spasojevic
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - L Korde
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - NS Russell
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - IDM den Hoed
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - AH Honkoop
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - AWG van der Velden
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - M van 't Riet
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - N Dijkstra
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - O Bogler
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - T Goulioti
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - S Hilsenbeck
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - KJ Ruddy
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - A Wolff
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - CHM van Deurzen
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - J Martens
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - JMS Bartlett
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - K Aalders
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - K Tryfonidis
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
| | - F Cardoso
- The University of Texas MD Anderson Cancer Center, Houston, TX; University Medical Center Groningen, Groningen, Netherlands; EORTC HQ, Brussel, Belgium; BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, Netherlands; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Portuguese Institute of Oncology of Porto, Porto, Portugal; Hosital General Vall D'Hebron, Barcelona, Spain; University of Michigan Health System, Ann Arbor, MI; Dana Farber Cancer Institute, Boston, MA; University of Edinburgh Cancer Research Centre, Western General Hospital, Edinburgh, United Kingdom; Esperanz - loc. Waterland, Netherlands; Jeroen Bosch Hospital, Den Bosch, Netherlands; Institute for Oncology and Radiology of Serbia, National Cancer Research Centre, Belgrade, Serbia; Seattle Cancer Center Alliance, Seattle; The Netherlands Cancer Institute Antoni van Leeuwenhoek Hospital, Amsterdam, Netherlands; Elisabeth-TweeSteden Hospital, Tilburg, Netherlands; Isala Hospital, Zwolle, Netherlands; Martini Hospita
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Foukakis T, Lövrot J, Matikas A, Zerdes I, Lorent J, Tobin N, Suzuki C, Brage SE, Carlsson L, Einbeigi Z, Linderholm B, Loman N, Malmberg M, Fernö M, Skoog L, Bergh J, Hatschek T. Immune gene expression and response to chemotherapy in advanced breast cancer. Br J Cancer 2018; 118:480-488. [PMID: 29370583 PMCID: PMC5830596 DOI: 10.1038/bjc.2017.446] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 11/11/2017] [Accepted: 11/14/2017] [Indexed: 12/30/2022] Open
Abstract
Background: Transcriptomic profiles have shown promise as predictors of response to neoadjuvant chemotherapy in breast cancer (BC). This study aimed to explore their predictive value in the advanced BC (ABC) setting. Methods: In a Phase 3 trial of first-line chemotherapy in ABC, a fine needle aspiration biopsy (FNAB) was obtained at baseline. Intrinsic molecular subtypes and gene modules related to immune response, proliferation, oestrogen receptor (ER) signalling and recurring genetic alterations were analysed for association with objective response to chemotherapy. Gene-set enrichment analysis (GSEA) of responders vs non-responders was performed independently. Lymphocytes were enumerated in FNAB smears and the absolute abundance of immune cell types was calculated using the Microenvironment Cell Populations counter method. Results: Gene expression data were available for 109 patients. Objective response to chemotherapy was statistically significantly associated with an immune module score (odds ratio (OR)=1.62; 95% confidence interval (CI), 1.03–2.64; P=0.04). Subgroup analysis showed that this association was restricted to patients with ER-positive or luminal tumours (OR=3.54; 95%, 1.43–10.86; P=0.012 and P for interaction=0.04). Gene-set enrichment analysis confirmed that in these subgroups, immune-related gene sets were enriched in responders. Conclusions: Immune-related transcriptional signatures may predict response to chemotherapy in ER-positive and luminal ABC.
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Affiliation(s)
- Theodoros Foukakis
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - John Lövrot
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Alexios Matikas
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Ioannis Zerdes
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Julie Lorent
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Nick Tobin
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Chikako Suzuki
- Department of Radiology and Nuclear Medicine, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Suzanne Egyházi Brage
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Lena Carlsson
- Department of Oncology, Sundsvall General Hospital, Sundsvall 85643, Sweden
| | - Zakaria Einbeigi
- Department of Oncology, Sahlgrenska University Hospital, Gothenborg 41345, Sweden
| | - Barbro Linderholm
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden.,Department of Oncology, Sahlgrenska University Hospital, Gothenborg 41345, Sweden
| | - Niklas Loman
- Department of Oncology, Skåne University Hospital, Lund 22241, Sweden
| | - Martin Malmberg
- Department of Oncology, Helsingborg General Hospital, Helsingborg 25187, Sweden
| | - Mårten Fernö
- Department of Oncology, Skåne University Hospital, Lund 22241, Sweden
| | - Lambert Skoog
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Jonas Bergh
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
| | - Thomas Hatschek
- Department of Oncology-Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm 17176, Sweden
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Matikas A, Margolin S, Hellström M, Johansson H, Bengtsson NO, Karlsson L, Edlund P, Karlsson P, Lidbrink E, Linderholm B, Lindman H, Malmstrom P, Villman K, Foukakis T, Bergh J. Long-term safety and survival outcomes from the Scandinavian Breast Group 2004-1 randomized phase II trial of tailored dose-dense adjuvant chemotherapy for early breast cancer. Breast Cancer Res Treat 2017; 168:349-355. [PMID: 29190004 PMCID: PMC5838137 DOI: 10.1007/s10549-017-4599-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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: 11/18/2017] [Accepted: 11/24/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Although adjuvant polychemotherapy improves outcomes for early breast cancer, the significant variability in terms of pharmacokinetics results in differences in efficacy and both short and long-term toxicities. Retrospective studies support the use of dose tailoring according to the hematologic nadirs. METHODS The SBG 2004-1 trial was a randomized feasibility phase II study which assessed tailored dose-dense epirubicin and cyclophosphamide (EC) followed by docetaxel (T) (group A), the same regimen with fixed doses (group B) and the TAC regimen (group C). Women aged 18-65 years, ECOG PS 0-1 with at least one positive axillary lymph node were randomized 1:1:1. The primary endpoint of the study was the safety and feasibility of the treatment. Toxicity was graded according to CTC-AE version 3.0. The design and short-term toxicity have been previously published. Here, we report safety and efficacy data after 10 years of follow-up. RESULTS A total of 124 patients were included in the study. After a median follow-up of 10.3 years, the probability for 10-year survival was 78.5, 75.1, and 63.4% and for relapse free survival 64.1, 71.0, and 59.5% for groups A, B, and C, respectively. There were no cases of clinically diagnosed cardiotoxicity or hematologic malignancies. No patient was lost to follow-up. CONCLUSIONS In this randomized phase II trial, tailored dose adjuvant chemotherapy was feasible, without an increased risk for long-term adverse events after a median follow-up of 10 years.
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Affiliation(s)
- Alexios Matikas
- Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden.
| | - Sara Margolin
- Department of Oncology, Stockholm South General Hospital, Stockholm, Sweden
| | - Mats Hellström
- Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden
| | | | | | | | - Per Karlsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Elisabet Lidbrink
- Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden
| | - Barbro Linderholm
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, Sahlgrenska University Hospital, University of Gothenburg, Gothenburg, Sweden
| | - Henrik Lindman
- Department of Oncology, Uppsala University Hospital, Uppsala, Sweden
| | - Per Malmstrom
- Department of Oncology and Radiation Physics, Skåne University Hospital, Lund, Sweden
| | | | - Theodoros Foukakis
- Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden
| | - Jonas Bergh
- Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm, Sweden
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Vermeulen MA, Slaets L, Cardoso F, Giordano SH, Tryfonidis K, van Diest PJ, Dijkstra NH, Schröder CP, van Asperen CJ, Linderholm B, Benstead K, Foekens R, Martens JW, Bartlett JM, van Deurzen CH. Pathological characterisation of male breast cancer: Results of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Eur J Cancer 2017; 82:219-227. [DOI: 10.1016/j.ejca.2017.01.034] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 01/31/2017] [Indexed: 02/08/2023]
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Aapro M, De Laurentiis M, Rea D, Bargallo Rocha JE, Elizalde R, Landherr L, Linderholm B, Mamounas E, Markopoulos C, Neven P, Petrovsky A, Rouzier R, Smit V, Svedman C, Schneider D, Thomssen C, Martin M. The MAGIC survey in hormone receptor positive (HR+), HER2-negative (HER2-) breast cancer: When might multigene assays be of value? Breast 2017; 33:191-199. [PMID: 28441617 DOI: 10.1016/j.breast.2017.01.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2015] [Revised: 01/15/2017] [Accepted: 01/23/2017] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND A modest proportion of patients with early stage hormone receptor-positive (HR+), HER2-negative (HER2-) breast cancer benefit from adjuvant chemotherapy. Traditionally, treatment recommendations are based on clinical/pathologic criteria that are not predictive of chemotherapy benefit. Multigene assays provide prognostic and predictive information that can help to make more informed treatment decisions. The MAGIC survey evaluated international differences in treatment recommendations, how traditional parameters are used for making treatment choices, and for which patients treating physicians feel most uncertain about their decisions. METHODS The MAGIC survey captured respondents' demographics, practice patterns, relevance of traditional parameters for treatment decisions, and use of or interest in using multigene assays. Using this information, a predictive model was created to simulate treatment recommendations for 672 patient profiles. RESULTS The survey was completed by 911 respondents (879 clinicians, 32 pathologists) from 52 countries. Chemo-endocrine therapy was recommended more often than endocrine therapy alone, but there was substantial heterogeneity in treatment recommendations in 52% of the patient profiles; approximately every fourth physician provided a different treatment recommendation. The majority of physicians indicated they wanted to use multigene assays clinically. Lack of reimbursement/availability were the main reasons for non-usage. CONCLUSIONS The survey reveals substantial heterogeneity in treatment recommendations. Physicians have uncertainty in treatment recommendations in a high proportion of patients with intermediate risk features using traditional parameters. In HR+, HER2- patients with early disease the findings highlight the need for additional markers that are both prognostic and predictive of chemotherapy benefit that may support more-informed treatment decisions.
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Affiliation(s)
- Matti Aapro
- Genolier Breast Center, Clinic of Genolier, Route du Muids 3, 1272 Genolier, Switzerland.
| | - Michelino De Laurentiis
- Department of Senology, National Cancer Institute G. Pascale Foundation, Via Mariano Semmola, 80131 Naples, Italy
| | - Dan Rea
- School of Cancer Sciences, University of Birmingham, Vincent Drive, Edgbaston, B15 2TT Birmingham, United Kingdom
| | - Juan Enrique Bargallo Rocha
- Department of Surgery, Instituto Nacional de Cancerología, Av. San Fernando No. 22, Col. Sección XVI Delegación Tlalpan, 14080 Mexico City, Mexico
| | - Roberto Elizalde
- División Ginecologia y Mastologia, Hospital Dr. I. Pirovano, Av Monroe 3555, 1428 Buenos Aires, Argentina
| | - László Landherr
- Department of Oncoradiology, Uzsoki Teaching Hospital, Uzsoki u. 29-41, 1145 Budapest, Hungary
| | - Barbro Linderholm
- Department of Oncology, Sahlgrenska Academy and University Hospital, Per Dubbsgatan 15, 413 45 Gothenburg, Sweden; Department of Oncology/Pathology, Karolinska Institutet, Karolinska Univ Hospital, Z1:00, 171 76 Stockholm, Sweden
| | - Eleftherios Mamounas
- University of Florida Health Cancer Center at Orlando Health, 1400 S. Orange Avenue, 32806 Orlando, FL, USA
| | - Christos Markopoulos
- Department of Surgery, Athens University Medical School, Iassiou Street 8, 11521 Athens, Greece
| | - Patrick Neven
- Multidisciplinary Breast Centre and Gynaecological Oncology, UZ Leuven, Herestraat 49, 3000 Leuven, Belgium
| | - Alexander Petrovsky
- Department of Radiosurgery, Russian Cancer Research Center, 23 Kashirskoye Shosse, Moscow, Russia
| | - Roman Rouzier
- Department of Surgery, Institut Curie-Université Versailles-Saint-Quentin, 35 rue Dailly, 92220 Paris-Saint-Cloud, France
| | - Vincent Smit
- Department of Pathology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands
| | - Christer Svedman
- Medical Affairs, Genomic Health, Quai du Sujet 10, Stockholm, Sweden
| | - Daniel Schneider
- International, Genomic Health, Quai du Sujet 10, Geneva, Switzerland
| | - Christoph Thomssen
- Department of Gynaecology, Martin-Luther University Halle-Wittenberg, Ernst-Grube-Str. 40, 06120 Halle (Saale), Germany
| | - Miguel Martin
- Instituto de Investigación Sanitaria Hospital Gregorio Marañón, Universidad Complutense, c/Dr Esquerdo 46, 28007 Madrid, Spain
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Doebar SC, Slaets L, Cardoso F, Giordano SH, Bartlett JM, Tryfonidis K, Dijkstra NH, Schröder CP, van Asperen CJ, Linderholm B, Benstead K, Dinjens WN, van Marion R, van Diest PJ, Martens JW, van Deurzen CH. Male breast cancer precursor lesions: analysis of the EORTC 10085/TBCRC/BIG/NABCG International Male Breast Cancer Program. Mod Pathol 2017; 30:509-518. [PMID: 28084333 DOI: 10.1038/modpathol.2016.229] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 11/23/2016] [Accepted: 11/23/2016] [Indexed: 12/21/2022]
Abstract
In men, data regarding breast cancer carcinogenesis are limited. The aim of our study was to describe the presence of precursor lesions adjacent to invasive male breast cancer, in order to increase our understanding of carcinogenesis in these patients. Central pathology review was performed for 1328 male breast cancer patients, registered in the retrospective joint analysis of the International Male Breast Cancer Program, which included the presence and type of breast cancer precursor lesions. In a subset, invasive breast cancer was compared with the adjacent precursor lesion by immunohistochemistry (n=83) or targeted next generation sequencing (n=7). Additionally, we correlated the presence of ductal carcinoma in situ with outcome. A substantial proportion (46.2%) of patients with invasive breast cancer also had an adjacent precursor lesion, mainly ductal carcinoma in situ (97.9%). The presence of lobular carcinoma in situ and columnar cell-like lesions were very low (<1%). In the subset of invasive breast cancer cases with adjacent ductal carcinoma in situ (n=83), a complete concordance was observed between the estrogen receptor, progesterone receptor, and HER2 status of both components. Next generation sequencing on a subset of cases with invasive breast cancer and adjacent ductal carcinoma in situ (n=4) showed identical genomic aberrations, including PIK3CA, GATA3, TP53, and MAP2K4 mutations. Next generation sequencing on a subset of cases with invasive breast cancer and an adjacent columnar cell-like lesion showed genomic concordance in two out of three patients. A multivariate Cox model for survival showed a trend that the presence of ductal carcinoma in situ was associated with a better overall survival, in particular in the Luminal B HER2+ subgroup. In conclusion, ductal carcinoma in situ is the most commonly observed precursor lesion in male breast cancer and its presence seems to be associated with a better outcome, in particular in Luminal B HER2+ cases. The rate of lobular carcinoma in situ and columnar cell-like lesions adjacent to male breast cancer is very low, but our findings support the role of columnar cell-like lesions as a precursor of male breast cancer.
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Affiliation(s)
- Shusma C Doebar
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Leen Slaets
- The European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Sharon H Giordano
- Departments of Health Services Research and Breast Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - John Ms Bartlett
- Transformative Pathology, Ontario Institute for Cancer Research, Toronto, Canada & University of Edinburgh, Scotland, UK
| | - Konstantinos Tryfonidis
- The European Organisation for Research and Treatment of Cancer Headquarters, Brussels, Belgium
| | - Nizet H Dijkstra
- BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands
| | - Caroline P Schröder
- Department of Medical Oncology, University Medical Center Groningen, Groningen, The Netherlands.,BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands
| | - Christi J van Asperen
- Department of Clinical Genetics, Leiden University Medical Center, Leiden, The Netherlands.,BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands
| | - Barbro Linderholm
- Department of Oncology, Swedish Association of Breast Oncologists (SABO), Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kim Benstead
- Department of Oncology, Cheltenham General Hospital, Gloucestershire, UK
| | - Winan Nm Dinjens
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Ronald van Marion
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Paul J van Diest
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - John Wm Martens
- Department of Medical Oncology and Cancer Genomics Netherlands, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.,BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands
| | - Carolien Hm van Deurzen
- Department of Pathology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.,BOOG Study Center/Dutch Breast Cancer Research Group, Amsterdam, The Netherlands
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Loman N, Linderholm B, Joensuu H, Ejlertsen B, Johannsson OT, Geisler J, Bendahl PO, Ahlgren J, Lindman H. Abstract OT3-02-10: Nordic trip, a randomized phase 3 study in early triple negative breast cancer. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-ot3-02-10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Adjuvant treatment among the heterogeneous group of triple negative breast cancers (TNBC) is still a challenge. Recently published data indicate that platinum salts may have a role in the treatment of TNBC (v Minckwitz 2014), especially in BRCA-associated cases (Tutt 2014). Subgroup analyses from two large adjuvant studies indicate that also oral capecitabine may add a significant value in this subset of BC (Lindman 2010, O'Shaughnessy, 2010).
As a planned collaboration between the nordic countries, we are currently preparing a three-armed randomized phase 3 study of the addition of carboplatin and capecitabine respectively to a chemo backbone consisting of a taxane-antracycline based treatment in both the adjuvant and the neoadjuvant setting.
Objectives: The primary endpoint will be invasive disease-free survival (IDFS). Secondary endpoints will include IDFS in subsets of TNBC, eg according to gene-expression-based subtypes of TNBC(Lehmann 2011), and BRCA-mutation status. In the cohort treated neoadjuvant, biomarkers predicting pathological response will be identified with the purpose to validate them in the adjuvant cohort.
Method: 1800 patients (pts) with early TNBC stage 1 (>10 mm) - 3 will be randomized 1:1:1 to three treatment arms.
A: nab-paclitaxel (nP) followed by epirubicine-cyclophosphamide (EC)
B: nP-capecitabine followed by EC-capecitabine.
C: nP-carboplatin followed by EC
Treatment will be given either in the adjuvant or in the neoadjuvant setting, the primary endpoint will include all randomized pts from both cohorts.
Statistical considerations: We assume a 75% five-year IDFS with standard treatment (A), and that a relative reduction of the event incidence of 30% for each of the two experimental treatments (B and C) would be a clinically relevant finding (HR=0.7). In order to achieve 80% power at a 0.05 significance level for each of the two comparisons A vs. B and A vs. C, 600 patients need to be evaluated in each of the three treatment arms. Stratification factors: pre- vs postoperative treatment, nodal status and treatment site.
Citation Format: Loman N, Linderholm B, Joensuu H, Ejlertsen B, Johannsson OT, Geisler J, Bendahl P-O, Ahlgren J, Lindman H. Nordic trip, a randomized phase 3 study in early triple negative breast cancer. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr OT3-02-10.
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Affiliation(s)
- N Loman
- Skane Universtiy Hospital, Lund Univeristy, Lund, Sweden; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Rigshospitalet, DBCG Secretariat, Copenhagen, Denmark; Landspitali, University Hospital, Reykjavik, Iceland; Akershus University Hospital, Lörenskog, Norway; Örebro University Hospital, Örebro, Sweden; Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - B Linderholm
- Skane Universtiy Hospital, Lund Univeristy, Lund, Sweden; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Rigshospitalet, DBCG Secretariat, Copenhagen, Denmark; Landspitali, University Hospital, Reykjavik, Iceland; Akershus University Hospital, Lörenskog, Norway; Örebro University Hospital, Örebro, Sweden; Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - H Joensuu
- Skane Universtiy Hospital, Lund Univeristy, Lund, Sweden; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Rigshospitalet, DBCG Secretariat, Copenhagen, Denmark; Landspitali, University Hospital, Reykjavik, Iceland; Akershus University Hospital, Lörenskog, Norway; Örebro University Hospital, Örebro, Sweden; Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - B Ejlertsen
- Skane Universtiy Hospital, Lund Univeristy, Lund, Sweden; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Rigshospitalet, DBCG Secretariat, Copenhagen, Denmark; Landspitali, University Hospital, Reykjavik, Iceland; Akershus University Hospital, Lörenskog, Norway; Örebro University Hospital, Örebro, Sweden; Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - OT Johannsson
- Skane Universtiy Hospital, Lund Univeristy, Lund, Sweden; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Rigshospitalet, DBCG Secretariat, Copenhagen, Denmark; Landspitali, University Hospital, Reykjavik, Iceland; Akershus University Hospital, Lörenskog, Norway; Örebro University Hospital, Örebro, Sweden; Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - J Geisler
- Skane Universtiy Hospital, Lund Univeristy, Lund, Sweden; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Rigshospitalet, DBCG Secretariat, Copenhagen, Denmark; Landspitali, University Hospital, Reykjavik, Iceland; Akershus University Hospital, Lörenskog, Norway; Örebro University Hospital, Örebro, Sweden; Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - P-O Bendahl
- Skane Universtiy Hospital, Lund Univeristy, Lund, Sweden; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Rigshospitalet, DBCG Secretariat, Copenhagen, Denmark; Landspitali, University Hospital, Reykjavik, Iceland; Akershus University Hospital, Lörenskog, Norway; Örebro University Hospital, Örebro, Sweden; Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - J Ahlgren
- Skane Universtiy Hospital, Lund Univeristy, Lund, Sweden; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Rigshospitalet, DBCG Secretariat, Copenhagen, Denmark; Landspitali, University Hospital, Reykjavik, Iceland; Akershus University Hospital, Lörenskog, Norway; Örebro University Hospital, Örebro, Sweden; Akademiska Hospital, Uppsala University, Uppsala, Sweden
| | - H Lindman
- Skane Universtiy Hospital, Lund Univeristy, Lund, Sweden; Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland; Rigshospitalet, DBCG Secretariat, Copenhagen, Denmark; Landspitali, University Hospital, Reykjavik, Iceland; Akershus University Hospital, Lörenskog, Norway; Örebro University Hospital, Örebro, Sweden; Akademiska Hospital, Uppsala University, Uppsala, Sweden
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Thulin A, Werner-Rönnerman E, Sundén M, de Lara S, Schoenfeldt A, Wallberg M, Chamalidou C, Kovács A, Enlund F, Linderholm B. P096 CHARACTERISATION OF BREAST CANCER BRAIN METASTASES THROUGH A 21-YEAR PERIOD – A STUDY FROM THE SWEDISH ASSOCIATION OF BREAST ONCOLOGISTS (SABO). Breast 2015. [DOI: 10.1016/s0960-9776(15)30108-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kimbung S, Johansson I, Danielsson A, Veerla S, Egyhazi Brage S, Frostvik Stolt M, Skoog L, Carlsson L, Einbeigi Z, Lidbrink E, Linderholm B, Loman N, Malmström PO, Söderberg M, Walz TM, Fernö M, Hatschek T, Hedenfalk I. Transcriptional Profiling of Breast Cancer Metastases Identifies Liver Metastasis-Selective Genes Associated with Adverse Outcome in Luminal A Primary Breast Cancer. Clin Cancer Res 2015; 22:146-57. [PMID: 26276891 DOI: 10.1158/1078-0432.ccr-15-0487] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2015] [Accepted: 07/26/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE The complete molecular basis of the organ-specificity of metastasis is elusive. This study aimed to provide an independent characterization of the transcriptional landscape of breast cancer metastases with the specific objective to identify liver metastasis-selective genes of prognostic importance following primary tumor diagnosis. EXPERIMENTAL DESIGN A cohort of 304 women with advanced breast cancer was studied. Associations between the site of recurrence and clinicopathologic features were investigated. Fine-needle aspirates of metastases (n = 91) were subjected to whole-genome transcriptional profiling. Liver metastasis-selective genes were identified by significance analysis of microarray (SAM) analyses and independently validated in external datasets. Finally, the prognostic relevance of the liver metastasis-selective genes in primary breast cancer was tested. RESULTS Liver relapse was associated with estrogen receptor (ER) expression (P = 0.002), luminal B subtype (P = 0.01), and was prognostic for an inferior postrelapse survival (P = 0.01). The major variation in the transcriptional landscape of metastases was also associated with ER expression and molecular subtype. However, liver metastases displayed unique transcriptional fingerprints, characterized by downregulation of extracellular matrix (i.e., stromal) genes. Importantly, we identified a 17-gene liver metastasis-selective signature, which was significantly and independently prognostic for shorter relapse-free (P < 0.001) and overall (P = 0.001) survival in ER-positive tumors. Remarkably, this signature remained independently prognostic for shorter relapse-free survival (P = 0.001) among luminal A tumors. CONCLUSIONS Extracellular matrix (stromal) genes can be used to partition breast cancer by site of relapse and may be used to further refine prognostication in ER positive primary breast cancer.
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Affiliation(s)
- Siker Kimbung
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Sweden. CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Ida Johansson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Sweden. CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Anna Danielsson
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Srinivas Veerla
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Sweden. CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Suzanne Egyhazi Brage
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Marianne Frostvik Stolt
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Lambert Skoog
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Lena Carlsson
- Department of Oncology, Sundsvall Hospital, Sundsvall, Sweden
| | - Zakaria Einbeigi
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Elisabet Lidbrink
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Barbro Linderholm
- Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Niklas Loman
- Department of Oncology, Skåne University Hospital, Lund/Malmö, Sweden
| | | | - Martin Söderberg
- Department of Oncology, Skåne University Hospital, Lund/Malmö, Sweden
| | - Thomas M Walz
- Division of Oncology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
| | - Mårten Fernö
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Sweden
| | - Thomas Hatschek
- Department of Oncology and Pathology, Karolinska Institutet and Karolinska University Hospital, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund, Lund University, Sweden. CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden.
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Aapro M, Bargallo Rocha JE, De Laurentiis M, Elizalde R, Landherr L, Linderholm B, Mamounas T, Markopoulos C, Martin M, Neven P, Petrovsky A, Rea D, Rouzier R, Smit V, Svedman C, Thomssen C. Abstract P6-08-06: The multidisciplinary application of genomics in clinical practice (MAGIC) survey: Identification of early stage hormone receptor-positive (HR+), HER2– breast cancer (BC) patients for whom multigene assays may be valuable. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p6-08-06] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Treatment recommendations for early stage HR+, HER2– BC patients depend on many factors. The MAGIC survey evaluated which criteria clinicians use regarding the need for adjuvant chemotherapy (AdjCT) and showed that there was substantial heterogeneity across clinicians and countries in treatment decisions (Aapro et al, EBCC 2014, abstract 24). Multigene assays (MGA) help to make more-informed decisions by providing prognostic and predictive information beyond traditional parameters, but are not always needed. The data presented here show for which BC patient profiles there is a high heterogeneity in treatment recommendations. We suggest that MGAs may be useful to guide treatment recommendations in these cases.
Methods
From August 2013 until January 2014, physicians with ≥5 years’ experience in BC treatment and participating in multidisciplinary teams were invited for the online MAGIC survey. The survey evaluated respondent characteristics and registered treatment recommendations for randomly generated early BC patient profiles (n=672). A conjoint analysis was used to assess which patient attributes were considered for treatment decisions.
Results
The survey was completed by 911 physicians from 52 countries, of whom 72% had >10 years’ experience. Their treatment recommendations showed that for BC patient profiles with only high-risk or only low-risk characteristics, there was a high consensus to recommend AdjCT or no AdjCT (endocrine treatment alone); 42% of the profiles had >75% probability of being recommended AdjCT and 6% had >75% chance of being recommended no AdjCT.
If interactions between patient characteristics were not considered, age was ranked as the most important patient characteristic for AdjCT decisions, followed by tumor grade, tumor size, nodal status, and expression of Ki67, estrogen receptor (ER), and progesterone receptor. The combination of patient attributes and their interactions were, as expected, of importance; some node-positive patients or patients with a Grade 3 tumor had >75% probability to be recommended no AdjCT (eg, older patients or patients with a small [<2 cm] tumor). Conversely, some patients with small, Grade 1 tumors had >75% probability to be recommended AdjCT (eg, young or node-positive patients).
In total, 104 patient profiles (15%) were identified for which treatment recommendations were highly heterogeneous, with a probability of <50% for both an AdjCT treatment recommendation and no AdjCT as a treatment recommendation. These patient profiles tended to have the following characteristics: >50 years old, tumor size <3 cm, Grade 1 or 2 tumor, high ER expression, and Ki67 expression <20%.
Conclusions
There was substantial heterogeneity in treatment recommendations and an overall tendency to give chemo-endocrine rather than endocrine treatment alone. The highest uncertainty in treatment decisions was seen in patients with intermediate risk by clinical and pathological parameters. This opens questions concerning treatment decisions and in such cases MGAs may be most useful.
Citation Format: Matti Aapro, Juan Enrique Bargallo Rocha, Michele De Laurentiis, Roberto Elizalde, László Landherr, Barbro Linderholm, Terry Mamounas, Christos Markopoulos, Miguel Martin, Patrick Neven, Alexander Petrovsky, Dan Rea, Roman Rouzier, Vincent Smit, Christer Svedman, Christoph Thomssen. The multidisciplinary application of genomics in clinical practice (MAGIC) survey: Identification of early stage hormone receptor-positive (HR+), HER2– breast cancer (BC) patients for whom multigene assays may be valuable [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-06.
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Affiliation(s)
- Matti Aapro
- 1Multidisciplinary Oncology Institute, Clinic of Genolier
| | | | | | | | | | | | - Terry Mamounas
- 7University of Florida Health Cancer Center at Orlando Health
| | | | - Miguel Martin
- 9Medical Oncology Service, Hospital General Universitario Gregorio Marañón
| | - Patrick Neven
- 10Multidisciplinary Breast Centre and Gynaecological Oncology, UZ Leuven
| | | | - Dan Rea
- 12School of Cancer Sciences, University of Birmingham
| | - Roman Rouzier
- 13Institut Curie-Université Versailles-Saint-Quentin
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Kimbung S, Johansson I, Danielsson A, Veerla S, Egyhazi S, Bergh J, Einbeigi Z, Linderholm B, Lidbrink E, Loman N, Malmström P, Söderberg M, Walz TM, Fernö M, Hatschek T, Hedenfalk I. Abstract P6-08-03: Transcriptional profiling of breast cancer metastases identifies liver metastasis-selective genes associated with adverse outcome in luminal A primary breast cancer. Cancer Res 2015. [DOI: 10.1158/1538-7445.sabcs14-p6-08-03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: The site of relapse is associated with the prognosis of metastatic breast cancer, but our understanding of the molecular determinants of organ-specificity of metastasis is incomplete. This study aimed to provide additional insight into the biology of breast cancer liver metastases and to identify liver metastasis-selective genes associated with outcome in primary breast cancer.
Methods: A cohort of 304 women with locally advanced and metastatic breast cancer was studied. Estrogen receptor (ER), progesterone receptor (PR), human epidermal growth factor receptor 2 (HER2) and Ki67 expression were quantified in primary tumors (N=217) by immunohistochemistry and in situ hybridization on tissue microarrays, and molecular subtypes were assigned according to the 2013 St Gallen guidelines. In addition, fine-needle aspirates of metastases (N=91) were subjected to whole genome transcriptional profiling.
Results: Liver relapse was significantly associated with ER positivity (P<0.002) and the luminal B-like subtype (P<0.01) and was prognostic of an inferior post-relapse survival (P<0.001). Transcriptional profiling revealed that the major variation in the transcriptional landscape of breast cancer metastases was associated with the expression of hormone receptors and the tumor molecular subtype. However, liver metastases displayed unique transcriptional fingerprints, characterized by down-regulation of extracellular matrix (i.e. stromal) genes involved in adhesion and skeletal development. Importantly, we identified a subset of 17 liver metastasis-selective genes that displayed significantly decreased expression in primary tumors of high histological grade (grade 3) and of the luminal B and basal subtypes (P<0.001). This 17-gene signature was significantly and independently prognostic of shorter relapse-free (P =0.001) and overall (P=0.03) survival among patients with ER positive primary tumors. Remarkably, the 17-gene signature remained an independent predictor of shorter relapse-free survival (P=0.004) among patients with luminal A primary tumors.
Conclusion: These results highlight a possible role of stroma-related genes in breast cancer liver metastasis biology and validate the prognostic relevance of extracellular matrix/stromal genes in hormone receptor positive primary breast cancer, specifically of the luminal A subtype.
Citation Format: Siker Kimbung, Ida Johansson, Anna Danielsson, Srinivas Veerla, Suzanne Egyhazi, Jonas Bergh, Zakaria Einbeigi, Barbro Linderholm, Elisabet Lidbrink, Niklas Loman, Per Malmström, Martin Söderberg, Thomas M Walz, Mårten Fernö, Thomas Hatschek, Ingrid Hedenfalk, the TEX Study Group. Transcriptional profiling of breast cancer metastases identifies liver metastasis-selective genes associated with adverse outcome in luminal A primary breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr P6-08-03.
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Affiliation(s)
| | | | | | | | | | - Jonas Bergh
- 4Karolinska Institutet and Karolinska University Hospital
| | | | - Barbro Linderholm
- 3Sahlgrenska University Hospital
- 4Karolinska Institutet and Karolinska University Hospital
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Aapro M, De Laurentiis M, Linderholm B, Mamounas E, Markopoulos C, Martin M, Neven P, Rea D, Rouzier R, Thomssen C. P105 The MAGIC survey in HR+, HER2− breast cancer (BC): when might multigene assays be of value? Breast 2015. [DOI: 10.1016/s0960-9776(15)70149-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Tobin NP, Harrell JC, Lövrot J, Egyhazi Brage S, Frostvik Stolt M, Carlsson L, Einbeigi Z, Linderholm B, Loman N, Malmberg M, Walz T, Fernö M, Perou CM, Bergh J, Hatschek T, Lindström LS. Molecular subtype and tumor characteristics of breast cancer metastases as assessed by gene expression significantly influence patient post-relapse survival. Ann Oncol 2015; 26:81-88. [PMID: 25361981 PMCID: PMC4269343 DOI: 10.1093/annonc/mdu498] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 09/09/2014] [Accepted: 10/14/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND We and others have recently shown that tumor characteristics are altered throughout tumor progression. These findings emphasize the need for re-examination of tumor characteristics at relapse and have led to recommendations from ESMO and the Swedish Breast Cancer group. Here, we aim to determine whether tumor characteristics and molecular subtypes in breast cancer metastases confer clinically relevant prognostic information for patients. PATIENTS AND METHODS The translational aspect of the Swedish multicenter randomized trial called TEX included 111 patients with at least one biopsy from a morphologically confirmed locoregional or distant breast cancer metastasis diagnosed from December 2002 until June 2007. All patients had detailed clinical information, complete follow-up, and metastasis gene expression information (Affymetrix array GPL10379). We assessed the previously published gene expression modules describing biological processes [proliferation, apoptosis, human epidermal receptor 2 (HER2) and estrogen (ER) signaling, tumor invasion, immune response, and angiogenesis] and pathways (Ras, MAPK, PTEN, AKT-MTOR, PI3KCA, IGF1, Src, Myc, E2F3, and β-catenin) and the intrinsic subtypes (PAM50). Furthermore, by contrasting genes expressed in the metastases in relation to survival, we derived a poor metastasis survival signature. RESULTS A significant reduction in post-relapse breast cancer-specific survival was associated with low-ER receptor signaling and apoptosis gene module scores, and high AKT-MTOR, Ras, and β-catenin module scores. Similarly, intrinsic subtyping of the metastases provided statistically significant post-relapse survival information with the worst survival outcome in the basal-like [hazard ratio (HR) 3.7; 95% confidence interval (CI) 1.3-10.9] and HER2-enriched (HR 4.4; 95% CI 1.5-12.8) subtypes compared with the luminal A subtype. Overall, 25% of the metastases were basal-like, 32% HER2-enriched, 10% luminal A, 28% luminal B, and 5% normal-like. CONCLUSIONS We show that tumor characteristics and molecular subtypes of breast cancer metastases significantly influence post-relapse patient survival, emphasizing that molecular investigations at relapse provide prognostic and clinically relevant information. CLINICALTRIALS.GOV: This is the translational part of the Swedish multicenter and randomized trial TEX, clinicaltrials.gov identifier nct01433614 (http://www.clinicaltrials.gov/ct2/show/nct01433614).
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Affiliation(s)
- N P Tobin
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - J C Harrell
- Department of Genetics and Pathology, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, USA
| | - J Lövrot
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - S Egyhazi Brage
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - M Frostvik Stolt
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - L Carlsson
- Department of Oncology, Sundsvall General Hospital, Sundsvall
| | - Z Einbeigi
- Department of Oncology, Sahlgrenska University Hospital, Gothenburg
| | - B Linderholm
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden; Department of Oncology, Sahlgrenska University Hospital, Gothenburg
| | - N Loman
- Department of Oncology, Skåne University Hospital, Lund
| | - M Malmberg
- Department of Oncology, Skåne University Hospital, Helsingborg
| | - T Walz
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden; Division of Oncology, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping
| | - M Fernö
- Department of Clinical Sciences, Division of Oncology and Pathology, Lund University, Lund, Sweden
| | - C M Perou
- Department of Genetics and Pathology, Lineberger Comprehensive Cancer Center, University of North Carolina-Chapel Hill, Chapel Hill, USA
| | - J Bergh
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - T Hatschek
- Department of Oncology and Pathology, Cancer Center Karolinska, Karolinska Institutet and University Hospital, Stockholm, Sweden
| | - L S Lindström
- Department of Surgery, University of California at San Francisco (UCSF), San Francisco, USA; Department of Biosciences and Nutrition, Karolinska Institutet and University Hospital, Stockholm, Sweden.
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Markopoulos C, Aapro M, Bargallo Rocha J, De Laurentiis M, Elizalde R, Landherr L, Linderholm B, Mamounas T, Martin M, Neven P, Petrovsky A, Rea D, Rouzier R, Smit V, Svedman C, Thomssen C. Elderly patients with early breast cancer (BC) are less likely to receive adjuvant chemotherapy (AdjCT) irrespective of disease risk factors: The multidisciplinary application of genomics in clinical practice (MAGIC) survey. J Geriatr Oncol 2014. [DOI: 10.1016/j.jgo.2014.09.165] [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: 11/29/2022]
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Martin M, Aapro M, Markopoulos C, Mamounas T, Rouzier R, Thomssen C, Rocha JB, Rea D, Neven P, Linderholm B, Smit V, Landherr L, Petrovsky A, Svedman C, De Laurentiis M. Traditional Prognostic Factors Used for Adjuvant Chemotherapy (Ct) Decisions in Early Stage Hr + , Her2– Breast Cancer in a Large International Survey (Magic) Among Breast Cancer Specialists. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.41] [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: 11/15/2022] Open
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De Laurentiis M, Aapro M, Markopoulos C, Mamounas T, Rouzier R, Thomssen C, Rocha JB, Rea D, Neven P, Linderholm B, Smit V, Landherr L, Petrovsky A, Svedman C, Martin M. The Effect of Physician'S Characteristics on Adjuvant Chemotherapy (Ct) Decisions for Early Stage Hr + , Her2– Breast Cancer (Bc) Patients (Pts). Ann Oncol 2014. [DOI: 10.1093/annonc/mdu327.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Johansson I, Killander F, Linderholm B, Hedenfalk I. Molecular profiling of male breast cancer - lost in translation? Int J Biochem Cell Biol 2014; 53:526-35. [PMID: 24842109 DOI: 10.1016/j.biocel.2014.05.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [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: 02/12/2014] [Revised: 05/07/2014] [Accepted: 05/09/2014] [Indexed: 02/06/2023]
Abstract
Breast cancer is the most common cancer form in women and it has been extensively studied on the molecular level. Male breast cancer (MBC), on the other hand, is rare and has not been thoroughly investigated in terms of transcriptional profiles or genomic aberrations. Most of our understanding of MBC has therefore been extrapolated from knowledge of female breast cancer. Although differences in addition to similarities with female breast cancer have been reported, the same prognostic and predictive markers are used to determine optimal management strategies for both men and women diagnosed with breast cancer. This review is focused on prognosis for MBC patients, prognostic and predictive factors and molecular subgrouping; comparisons are made with female breast cancer. Information was collected from relevant literature on both male and female breast cancer from the MEDLINE database between 1992 and 2014. MBC is a heterogeneous disease, and on the molecular level many differences compared to female breast cancer have recently been revealed. Two distinct subgroups of MBC, luminal M1 and luminal M2, have been identified which differ from the well-established intrinsic subtypes of breast cancer in women. These novel subgroups of breast cancer therefore appear unique to MBC. Furthermore, several studies report inferior survival for men diagnosed with breast cancer compared to women. New promising prognostic biomarkers for MBC (e.g. NAT1) deserving further attention are reviewed. Further prospective studies aimed at validating the novel subgroups and recently proposed biomarkers for MBC are warranted to provide the basis for optimal patient management in this era of personalized medicine. This article is part of a Directed Issue entitled: Rare Cancers.
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Affiliation(s)
- Ida Johansson
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University Cancer Center, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden
| | - Fredrika Killander
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University Cancer Center, Lund, Sweden; Department of Oncology, Skåne University Hospital, Lund, Sweden
| | - Barbro Linderholm
- Department of Oncology, Sahlgrenska Academy and University Hospital, Gothenburg, Sweden; Cancer Center Karolinska, Karolinska Institutet, Stockholm, Sweden
| | - Ingrid Hedenfalk
- Division of Oncology and Pathology, Department of Clinical Sciences, Lund University Cancer Center, Lund, Sweden; CREATE Health Strategic Center for Translational Cancer Research, Lund University, Lund, Sweden.
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Bjöhle J, Bergqvist J, Gronowitz JS, Johansson H, Carlsson L, Einbeigi Z, Linderholm B, Loman N, Malmberg M, Söderberg M, Sundquist M, Walz TM, Fernö M, Bergh J, Hatschek T. Serum thymidine kinase activity compared with CA 15-3 in locally advanced and metastatic breast cancer within a randomized trial. Breast Cancer Res Treat 2013; 139:751-8. [PMID: 23736998 DOI: 10.1007/s10549-013-2579-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 05/22/2013] [Indexed: 11/29/2022]
Abstract
The primary objective was to estimate serum thymidine kinase 1 (TK1) activity, reflecting total body cell proliferation rate including cancer cell proliferation, in women with loco regional inoperable or metastatic breast cancer participating in a prospective and randomized study. Secondary objectives were to analyze TK1 in relation to progression-free survival (PFS), overall survival (OS), therapy response and other tumour characteristics, including CA 15-3, widely used as a standard serum marker for disease progression. TK1 and CA 15-3 were analysed in 198 serum samples collected prospectively from women included in the randomized TEX trial between December 2002 and June 2007. TK1 activity was determined by the ELISA based DiviTum™ assay, and CA 15-3 analyses was generated with the electrochemiluminescence immunoassay Cobas Elecsys CA 15-3 II. High pre-treatment TK1 activity predicted shorter PFS (10 vs. 15 months p = 0.02) and OS (21 vs. 38 months, p < 0.0001), respectively. After adjustment for age, metastatic site and study treatment TK1 showed a trend as predictor of PFS (p = 0.059) and was an independent prognostic factor for OS, (HR 1.81, 95 % confidence interval (CI) 1.26-2.61, p = 0.001). There was a trend of shortened OS for women with high CA 15-3 (p = 0.054) in univariate analysis, but not after adjustment for the above mentioned covariates. Both TK1 (p = 0.0011) and CA 15-3 (p = 0.0004) predicted response to treatment. There were statistically different distributions of TK1 and CA 15-3 in relation to the site of metastases. TK1 activity measured by DiviTum™ predicted therapy response, PFS and OS in loco regional inoperable or disseminated breast cancer. These results suggest that this factor is a useful serum marker. In the present material, a prognostic value of CA 15-3 could not be proven.
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Affiliation(s)
- J Bjöhle
- Department of Oncology, Karolinska Institutet and University Hospital, Radiumhemmet, 171 76 Stockholm, Sweden.
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Kimbung S, Johansson I, Kovács A, Lövgren K, Bergh J, Carlsson L, Einbeigi Z, Frostvik-Stolt M, Linderholm B, Lindh B, Loman N, Malmberg M, Sundquist M, Söderberg M, Walz T, Hatschek T, Fernö M, Hedenfalk I. Abstract 3386: Molecular profiling of breast cancer organ-specific metastases. Cancer Res 2012. [DOI: 10.1158/1538-7445.am2012-3386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Breast cancer molecular subtypes preferentially metastasize to specific organs, but the underlying molecular mechanisms are not well understood. While several studies have attempted to delineate these mechanisms by making predictions from primary tumours, the likelihood of missing further relevant biological differences which may be enriched or distinctively present in the metastases cannot be overlooked. In addition, survival after relapse is influenced by the anatomical location of the metastasis, with visceral involvement associated with the poorest survival, suggesting that differences in biology and response to treatment may exist. However, the scarcity of clinical material from metastatic lesions has largely prevented detailed molecular characterization of breast cancer site-specific metastases. Material and Methods: We performed global gene expression profiling on 122 fine needle aspirates of metastatic lesions from different anatomical sites obtained from breast cancer patients treated within the Swedish randomized trial (TEX) of chemotherapy for metastatic breast cancer. Sub-classification was performed using unsupervised hierarchical clustering, while differentially expressed genes and modulated pathways in metastases from different sites and sub-classes were identified using Significance Analysis of Microarrays (SAM) analysis. Breast cancer survival after relapse was also compared between patients. Results: We confirmed the observation that breast cancer metastasis to visceral organs is associated with the poorest outcome. Molecularly, samples were sub-classified into groups with strong correlations with the previously described breast cancer intrinsic subtypes and also striking overlap with pathological characteristics of the primary tumour. Metastasis pairs from the same individual were more similar to each other than to independent metastatic lesions from other patients. More interestingly, liver metastases formed a unique sub-cluster which could be distinguished from the other sites by the expression of several genes (and pathways) involved in focal adhesion, matrix remodelling, and wnt signalling. Conclusions: Our data suggest that breast cancer molecular subtypes and primary tumour characteristics are to a large extent maintained in recurrences and further that liver metastases may be notably different and represent a distinct entity with a separate underlying biology which may hence require specific targeted therapeutic management.
Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 103rd Annual Meeting of the American Association for Cancer Research; 2012 Mar 31-Apr 4; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2012;72(8 Suppl):Abstract nr 3386. doi:1538-7445.AM2012-3386
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Affiliation(s)
| | | | | | | | - Jonas Bergh
- 3Department of Oncology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | - Marianne Frostvik-Stolt
- 3Department of Oncology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | - Barbro Linderholm
- 3Department of Oncology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
| | | | | | | | | | | | - Thomas Walz
- 9Linköping University Hospital, Linköping, Sweden
| | - Thomas Hatschek
- 3Department of Oncology, Karolinska University Hospital and Karolinska Institutet, Stockholm, Sweden
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