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Powles T, Burotto M, Escudier B, Apolo AB, Bourlon MT, Shah AY, Suárez C, Porta C, Barrios CH, Richardet M, Gurney H, Kessler ER, Tomita Y, Bedke J, George S, Scheffold C, Wang P, Fedorov V, Motzer RJ, Choueiri TK. Nivolumab plus cabozantinib versus sunitinib for first-line treatment of advanced renal cell carcinoma: extended follow-up from the phase III randomised CheckMate 9ER trial. ESMO Open 2024; 9:102994. [PMID: 38642472 PMCID: PMC11046044 DOI: 10.1016/j.esmoop.2024.102994] [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: 10/04/2023] [Revised: 02/07/2024] [Accepted: 03/11/2024] [Indexed: 04/22/2024] Open
Abstract
BACKGROUND Nivolumab plus cabozantinib (NIVO + CABO) was approved for first-line treatment of advanced renal cell carcinoma (aRCC) based on superiority versus sunitinib (SUN) in the phase III CheckMate 9ER trial (18.1 months median survival follow-up per database lock date); efficacy benefit was maintained with an extended 32.9 months of median survival follow-up. We report updated efficacy and safety after 44.0 months of median survival follow-up in intent-to-treat (ITT) patients and additional subgroup analyses, including outcomes by International Metastatic Renal Cell Carcinoma Database Consortium (IMDC) prognostic risk score. PATIENTS AND METHODS Patients with treatment-naïve aRCC received NIVO 240 mg every 2 weeks plus CABO 40 mg once daily or SUN 50 mg for 4 weeks (6-week cycles), until disease progression/unacceptable toxicity (maximum NIVO treatment, 2 years). Primary endpoint was progression-free survival (PFS) per blinded independent central review (BICR). Secondary endpoints were overall survival (OS), objective response rate (ORR) per BICR, and safety and tolerability. RESULTS Overall, 323 patients were randomised to NIVO + CABO and 328 to SUN. Median PFS was improved with NIVO + CABO versus SUN [16.6 versus 8.4 months; hazard ratio (HR) 0.59; 95% confidence interval (CI) 0.49-0.71]; median OS favoured NIVO + CABO versus SUN (49.5 versus 35.5 months; HR 0.70; 95% CI 0.56-0.87). ORR (95% CI) was higher with NIVO + CABO versus SUN [56% (50% to 62%) versus 28% (23% to 33%)]; 13% versus 5% of patients achieved complete response, and median duration of response was 22.1 months versus 16.1 months, respectively. PFS and OS favoured NIVO + CABO over SUN across intermediate, poor and intermediate/poor IMDC risk subgroups; higher ORR and complete response rates were seen with NIVO + CABO versus SUN regardless of IMDC risk subgroup. Any-grade (grade ≥3) treatment-related adverse events occurred in 97% (67%) versus 93% (55%) of patients treated with NIVO + CABO versus SUN. CONCLUSIONS After extended follow-up, NIVO + CABO maintained survival and response benefits; safety remained consistent with previous follow-ups. These results continue to support NIVO + CABO as a first-line treatment for aRCC. TRIAL REGISTRATION ClinicalTrials.gov, NCT03141177.
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Affiliation(s)
- T Powles
- Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, London; Royal Free National Health Service Trust, London, UK.
| | - M Burotto
- Bradford Hill Clinical Research Center, Santiago, Chile
| | | | - A B Apolo
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, USA
| | - M T Bourlon
- Urologic Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - A Y Shah
- MD Anderson Cancer Center, Houston, USA
| | - C Suárez
- Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - C Porta
- Department of Internal Medicine, University of Pavia, Pavia, Italy
| | - C H Barrios
- Centro de Pesquisa em Oncologia, Hospital São Lucas, PUCRS, Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - M Richardet
- Fundación Richardet Longo, Instituto Oncológico de Córdoba, Córdoba, Argentina
| | - H Gurney
- Westmead Hospital and Macquarie University, Westmead and Sydney, Australia
| | - E R Kessler
- Division of Medical Oncology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, USA
| | - Y Tomita
- Departments of Urology and Molecular Oncology, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - J Bedke
- Department of Urology, Eberhard Karls University Tübingen, Tübingen, Germany
| | - S George
- Roswell Park Comprehensive Cancer Center, Buffalo
| | | | - P Wang
- Bristol Myers Squibb, Princeton
| | | | - R J Motzer
- Memorial Sloan Kettering Cancer Center, New York
| | - T K Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Boston; Brigham and Women's Hospital, Harvard Medical School, Boston, USA
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Coles CE, Earl H, Anderson BO, Barrios CH, Bienz M, Bliss JM, Cameron DA, Cardoso F, Cui W, Francis PA, Jagsi R, Knaul FM, McIntosh SA, Phillips KA, Radbruch L, Thompson MK, André F, Abraham JE, Bhattacharya IS, Franzoi MA, Drewett L, Fulton A, Kazmi F, Inbah Rajah D, Mutebi M, Ng D, Ng S, Olopade OI, Rosa WE, Rubasingham J, Spence D, Stobart H, Vargas Enciso V, Vaz-Luis I, Villarreal-Garza C. The Lancet Breast Cancer Commission. Lancet 2024:S0140-6736(24)00747-5. [PMID: 38636533 DOI: 10.1016/s0140-6736(24)00747-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Revised: 12/18/2023] [Accepted: 04/09/2024] [Indexed: 04/20/2024]
Affiliation(s)
| | - Helena Earl
- Department of Oncology, University of Cambridge, Cambridge, UK
| | - Benjamin O Anderson
- Global Breast Cancer Initiative, World Health Organisation and Departments of Surgery and Global Health Medicine, University of Washington, Seattle, WA, USA
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Porto Alegre, Brazil
| | - Maya Bienz
- Mount Vernon Cancer Centre, East and North Hertfordshire NHS Trust, London, UK; Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | | | - David A Cameron
- Institute of Genetics and Cancer and Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Fatima Cardoso
- Breast Unit, Champalimaud Clinical Center/Champalimaud Foundation, Lisbon, Portugal
| | - Wanda Cui
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Prudence A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Reshma Jagsi
- Emory University School of Medicine, Atlanta, GA, USA
| | - Felicia Marie Knaul
- Institute for Advanced Study of the Americas, University of Miami, Miami, FL, USA; Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, USA; Tómatelo a Pecho, Mexico City, Mexico
| | - Stuart A McIntosh
- School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, UK
| | - Kelly-Anne Phillips
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, VIC, Australia; Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, VIC, Australia
| | - Lukas Radbruch
- Department of Palliative Medicine, University Hospital Bonn, Bonn, Germany
| | | | | | - Jean E Abraham
- Department of Oncology, University of Cambridge, Cambridge, UK
| | | | | | - Lynsey Drewett
- Royal Devon University Healthcare NHS Foundation Trust, Exeter, UK
| | | | - Farasat Kazmi
- Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - Dianna Ng
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Szeyi Ng
- The Institute of Cancer Research, London, UK
| | | | - William E Rosa
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | | | | | | | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, Monterrey, Mexico
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3
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Schmid P, Turner NC, Barrios CH, Isakoff SJ, Kim SB, Sablin MP, Saji S, Savas P, Vidal GA, Oliveira M, O'Shaughnessy J, Italiano A, Espinosa E, Boni V, White S, Rojas B, Freitas-Junior R, Chae Y, Bondarenko I, Lee J, Torres Mattos C, Martinez Rodriguez JL, Lam LH, Jones S, Reilly SJ, Huang X, Shah K, Dent R. First-Line Ipatasertib, Atezolizumab, and Taxane Triplet for Metastatic Triple-Negative Breast Cancer: Clinical and Biomarker Results. Clin Cancer Res 2024; 30:767-778. [PMID: 38060199 PMCID: PMC10870115 DOI: 10.1158/1078-0432.ccr-23-2084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Revised: 10/18/2023] [Accepted: 12/05/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE To evaluate a triplet regimen combining immune checkpoint blockade, AKT pathway inhibition, and (nab-) paclitaxel as first-line therapy for locally advanced/metastatic triple-negative breast cancer (mTNBC). PATIENTS AND METHODS The single-arm CO40151 phase Ib study (NCT03800836), the single-arm signal-seeking cohort of IPATunity130 (NCT03337724), and the randomized phase III IPATunity170 trial (NCT04177108) enrolled patients with previously untreated mTNBC. Triplet therapy comprised intravenous atezolizumab 840 mg (days 1 and 15), oral ipatasertib 400 mg/day (days 1-21), and intravenous paclitaxel 80 mg/m2 (or nab-paclitaxel 100 mg/m2; days 1, 8, and 15) every 28 days. Exploratory translational research aimed to elucidate mechanisms and molecular markers of sensitivity and resistance. RESULTS Among 317 patients treated with the triplet, efficacy ranged across studies as follows: median progression-free survival (PFS) 5.4 to 7.4 months, objective response rate 44% to 63%, median duration of response 5.6 to 11.1 months, and median overall survival 15.7 to 28.3 months. The safety profile was consistent with the known toxicities of each agent. Grade ≥3 adverse events were more frequent with the triplet than with doublets or single-agent paclitaxel. Patients with PFS >10 months were characterized by NF1, CCND3, and PIK3CA alterations and increased immune pathway activity. PFS <5 months was associated with CDKN2A/CDKN2B/MTAP alterations and lower predicted phosphorylated AKT-S473 levels. CONCLUSIONS In patients with mTNBC receiving an ipatasertib/atezolizumab/taxane triplet regimen, molecular characteristics may identify those with particularly favorable or unfavorable outcomes, potentially guiding future research efforts.
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Affiliation(s)
- Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Nicholas C. Turner
- The Royal Marsden NHS Foundation Trust, London, United Kingdom
- Breast Cancer Now Research Centre, London, United Kingdom
| | - Carlos H. Barrios
- Centro de Pesquisa em Oncologia, Hospital São Lucas, PUCRS, Latin American Cooperative Oncology Group (LACOG), Brazil
| | | | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Marie-Paule Sablin
- Department of Drug Development and Innovation (D3i), Institut Curie, Paris, France
| | - Shigehira Saji
- Department of Medical Oncology, Fukushima Medical University, Fukushima, Japan
| | - Peter Savas
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, The University of Melbourne, Melbourne, Australia
| | - Gregory A. Vidal
- West Cancer Center and Research Institute, Germantown, Tennessee
| | - Mafalda Oliveira
- Medical Oncology Department, Vall d'Hebron University Hospital and Breast Cancer Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - Joyce O'Shaughnessy
- Baylor University Medical Center, Texas Oncology, US Oncology, Dallas, Texas
| | | | | | - Valentina Boni
- Oncology Service, Hospital Universitario La Paz, Madrid – Centro de Investigación Biomédica en Red de Cáncer (CIBERONC), Madrid, Spain
| | | | - Beatriz Rojas
- Oncology Service, Centro Integral Oncologico Clara Campal, Madrid, Spain
| | - Ruffo Freitas-Junior
- Gynaecology and Breast Department, Hospital Araujo Jorge, Goias Anticancer Association, Goiânia, Brazil
| | - Yeesoo Chae
- Kyungpook National University Chilgok Hospital, Daegu, Republic of Korea
| | | | - Jieun Lee
- Seoul St Mary's Hospital, The Catholic University of Korea, Seoul, Republic of Korea
| | - Cesar Torres Mattos
- Clínica San Gabriel, Unidad de Investigación Oncológica de la Clínica San Gabriel, Lima, Perú
| | | | - Lisa H. Lam
- Product Development Oncology, Genentech, Inc., South San Francisco, California
| | - Surai Jones
- Data Sciences, Safety and Medical (DSSM), IQVIA Inc., Durham, North Carolina
| | | | - Xiayu Huang
- gRED Computational Science, Roche (China) Holding Ltd, Pudong, Shanghai, China
| | - Kalpit Shah
- Oncology Biomarker Development, Genentech, Inc., South San Francisco, California
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Loibl S, André F, Bachelot T, Barrios CH, Bergh J, Burstein HJ, Cardoso MJ, Carey LA, Dawood S, Del Mastro L, Denkert C, Fallenberg EM, Francis PA, Gamal-Eldin H, Gelmon K, Geyer CE, Gnant M, Guarneri V, Gupta S, Kim SB, Krug D, Martin M, Meattini I, Morrow M, Janni W, Paluch-Shimon S, Partridge A, Poortmans P, Pusztai L, Regan MM, Sparano J, Spanic T, Swain S, Tjulandin S, Toi M, Trapani D, Tutt A, Xu B, Curigliano G, Harbeck N. Early breast cancer: ESMO Clinical Practice Guideline for diagnosis, treatment and follow-up. Ann Oncol 2024; 35:159-182. [PMID: 38101773 DOI: 10.1016/j.annonc.2023.11.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/21/2023] [Accepted: 11/28/2023] [Indexed: 12/17/2023] Open
Affiliation(s)
- S Loibl
- GBG Forschungs GmbH, Neu-Isenburg; Centre for Haematology and Oncology, Bethanien, Frankfurt, Germany
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy, Cancer Campus, Villejuif
| | - T Bachelot
- Department of Medical Oncology, Centre Léon Bérard, Lyon, France
| | - C H Barrios
- Oncology Department, Latin American Cooperative Oncology Group and Oncoclínicas, Porto Alegre, Brazil
| | - J Bergh
- Department of Oncology-Pathology, Bioclinicum, Karolinska Institutet and Breast Cancer Centre, Karolinska Comprehensive Cancer Centre and University Hospital, Stockholm, Sweden
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - M J Cardoso
- Breast Unit, Champalimaud Foundation, Champalimaud Cancer Centre, Lisbon; Faculty of Medicine, Lisbon University, Lisbon, Portugal
| | - L A Carey
- Division of Medical Oncology, The University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - S Dawood
- Department of Oncology, Mediclinic City Hospital, Dubai, UAE
| | - L Del Mastro
- Medical Oncology Clinic, IRCCS Ospedale Policlinico San Martino, Genoa; Department of Internal Medicine and Medical Specialities, School of Medicine, University of Genoa, Genoa, Italy
| | - C Denkert
- Institute of Pathology, Philipps-University Marburg and University Hospital Giessen and Marburg, Marburg
| | - E M Fallenberg
- Department of Diagnostic and Interventional Radiology, School of Medicine & Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - P A Francis
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H Gamal-Eldin
- Department of Surgical Oncology, National Cancer Institute, Cairo University, Cairo, Egypt
| | - K Gelmon
- Department of Medical Oncology, British Columbia Cancer, Vancouver, Canada
| | - C E Geyer
- Department of Internal Medicine, Hillman Cancer Center, University of Pittsburgh, Pittsburgh, USA
| | - M Gnant
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - V Guarneri
- Department of Surgery, Oncology and Gastroenterology, University of Padova, Padova; Oncology 2 Unit, Istituto Oncologico Veneto IOV IRCCS, Padova, Italy
| | - S Gupta
- Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - S B Kim
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein, Kiel, Germany
| | - M Martin
- Hospital General Universitario Gregorio Maranon, Universidad Complutense, GEICAM, Madrid, Spain
| | - I Meattini
- Department of Radiation Oncology, Azienda Ospedaliero-Universitaria Careggi, Florence; Department of Experimental and Clinical Biomedical Sciences 'M. Serio', University of Florence, Florence, Italy
| | - M Morrow
- Breast Service, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, USA
| | - W Janni
- Department of Obstetrics and Gynaecology, University of Ulm, Ulm, Germany
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - A Partridge
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - P Poortmans
- Department of Radiation Oncology, Iridium Netwerk, Antwerp; Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - L Pusztai
- Yale Cancer Center, Yale School of Medicine, New Haven
| | - M M Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston
| | - J Sparano
- Department of Medicine, Division of Hematology/Oncology, Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, USA
| | - T Spanic
- Europa Donna Slovenia, Ljubljana, Slovenia
| | - S Swain
- Medicine Department, Georgetown University Medical Centre and MedStar Health, Washington, USA
| | - S Tjulandin
- N.N. Blokhin National Medical Research Centre of Oncology, Moscow, Russia
| | - M Toi
- Tokyo Metropolitan Cancer and Infectious Disease Center, Komagome Hospital, Bunkyo-ku, Japan
| | - D Trapani
- Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - A Tutt
- Breast Cancer Research Division, The Institute of Cancer Research, London; Comprehensive Cancer Centre, Division of Cancer Studies, Kings College London, London, UK
| | - B Xu
- Department of Medical Oncology, National Cancer Centre/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS, Milan; Department of Oncology and Hemato-Oncology, University of Milano, Milan, Italy
| | - N Harbeck
- Breast Centre, Department of Obstetrics & Gynaecology and Comprehensive Cancer Centre Munich, LMU University Hospital, Munich, Germany
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Al Sukhun S, Temin S, Barrios CH, Antone NZ, Guerra YC, Mac Gregor MC, Chopra R, Danso MA, Gomez HL, Homian NM, Kandil A, Kithaka B, Koczwara B, Moy B, Nakigudde G, Petracci FE, Rugo HS, El Saghir NS, Arun BK. Systemic Treatment of Patients With Metastatic Breast Cancer: ASCO Resource-Stratified Guideline. JCO Glob Oncol 2024; 10:e2300285. [PMID: 38206277 DOI: 10.1200/go.23.00285] [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: 08/15/2023] [Accepted: 11/22/2023] [Indexed: 01/12/2024] Open
Abstract
PURPOSE To guide clinicians and policymakers in three global resource-constrained settings on treating patients with metastatic breast cancer (MBC) when Maximal setting-guideline recommended treatment is unavailable. METHODS A multidisciplinary, multinational panel reviewed existing ASCO guidelines and conducted modified ADAPTE and formal consensus processes. RESULTS Four published resource-agnostic guidelines were adapted for resource-constrained settings; informing two rounds of formal consensus; recommendations received ≥75% agreement. RECOMMENDATIONS Clinicians should recommend treatment according to menopausal status, pathological and biomarker features when quality results are available. In first-line, for hormone receptor (HR)-positive MBC, when a non-steroidal aromatase inhibitor and CDK 4/6 inhibitor combination is unavailable, use hormonal therapy alone. For life-threatening disease, use single-agent chemotherapy or surgery for local control. For premenopausal patients, use ovarian suppression or ablation plus hormone therapy in Basic settings. For human epidermal growth factor receptor 2 (HER2)-positive MBC, if trastuzumab, pertuzumab, and chemotherapy are unavailable, use trastuzumab and chemotherapy; if unavailable, use chemotherapy. For HER2-positive, HR-positive MBC, use standard first-line therapy, or endocrine therapy if contraindications. For triple-negative MBC with unknown PD-L1 status, or if PD-L1-positive and immunotherapy unavailable, use single-agent chemotherapy. For germline BRCA1/2 mutation-positive MBC, if poly(ADP-ribose) polymerase inhibitor is unavailable, use hormonal therapy (HR-positive MBC) and chemotherapy (HR-negative MBC). In second-line, for HR-positive MBC, Enhanced setting recommendations depend on prior treatment; for Limited, use tamoxifen or chemotherapy. For HER2-positive MBC, if trastuzumab deruxtecan is unavailable, use trastuzumab emtansine; if unavailable, capecitabine and lapatinib; if unavailable, trastuzumab and/or chemotherapy (hormonal therapy alone for HR-positive MBC).Additional information is available at www.asco.org/resource-stratified-guidelines. It is ASCO's view that healthcare providers and system decision-makers should be guided by the recommendations for the highest stratum of resources available. The guideline is intended to complement but not replace local guidelines.
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Affiliation(s)
| | - Sarah Temin
- American Society of Clinical Oncology, Alexandria, VA
| | | | | | - Yanin Chavarri Guerra
- Departamento de Hemato-Oncología, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Alaa Kandil
- Alexandria Comprehensive Cancer Center, Alexandria, Egypt
| | | | | | | | | | | | - Hope S Rugo
- University of California San Francisco, San Francisco, CA
| | | | - Banu K Arun
- University of Texas MD Anderson Cancer Center, Houston, TX
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Resende H, Rebelatto TF, Werutsky G, Gossling G, Aguiar VQ, Lopes GMC, de Assis BR, Arruda L, Barrios CH. Current scenario and future perspectives of clinical research in Brazil: a national survey. Ecancermedicalscience 2023; 17:1640. [PMID: 38414936 PMCID: PMC10898894 DOI: 10.3332/ecancer.2023.1640] [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: 08/31/2023] [Indexed: 02/29/2024] Open
Abstract
Background Epidemiological and clinical cancer research is essential to understanding tumour behaviour and developing new therapies in oncology. However, several countries including Brazil as well as many other regions of the world have limited participation in cancer research. Despite 625,000 new cancer cases recorded in Brazil in 2022, only 2.2% of ongoing cancer clinical trials are available in the country. We conducted an online survey to describe physician engagement with research and to identify the main barriers precluding participation in and conduct of clinical cancer research in the country. Methods An anonymous online survey of 23 objective questions was sent by e-mail to Brazilian members of the Latin American Cooperative Oncology Group and the Brazilian Society of Clinical Oncology. The first 13 questions addressed demographic information, medical training and previous research participation. In the second part, the main barriers to engagement and participation in clinical trials in Brazil were addressed. Continuous variables were measured by median and range. Analyses were performed using SAS statistical software (version 9.4; SAS Institute, Inc. Cary, NC). Results 109 physicians answered the survey. Most participants were oncologists (N = 98, 89.9%), living in capital cities (N = 84, 77.1%), were from the Southeast region of Brazil (N = 63, 57.8%) and worked at institutions providing exclusively private healthcare (N = 59, 54.1%). Of the 109 respondents, 83 (76.1%) reported working in research centres (as investigators or sub-investigators). Surprisingly, 31.2% of physicians recognised they invite less than 1% of their patients to participate in clinical trials, even though 98 (89.9%) considered the participation of patients in clinical trials extremely relevant. The main barriers compromising the conduct of research in the country were the low number of available trials (48.2%) and the lack of qualified human resources to staff research sites (22.9%). Other reported barriers were the lengthy regulatory approval process (42.2%), followed by a lack of awareness of clinical research by patients resulting in low recruitment rates (24.1%). Of the 26 (23.8%) respondents not working with research, 25 (96.1%) reported interest in being involved, 31.8% have tried participating in research and 62.4% reported limited knowledge of trial procedures. Conclusion These results suggest a clear need to further engage physicians in clinical research activities in Brazil. Patient education strategies should improve the low recruitment rates and secondarily increase the number of proposed trials in the country.
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Affiliation(s)
- Heloisa Resende
- Associação Instituto Projeto Cura, São Paulo 05507-020, Brazil
- https://orcid.org/0000-0003-4692-3743
| | - Taiane F Rebelatto
- Latin American Cooperative Oncology Group, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0001-7306-5428
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0001-6271-105X
| | - Gustavo Gossling
- Latin American Cooperative Oncology Group, Porto Alegre 90619-900, Brazil
- https://orcid.org/0000-0002-4361-2889
| | - Vinícius Q Aguiar
- Centro Universitário de Volta Redonda, UniFOA, Volta Redonda 27240-560, Brazil
- https://orcid.org/0000-0002-6257-0119
| | - Guilherme M C Lopes
- Centro Universitário de Volta Redonda, UniFOA, Volta Redonda 27240-560, Brazil
- https://orcid.org/0000-0002-5654-3579
| | - Biazi R de Assis
- Hospital Hinja, Volta Redonda 27251-260, Brazil
- https://orcid.org/0000-0002-2727-5472
| | - Lilian Arruda
- Hospital São Camilo, São Paulo 17580-000, Brazil
- https://orcid.org/0000-0002-7101-4325
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group, Porto Alegre 90619-900, Brazil
- Grupo Oncoclínicas, São Paulo 04543-906, Brazil
- https://orcid.org/0000-0001-6021-667X
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7
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Moriguchi-Jeckel CM, Madke RR, Radaelli G, Viana A, Nabinger P, Fernandes B, Gössling G, Berdichevski EH, Vilas E, Giacomazzi J, Rocha MS, Borges JA, Hoffmann E, Greggio S, Venturin GT, Barrios CH, Zaffaroni F, Werutsky G, da Costa JC. Clinical validation and diagnostic accuracy of 99mTc-EDDA/HYNIC-TOC compared to 111In-DTPA-octreotide in patients with neuroendocrine tumours: the LACOG 0214 study. Ecancermedicalscience 2023; 17:1582. [PMID: 37533941 PMCID: PMC10393301 DOI: 10.3332/ecancer.2023.1582] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Indexed: 08/04/2023] Open
Abstract
99mTc-EDDA/HYNIC-TOC is an easily available and cheaper radionuclide that could be used for somatostatin-receptor-based imaging of neuroendocrine tumours (NETs). We aimed to evaluate the diagnostic performance of 99mTc-EDDA/HYNIC-TOC compared to111In-DTPA-octreotide in patients (pts) with NETs. We performed a prospective diagnostic study including pts with biopsy-confirmed NET and at least one visible lesion at conventional imaging. Two independent nuclear medicine physicians evaluated pts who underwent 99mTc and 111In scans and images. The primary outcome was comparative diagnostic accuracy of 99mTc and 111In. Secondary outcomes include safety. Nine pts were included and performed 14 paired scans. Overall, 126 lesions were identified. 99mTc demonstrated superior sensitivity both when all images were analysed (93.7, 95% CI 88.1% - 96.8% versus 74.8%, 95% CI 66.6 - 81.6%, p < 0.001) and when liver-specific images were analysed (97.8%, 95% CI 92.7% - 99.5% versus 85.1%, 95% CI 76.6% - 91.0%, p < 0.001). 99mTc was also associated with a lower negative likelihood ratio (LR) (0.002, 95% CI 0.009 - 0.1 versus 0.19, 95% CI 0.12 - 0.42, p = 0.009) when evaluating hepatic lesions. Adverse events happened in 3 pts after 111In and in 2 pts after 99mTc, all grade 1. The 99mTc demonstrated a higher sensitivity overall and a better negative LR in liver-specific images compared to 111In in pts with NETs. Our findings suggest that 99mTc is an alternative to 111In and is especially useful in ruling out liver metastases. NCT02691078.
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Affiliation(s)
- Cristina M Moriguchi-Jeckel
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
- Escola de Ciências da Saúde e da Vida (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | | | - Graciane Radaelli
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Alice Viana
- Grupo RPH, Av Ipiranga, Porto Alegre 90619-900, Brazil
| | | | | | - Gustavo Gössling
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | | | - Eduardo Vilas
- Hospital São Lucas da PUCRS, Av Ipiranga, Porto Alegre 90610-001, Brazil
| | - Juliana Giacomazzi
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Matheus Soares Rocha
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | | | - Elias Hoffmann
- P3DMED, Rua Gomes Jardim, 201 Sala 1109A, Porto Alegre 90620-130, Brazil
- Núcleo de Imagens Médicas (Nimed), P96A do Tecnopuc – PUCRS, Porto Alegre, Brazil
| | - Samuel Greggio
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
- Escola de Ciências da Saúde e da Vida (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Gianina T Venturin
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Facundo Zaffaroni
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Av Ipiranga, Porto Alegre 90619-900, Brazil
| | - Jaderson C da Costa
- Instituto do Cérebro do Rio Grande do Sul – Brain Institute (BraIns), Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Av Ipiranga, Porto Alegre 90619-900, Brazil
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8
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Slamon DJ, Fasching PA, Hurvitz S, Chia S, Crown J, Martín M, Barrios CH, Bardia A, Im SA, Yardley DA, Untch M, Huang CS, Stroyakovskiy D, Xu B, Moroose RL, Loi S, Visco F, Bee-Munteanu V, Afenjar K, Fresco R, Taran T, Chakravartty A, Zarate JP, Lteif A, Hortobagyi GN. Rationale and trial design of NATALEE: a Phase III trial of adjuvant ribociclib + endocrine therapy versus endocrine therapy alone in patients with HR+/HER2- early breast cancer. Ther Adv Med Oncol 2023; 15:17588359231178125. [PMID: 37275963 PMCID: PMC10233570 DOI: 10.1177/17588359231178125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/09/2023] [Indexed: 06/07/2023] Open
Abstract
Background Ribociclib has demonstrated a statistically significant overall survival benefit in pre- and postmenopausal patients with hormone receptor positive/human epidermal growth factor receptor 2 negative (HR+/HER2-) advanced breast cancer. New Adjuvant Trial with Ribociclib [LEE011] (NATALEE) is a trial evaluating the efficacy and safety of adjuvant ribociclib plus endocrine therapy (ET) versus ET alone in patients with HR+/HER2- early nonmetastatic breast cancer (EBC). Methods/design NATALEE is a multicenter, randomized, open-label, Phase III trial in patients with HR+/HER2- EBC. Eligible patients include women, regardless of menopausal status, and men aged ⩾18 years. Select patients with stage IIA, stage IIB, or stage III disease (per the anatomic classification in the AJCC Cancer Staging Manual, 8th edition) with an initial diagnosis ⩽18 months prior to randomization are eligible. Patients receiving standard (neo)adjuvant ET are eligible if treatment was initiated ⩽12 months before randomization. Patients undergo 1:1 randomization to ribociclib 400 mg/day (3 weeks on/1 week off) +ET (letrozole 2.5 mg/day or anastrozole 1 mg/day [investigator's discretion] plus goserelin [men or premenopausal women]) or ET alone. Ribociclib treatment duration is 36 months; ET treatment duration is ⩾60 months. The primary end point is invasive disease-free survival. Discussion The 36-month treatment duration of ribociclib in NATALEE is extended compared with that in other adjuvant cyclin-dependent kinases 4 and 6 (CDK4/6) inhibitor trials and is intended to maximize efficacy due to longer duration of CDK4/6 inhibition. Compared with the 600-mg/day dose used in advanced breast cancer, the reduced ribociclib dose used in NATALEE may improve tolerability while maintaining efficacy. NATALEE includes the broadest population of patients with HR+/HER2- EBC of any Phase III trial currently evaluating adjuvant CDK4/6 inhibitor treatment. Trial registration ClinicalTrials.gov identifier: NCT03701334 (https://clinicaltrials.gov/ct2/show/NCT03701334).
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Affiliation(s)
- Dennis J. Slamon
- David Geffen School of Medicine at UCLA, 10945
Le Conte Ave. Suite 3360, Los Angeles, CA 90095, USA
| | - Peter A. Fasching
- University Hospital Erlangen Comprehensive
Cancer Center Erlangen-EMN, Friedrich-Alexander University
Erlangen-Nuremberg, Erlangen, Germany
| | - Sara Hurvitz
- University of California, Los Angeles Jonsson
Comprehensive Cancer Center, Los Angeles, CA, USA
| | - Stephen Chia
- British Columbia Cancer Agency, Vancouver, BC,
Canada
| | | | - Miguel Martín
- Instituto de Investigación Sanitaria Gregorio
Marañon, Centro de Investigación Biomédica en Red de Cáncer, Grupo Español
de Investigación en Cáncer de Mama, Universidad Complutense, Madrid,
Spain
| | - Carlos H. Barrios
- Centro de Pesquisa em Oncologia, Hospital São
Lucas, PUCRS, Latin American Cooperative Oncology Group (LACOG), Porto
Alegre, Brazil
| | - Aditya Bardia
- Massachusetts General Hospital Cancer Center,
Harvard Medical School, Boston, MA, USA
| | - Seock-Ah Im
- Cancer Research Institute, Seoul National
University Hospital, Seoul National University College of Medicine, Seoul,
Republic of Korea
| | - Denise A. Yardley
- Sarah Cannon Research Institute, Tennessee
Oncology, Nashville, TN, USA
| | - Michael Untch
- Interdisciplinary Breast Cancer Center, Helios
Klinikum Berlin-Buch, Berlin, Germany
| | - Chiun-Sheng Huang
- National Taiwan University Hospital, National
Taiwan University College of Medicine, Taipei City, Taiwan
| | - Daniil Stroyakovskiy
- Moscow City Oncology Hospital No. 62 of Moscow
Healthcare Department, Moscow Oblast, Russia
| | - Binghe Xu
- Department of Medical Oncology Cancer
Hospital, Chinese Academy of Medical Sciences and Peking Union Medical
College, Beijing, China
| | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne,
Australia
| | - Frances Visco
- National Breast Cancer Coalition, Washington,
DC, USA
| | | | - Karen Afenjar
- TRIO – Translational Research in Oncology,
Paris, France
| | - Rodrigo Fresco
- TRIO – Translational Research in Oncology,
Montevideo, Uruguay
| | | | | | | | - Agnes Lteif
- Novartis Pharmaceuticals Corporation, East
Hanover, NJ, USA
| | - Gabriel N. Hortobagyi
- Department of Breast Medical Oncology, The
University of Texas MD Anderson Cancer Center, Houston, TX, USA
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9
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Schettini F, Chic N, Brasó-Maristany F, Paré L, Pascual T, Conte B, Martínez-Sáez O, Adamo B, Vidal M, Barnadas E, Fernández-Martinez A, González-Farre B, Sanfeliu E, Cejalvo JM, Perrone G, Sabarese G, Zalfa F, Peg V, Fasani R, Villagrasa P, Gavilá J, Barrios CH, Lluch A, Martín M, Locci M, De Placido S, Prat A. Author Correction: Clinical, pathological, and PAM50 gene expression features of HER2-low breast cancer. NPJ Breast Cancer 2023; 9:32. [PMID: 37120452 PMCID: PMC10148804 DOI: 10.1038/s41523-023-00538-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023] Open
Affiliation(s)
- Francesco Schettini
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Nuria Chic
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- SOLTI Breast Cancer Research Group, Barcelona, Spain
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Fara Brasó-Maristany
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Laia Paré
- SOLTI Breast Cancer Research Group, Barcelona, Spain
| | - Tomás Pascual
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- SOLTI Breast Cancer Research Group, Barcelona, Spain
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
- Department of Genetics, University of North Carolina, Chapel Hill, NC, USA
| | - Benedetta Conte
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Department of Medical Oncology, Ospedale Policlinico San Martino, University of Genova, Genova, Italy
| | - Olga Martínez-Sáez
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Barbara Adamo
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- SOLTI Breast Cancer Research Group, Barcelona, Spain
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Maria Vidal
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- SOLTI Breast Cancer Research Group, Barcelona, Spain
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain
| | - Esther Barnadas
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
| | | | - Blanca González-Farre
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- SOLTI Breast Cancer Research Group, Barcelona, Spain
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Esther Sanfeliu
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain
- SOLTI Breast Cancer Research Group, Barcelona, Spain
- Department of Pathology, Hospital Clínic, Barcelona, Spain
| | - Juan Miguel Cejalvo
- INCLIVA Biomedical Research Institute, Hospital Clínico Universitario Valencia, University of Valencia, Valencia, Spain
| | | | | | - Francesca Zalfa
- Pathology Department, Campus Bio-Medico University, Rome, Italy
| | - Vicente Peg
- Vall d´Hebron University Hospital, Barcelona, Spain
- GEICAM, Grupo Español de Investigación en Cáncer de Mama, Madrid, Spain
| | - Roberta Fasani
- Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | | | - Joaquín Gavilá
- SOLTI Breast Cancer Research Group, Barcelona, Spain
- Instituto Valenciano de Oncología (IVO), Valencia, Spain
| | - Carlos H Barrios
- Centro de Pesquisa Clínica Hospital São Lucas da PUCRS, Porto Alegre, Brazil
- LACOG, Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Ana Lluch
- GEICAM, Grupo Español de Investigación en Cáncer de Mama, Madrid, Spain
- Hospital Universitario Clínico Valencia, Valencia, Spain
- Biomedical Research Centre Network in Cancer (CIBERONC), Valencia, Spain
| | - Miguel Martín
- GEICAM, Grupo Español de Investigación en Cáncer de Mama, Madrid, Spain
- Hospital Gregorio Marañon, Madrid, Spain
| | - Mariavittoria Locci
- Department of Neuroscience, Reproductive Sciences and Dentistry, University of Naples Federico II, Naples, Italy
| | - Sabino De Placido
- Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Aleix Prat
- Translational Genomics and Targeted Therapeutics in Solid Tumors, August Pi i Sunyer Biomedical Research Institute, Barcelona, Spain.
- SOLTI Breast Cancer Research Group, Barcelona, Spain.
- Department of Medical Oncology, Hospital Clínic, Barcelona, Spain.
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10
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Sternberg CN, Davis ID, Mardiak J, Szczylik C, Lee E, Wagstaff J, Barrios CH, Salman P, Gladkov OA, Kavina A, Zarbá JJ, Chen M, McCann L, Pandite L, Roychowdhury DF, Hawkins RE. Pazopanib in Locally Advanced or Metastatic Renal Cell Carcinoma: Results of a Randomized Phase III Trial. J Clin Oncol 2023; 41:1957-1964. [PMID: 37018920 DOI: 10.1200/jco.22.02622] [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: 04/07/2023] Open
Abstract
PURPOSE Pazopanib is an oral angiogenesis inhibitor targeting vascular endothelial growth factor receptor, platelet-derived growth factor receptor, and c-Kit. This randomized, double-blind, placebo-controlled phase III study evaluated efficacy and safety of pazopanib monotherapy in treatment-naive and cytokine-pretreated patients with advanced renal cell carcinoma (RCC). PATIENTS AND METHODS Adult patients with measurable, locally advanced, and/or metastatic RCC were randomly assigned 2:1 to receive oral pazopanib or placebo. The primary end point was progression-free survival (PFS). Secondary end points included overall survival, tumor response rate (Response Evaluation Criteria in Solid Tumors), and safety. Radiographic assessments of tumors were independently reviewed. RESULTS Of 435 patients enrolled, 233 were treatment naive (54%) and 202 were cytokine pretreated (46%). PFS was significantly prolonged with pazopanib compared with placebo in the overall study population (median, PFS 9.2 v 4.2 months; hazard ratio [HR], 0.46; 95% CI, 0.34 to 0.62; P < .0001), the treatment-naive subpopulation (median PFS 11.1 v 2.8 months; HR, 0.40; 95% CI, 0.27 to 0.60; P < .0001), and the cytokine-pretreated subpopulation (median PFS, 7.4 v 4.2 months; HR, 0.54; 95% CI, 0.35 to 0.84; P < .001). The objective response rate was 30% with pazopanib compared with 3% with placebo (P < .001). The median duration of response was longer than 1 year. The most common adverse events were diarrhea, hypertension, hair color changes, nausea, anorexia, and vomiting. There was no evidence of clinically important differences in quality of life for pazopanib versus placebo. CONCLUSION Pazopanib demonstrated significant improvement in PFS and tumor response compared with placebo in treatment-naive and cytokine-pretreated patients with advanced and/or metastatic RCC.
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Affiliation(s)
- Cora N Sternberg
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Ian D Davis
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Jozef Mardiak
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Cezary Szczylik
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Eunsik Lee
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - John Wagstaff
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Carlos H Barrios
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Pamela Salman
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Oleg A Gladkov
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Alexander Kavina
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Juan J Zarbá
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Mei Chen
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Lauren McCann
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Lini Pandite
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Debasish F Roychowdhury
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
| | - Robert E Hawkins
- From the Department of Medical Oncology, San Camillo and Forlanini Hospitals, Rome, Italy; Ludwig Oncology Unit, Austin Hospital, Melbourne, Australia; National Oncological Institute, Klenová, Bratislava, Slovakia; Department of Oncology, Military Institute of Medicine, Warsaw, Poland; Department of Urology, Seoul National University College of Medicine, Seoul, Korea; The South West Wales Cancer Institute, Singleton Hospital, Swansea; Cancer Research UK, Department of Medical Oncology, University of Manchester; Christie Hospital National Health Services Foundation Trust, Manchester, United Kingdom; Oncology Research Unit, Oncology Service, Hospital Sao Lucas, Pontifícia Universidade Católica do Rio Grande do Sol, Porto Alegre, Brazil; Division of Medical Oncology and Hematology, Fundación Arturo López Pérez, Santiago, Chile; Chelyabinsk Regional Oncology Center, Chelyabinsk, Russian Federation; Krankenhaus Heitzing, mit Neurologischem Zentrum Rosenhugel, Vienna, Austria; Centro Médico San Roque, Tucumán, Argentina; GlaxoSmithKline, Collegeville, PA; and GlaxoSmithKline, Research Triangle Park, NC
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11
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Burotto M, Powles T, Escudier B, Apolo AB, Bourlon MT, Shah AY, Suárez C, Porta C, Barrios CH, Richardet M, Gurney H, Kessler ER, Tomita Y, Bedke J, George S, Scheffold C, Wang P, Fedorov V, Motzer RJ, Choueiri TK. Nivolumab plus cabozantinib vs sunitinib for first-line treatment of advanced renal cell carcinoma (aRCC): 3-year follow-up from the phase 3 CheckMate 9ER trial. J Clin Oncol 2023. [DOI: 10.1200/jco.2023.41.6_suppl.603] [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: 03/17/2023] Open
Abstract
603 Background: First-line nivolumab plus cabozantinib (N+C) demonstrated superiority over sunitinib (S) with 25.4 mo minimum follow-up (median, 32.9 mo) in patients (pts) with aRCC in the CheckMate 9ER trial. Here, we report survival, response per blinded independent central review (BICR), and safety after 3 y minimum follow-up in all randomized pts and by IMDC risk score. Methods: Pts were randomized 1:1 (stratified by IMDC risk score, tumor PD-L1 expression, region) to N 240 mg flat dose IV Q2W + C 40 mg PO QD vs SUN 50 mg PO for 4 wk (6-wk cycles) until disease progression or unacceptable toxicity (max N treatment, 2 y). Primary endpoint: progression-free survival (PFS) by BICR. Secondary endpoints: overall survival (OS), objective response rate (ORR) by BICR, and safety. Results: In total, 323 pts were randomized to N+C and 328 to S. With 36.5 mo minimum follow-up (median, 44.0 mo), PFS and OS benefits were maintained with N+C vs S in intent-to-treat pts. Median PFS was 16.6 vs 8.4 mo (HR 0.58 [95% CI 0.48–0.71], P < 0.0001) and median OS was 49.5 vs 35.5 mo (HR 0.70 [95% CI 0.56–0.87], P = 0.0014). ORR (95% CI) was higher with N+C vs S (56% [50–61] vs 28% [24–34]), and 12% vs 5% of pts achieved complete response (CR), respectively. Median duration of response was 23.1 vs 15.2 mo for N+C vs S. PFS, OS, and response are reported across prespecified IMDC risk groups in the table. Any-grade treatment-related adverse events (TRAEs) occurred in 97% vs 93% of pts treated with N+C vs S (grade ≥ 3 TRAE, 67% vs 55%). TRAEs led to discontinuation of C only in 10% of pts, N only in 10% of pts, N+C in 7% of pts, N or C in 28% of pts, and S in 11% of pts. Conclusions: After 3 y minimum follow-up, survival and response benefits were maintained with N+C and remained consistent with previous follow-ups. Median OS with N+C improved by 11.8 mo since the previous data cut. Responses with N+C were durable, with higher CR rates with N+C vs S regardless of IMDC risk group. No new safety signals emerged with additional follow-up in either arm. These results continue to support N+C as a first-line treatment for pts with aRCC. Clinical trial information: NCT03141177 . [Table: see text]
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Affiliation(s)
| | - Thomas Powles
- Barts Cancer Centre, London, UK; The Royal Free London NHS Foundation Trust, London, United Kingdom
| | | | - Andrea B. Apolo
- Center for Cancer Research, National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Maria Teresa Bourlon
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | - Cristina Suárez
- Vall d'Hebron Institute of Oncology (VHIO), Vall d'Hebron University Hospital, Barcelona, Spain
| | | | | | - Martin Richardet
- Fundación Richardet Longo, Instituto Oncologico de Cordoba, Cordoba, Argentina
| | - Howard Gurney
- Westmead Hospital and Macquarie University, Sydney, NSW, Australia
| | | | - Yoshihiko Tomita
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jens Bedke
- Eberhard Karls University of Tübingen, Tübingen, Germany
| | - Saby George
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | | | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
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12
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Holmes FA, Moy B, Delaloge S, Chia SKL, Ejlertsen B, Mansi J, Iwata H, Gnant M, Buyse M, Barrios CH, Silovski T, Šeparović R, Bashford A, Zotano AG, Denduluri N, Patt D, Gokmen E, Gore I, Smith JW, Loibl S, Masuda N, Tomašević Z, Petráková K, DiPrimeo D, Wong A, Martin M, Chan A. Overall survival with neratinib after trastuzumab-based adjuvant therapy in HER2-positive breast cancer (ExteNET): A randomised, double-blind, placebo-controlled, phase 3 trial. Eur J Cancer 2023; 184:48-59. [PMID: 36898233 DOI: 10.1016/j.ejca.2023.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/02/2023] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
BACKGROUND ExteNET showed that neratinib, an irreversible pan-HER tyrosine kinase inhibitor, given for 1 year after trastuzumab-based therapy significantly improved invasive disease-free survival in women with early-stage HER2-positive breast cancer. We report the final analysis of overall survival in ExteNET. METHODS In this international, randomised, double-blind, placebo-controlled, phase 3 trial, women aged 18 years or older with stage 1-3c (amended to stage 2-3c) HER2-positive breast cancer who had completed neoadjuvant and adjuvant chemotherapy plus trastuzumab were eligible. Patients were randomly assigned to oral neratinib 240 mg/day or placebo for 1 year. Randomisation was stratified according to hormone receptor (HR) status (HR-positive vs. HR-negative), nodal status (0, 1-3 or 4+), and trastuzumab regimen (sequentially vs. concurrently with chemotherapy). Overall survival was analysed by intention to treat. ExteNET is registered (Clinicaltrials.gov: NCT00878709) and is complete. RESULTS Between July 9, 2009, and October 24, 2011, 2840 women received neratinib (n = 1420) or placebo (n = 1420). After a median follow-up of 8.1 (IQR, 7.0-8.8) years, 127 patients (8.9%) in the neratinib group and 137 patients (9.6%) in the placebo group in the intention-to-treat population had died. Eight-year overall survival rates were 90.1% (95% CI 88.3-91.6) with neratinib and 90.2% (95% CI 88.4-91.7) with placebo (stratified hazard ratio 0.95; 95% CI 0.75-1.21; p = 0.6914). CONCLUSIONS Overall survival in the extended adjuvant setting was comparable for neratinib and placebo after a median follow-up of 8.1 years in women with early-stage HER2-positive breast cancer.
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Affiliation(s)
| | - Beverly Moy
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | | | | | | | - Janine Mansi
- Guy's and St Thomas Hospital NHS Foundation Trust and Biomedical Research Centre, King's College, London, United Kingdom
| | | | - Michael Gnant
- Comprehensive Cancer Centre, Medical University of Vienna, Vienna, Austria
| | - Marc Buyse
- International Drug Development Institute (IDDI), Louvain-la-Neuve, Belgium
| | | | | | - Robert Šeparović
- University Hospital for Tumors, University Hospital Center "Sestre Milosrdnice", Zagreb, Croatia
| | | | | | - Neelima Denduluri
- Virginia Cancer Specialists, US Oncology Research, Arlington, VA, USA
| | - Debra Patt
- Texas Oncology - Round Rock, US Oncology Research, Austin, TX, USA
| | - Erhan Gokmen
- Ege University Faculty of Medicine, Izmir, Turkey
| | - Ira Gore
- Alabama Oncology, Birmingham, AL, USA
| | - John W Smith
- Northwest Cancer Specialists, P.C., US Oncology Research, Vancouver, VA, USA
| | - Sibylle Loibl
- Center for Hematology and Oncology Bethanien, Frankfurt, Germany and German Breast Group, Neu-Isenburg, Germany
| | - Norikazu Masuda
- Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Zorica Tomašević
- Daily Chemotherapy Hospital, Institute for Oncology and Radiology of Serbia, Belgrade, Serbia
| | | | | | - Alvin Wong
- Puma Biotechnology Inc., Los Angeles, CA, USA
| | - Miguel Martin
- Instituto de Investigación Sanitaria Gregorio Marañón, CIBERONC, GEICAM, Universidad Complutense, Madrid, Spain
| | - Arlene Chan
- Breast Cancer Research Centre-WA & Curtin University, Perth, Australia
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13
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Rugo HS, Cortes J, Barrios CH, Cabrera P, Xu B, Huang CS, Kim SB, Melisko M, Nanda R, Pieńkowski T, Rapoport BL, Schwab R. GLORIA: phase III, open-label study of adagloxad simolenin/OBI-821 in patients with high-risk triple-negative breast cancer. Future Oncol 2022; 18:3801-3813. [PMID: 36268941 DOI: 10.2217/fon-2022-0812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Triple-negative breast cancer (TNBC) has the highest rate of distant metastasis and poorest overall survival among breast cancer subtypes. In a phase II study, adagloxad simolenin (AdaSim), a synthetic Globo H conjugate vaccine administered with adjuvant OBI-821, was shown to induce IgM and IgG anti-Globo H humoral responses in patients with metastatic breast cancer overexpressing the glycosphingolipid Globo H. GLORIA is an ongoing phase III, randomized, open-label clinical trial to evaluate the safety and efficacy of AdaSim and the quality of life (QoL) of patients receiving AdaSim plus standard of care (SOC) versus SOC alone in high-risk, early-stage TNBC. The primary end point is invasive progression-free survival; secondary end points include overall survival, QoL, breast cancer-free interval, distant disease-free survival, safety, and tolerability.
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Affiliation(s)
- Hope S Rugo
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Javier Cortes
- International Breast Cancer Center (IBCC), Barcelona, Spain
| | - Carlos H Barrios
- Centro de Pesquisa Clínica, Hospital São Lucas, Porto Alegre, Brazil
| | - Paula Cabrera
- Instituto Nacional de Cancerología, Mexico City, Mexico
| | - Binghe Xu
- Cancer Hospital, Chinese Academy of Medical Sciences (CAMS), Beijing, China
| | | | - Sung-Bae Kim
- Asan Medical Center, University of Ulsan, Seoul, Republic of Korea
| | - Michelle Melisko
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA 94115, USA
| | - Rita Nanda
- University of Chicago Medicine, Chicago, IL, USA
| | - Tadeusz Pieńkowski
- Department of Oncology & Breast Diseases, Medical Center of Postgraduate Education, Warsaw, Poland
| | | | - Richard Schwab
- Moores Cancer Center at University of California San Diego Health, La Jolla, CA, USA
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14
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Cortes J, Rugo HS, Cescon DW, Im SA, Yusof MM, Gallardo C, Lipatov O, Barrios CH, Perez-Garcia J, Iwata H, Masuda N, Torregroza Otero M, Gokmen E, Loi S, Guo Z, Zhou X, Karantza V, Pan W, Schmid P. Pembrolizumab plus Chemotherapy in Advanced Triple-Negative Breast Cancer. N Engl J Med 2022; 387:217-226. [PMID: 35857659 DOI: 10.1056/nejmoa2202809] [Citation(s) in RCA: 239] [Impact Index Per Article: 119.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND In an interim analysis of this phase 3 trial, the addition of pembrolizumab to chemotherapy resulted in longer progression-free survival than chemotherapy alone among patients with advanced triple-negative breast cancer whose tumors expressed programmed death ligand 1 (PD-L1) with a combined positive score (CPS; the number of PD-L1-staining tumor cells, lymphocytes, and macrophages, divided by the total number of viable tumor cells, multiplied by 100) of 10 or more. The results of the final analysis of overall survival have not been reported. METHODS We randomly assigned patients with previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer in a 2:1 ratio to receive pembrolizumab (200 mg) every 3 weeks plus the investigator's choice of chemotherapy (nanoparticle albumin-bound paclitaxel, paclitaxel, or gemcitabine-carboplatin) or placebo plus chemotherapy. The primary end points were progression-free survival (reported previously) and overall survival among patients whose tumors expressed PD-L1 with a CPS of 10 or more (the CPS-10 subgroup), among patients whose tumors expressed PD-L1 with a CPS of 1 or more (the CPS-1 subgroup), and in the intention-to-treat population. Safety was also assessed. RESULTS A total of 847 patients underwent randomization: 566 were assigned to the pembrolizumab-chemotherapy group, and 281 to the placebo-chemotherapy group. The median follow-up was 44.1 months. In the CPS-10 subgroup, the median overall survival was 23.0 months in the pembrolizumab-chemotherapy group and 16.1 months in the placebo-chemotherapy group (hazard ratio for death, 0.73; 95% confidence interval [CI], 0.55 to 0.95; two-sided P = 0.0185 [criterion for significance met]); in the CPS-1 subgroup, the median overall survival was 17.6 and 16.0 months in the two groups, respectively (hazard ratio, 0.86; 95% CI, 0.72 to 1.04; two-sided P = 0.1125 [not significant]); and in the intention-to-treat population, the median overall survival was 17.2 and 15.5 months, respectively (hazard ratio, 0.89; 95% CI, 0.76 to 1.05 [significance not tested]). Adverse events of grade 3, 4, or 5 that were related to the trial regimen occurred in 68.1% of the patients in the pembrolizumab-chemotherapy group and in 66.9% in the placebo-chemotherapy group, including death in 0.4% of the patients in the pembrolizumab-chemotherapy group and in no patients in the placebo-chemotherapy group. CONCLUSIONS Among patients with advanced triple-negative breast cancer whose tumors expressed PD-L1 with a CPS of 10 or more, the addition of pembrolizumab to chemotherapy resulted in significantly longer overall survival than chemotherapy alone. (Funded by Merck Sharp and Dohme; KEYNOTE-355 ClinicalTrials.gov number, NCT02819518.).
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Affiliation(s)
- Javier Cortes
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Hope S Rugo
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - David W Cescon
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Seock-Ah Im
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Mastura M Yusof
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Carlos Gallardo
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Oleg Lipatov
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Carlos H Barrios
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Jose Perez-Garcia
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Hiroji Iwata
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Norikazu Masuda
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Marco Torregroza Otero
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Erhan Gokmen
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Sherene Loi
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Zifang Guo
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Xuan Zhou
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Vassiliki Karantza
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Wilbur Pan
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
| | - Peter Schmid
- From the International Breast Cancer Center, Pangaea Oncology, Quirónsalud Group, Barcelona (J.C., J.P.-G.), and the Faculty of Biomedical and Health Sciences, Department of Medicine, Universidad Europea de Madrid, Madrid (J.C.) - both in Spain; the Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco (H.S.R.); Princess Margaret Cancer Centre, Toronto (D.W.C.); Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul (S.-A.I.); Cancer Center at Pantai Hospital Kuala Lumpur, Kuala Lumpur, Malaysia (M.M.Y.); the Oncology Institute, Arturo Lopez Perez Foundation, Santiago, Chile (C.G.); the Department of Oncology, Republican Clinical Oncology Dispensary, Ufa, Russia (O.L.); the Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil (C.H.B.); the Department of Breast Oncology, Aichi Cancer Center Hospital (H.I.), and the Department of Breast and Endocrine Surgery, Nagoya University Graduate School of Medicine (N.M.) - both in Nagoya, Japan; the Department of Hematology and Oncology, Oncomedica, Montería, Colombia (M.T.O.); Ege University Medical Faculty, Izmir, Turkey (E.G.); the Division of Cancer Research, Peter MacCallum Cancer Centre, Melbourne, and the Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville - both in Australia (S.L.); Merck, Rahway, NJ (Z.G., X.Z., V.K., W.P.); and the Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London (P.S.)
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15
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Huober J, Barrios CH, Niikura N, Jarząb M, Chang YC, Huggins-Puhalla SL, Pedrini J, Zhukova L, Graupner V, Eiger D, Henschel V, Gochitashvili N, Lambertini C, Restuccia E, Zhang H. Atezolizumab With Neoadjuvant Anti-Human Epidermal Growth Factor Receptor 2 Therapy and Chemotherapy in Human Epidermal Growth Factor Receptor 2-Positive Early Breast Cancer: Primary Results of the Randomized Phase III IMpassion050 Trial. J Clin Oncol 2022; 40:2946-2956. [PMID: 35763704 PMCID: PMC9426828 DOI: 10.1200/jco.21.02772] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Combining standard of care (pertuzumab-trastuzumab [PH], chemotherapy) with cancer immunotherapy may potentiate antitumor immunity, cytotoxic activity, and patient outcomes in high-risk, human epidermal growth factor receptor 2 (HER2)–positive early breast cancer. We report the phase III IMpassion050 primary analysis of neoadjuvant atezolizumab, PH, and chemotherapy in these patients.
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Affiliation(s)
- Jens Huober
- Cantonal Hospital, Breast Center St Gallen, St Gallen, Switzerland.,University Hospital, Ulm, Germany
| | - Carlos H Barrios
- Centro de Pesquisa em Oncologia, Hospital São Lucas, PUCRS, Porto Alegre, Brazil
| | - Naoki Niikura
- Department of Breast Oncology, Tokai University School of Medicine, Isehara, Japan
| | - Michał Jarząb
- Breast Cancer Unit, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | | | | | - José Pedrini
- Hospital Nossa Senhora da Conceição, Porto Alegre, Brazil
| | - Lyudmila Zhukova
- SBIH Moscow Clinical Scientific and Practical Center named after A.S. Loginov of DHM, Moscow, Russia
| | - Vilma Graupner
- Product Development Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Daniel Eiger
- Product Development Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Volkmar Henschel
- Product Development Data Science, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Nino Gochitashvili
- Product Development Safety, Roche Products Limited, Welwyn Garden City, United Kingdom
| | - Chiara Lambertini
- Oncology Biomarker Development, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Eleonora Restuccia
- Product Development Oncology, F. Hoffmann-La Roche Ltd, Basel, Switzerland
| | - Hong Zhang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
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16
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De Marchi P, Nazareth Aguiar P, Paes R, Costa e Silva M, Favato Barcelos I, Taveira GMT, Montella TC, Ferrari BL, Barrios CH, Ferreira CGM, Dienstmann R. A real-world evidence of immunotherapy adoption in non-small cell lung cancer (NSCLC) treatment and its transition from platinum-refractory to the first line of therapy. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e18714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e18714 Background: over the past few years, multiple clinical trials have shown that immune checkpoint inhibitors (ICI) are active in NSCLC treatment. In 2015, survival improvement was demonstrated with second line immunotherapy. More recently, benefit was proven in the first line setting, both with ICI alone or in combination with chemotherapy. How fast the medical community has incorporated these advances into its clinical practice needs to be evaluated, as well as ICI efficacy in a real-world setting. Methods: retrospective analysis of the Oncoclinicas Data Lake was carried out to extract and curate information on the use of ICI in NSCLC patients from 2015 onwards, as well as survival outcomes from start of treatment to death or last follow-up. Patients with actionable driver alterations were excluded from this analysis. Results: 767 patients were identified. Median age was 72 years, 54% were male. The number of patients treated with ICI increased dramatically in the period, from 13 in 2015 to 243 in 2020. Most patients (86%) received ICI in the second line or beyond in 2015, while in 2019 and 2020 the preference was immunotherapy in the first-line setting (60%). The transition from platinum-refractory to the first line was observed for both ICI single agents and ICI combinations. As of 2021, 75% of ICI + chemotherapy treatments take place in the first line setting and 54% of ICI monotherapy treatments are given in first line setting. Overall, median overall survival was 15.7 months for first line setting use of ICI (CI 95% 12.2-19.6) and 11.6 months for second line and beyond (CI 95% 8.9-14.2). Survival rates at 12 and 24 months for first line ICI use were 56% and 48.5% and for second line and beyond 35% and 25.5%, respectively. Conclusions: ICI was promptly incorporated into the treatment of NSCLC and its use has shifted from platinum-refractory to treatment-naïve setting, mostly with combination regimens. Our cohort shows real-world overall survival rates comparable with published literature, despite a more elderly population than clinical trials.
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Resende CAAD, Dienstmann R, Barrios CH, Ferrari BL, Goncalves AC, Cascelli F, Souto AK, Costa e Silva M, Cruz H, Oliveira LC, Andrade DAPD, Millen EC, Zerwes F, Reinert T, Moraes P, Mano MS. Impact of the COVID-19 pandemic on stage at diagnosis of patients with breast cancer: An analysis of 11,752 patients from Oncoclínicas. J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.10559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
10559 Background: As a reaction to the COVID-19 pandemic, a nation-wide lockdown was enforced in Brazil in March 2020, cancer care was impacted, and cancer screening reduced. Therefore, an increase in cancer diagnoses at more advanced stages was expected. In this study, we extracted data from our nationwide real-world database to evaluate the impact of the COVID-19 pandemic on the stage at diagnosis of breast cancer (BC) cases. Methods: We explored curated electronic medical record data of female patients, over 18 years of age, diagnosed with BC and with established disease stage based on the AJCC 8th edition, who started treatment or follow-up in the Oncoclínicas (OC) between Jan 1, 2018, and Dec 31, 2021. The primary objective was to compare stage distribution at first visit during COVID-19 pandemic (2020-2021) with a historical control cohort from a period prior to the pandemic (2018-2019). We investigated stage distribution according to age at diagnosis and tumor ER/HER2 subtype in univariate models. Associations were considered significant if they had a minimum significance (P < 0.1 in Chi-square test). The historical numbers of patients with BC at OC make it possible to identify differences in the prevalence of stages in the order of 5% comparing pre and post pandemic periods with a statistical power greater than 80%. Results: We collected data for 11,752 patients with initial diagnosis of BC, with 6,492 patients belonging to the pandemic (2020-2021) and 5,260 patients to the pre-pandemic period (2018-2019). For both ER+/ HER2- and HER2+ tumors, there was a lower percentage of patients with early-stage (defined as stage I-II) in the years 2020-2021 vs 2018-2019 and a considerable increase in advanced-stage disease (defined as stage IV). For triple negative BC (TNBC), there was a significant higher percentage of patients with advanced-stage disease in the pandemic vs pre-pandemic period (table 1). Age over 50 years was associated with a greater risk of advanced stage at diagnosis after the onset of the pandemic, with an absolute increase of 7% (P two-sided <0.01) Conclusions: We observed a substantial increase in cases of advanced-stage BC in OC institutions as a result of delays in BC diagnoses due to the COVID-19 pandemic. The impact appeared greater in older adults, potentially because of stricter confinement in this group. [Table: see text]
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Paulo Moraes
- Centro Oncologico Antônio Ermírio de Moraes, São Paulo, Brazil
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Barrios CH, Montella TC, Ferreira CGM, De Marchi P, Coutinho LF, Lemos Duarte I, Costa e Silva M, Duarte Paes R, Correia e Silva GM, Dienstmann R. Time-of-day infusion of immunotherapy may impact outcomes in advanced non-small cell lung cancer patients (NSCLC). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.e21126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e21126 Background: Circadian rhythms have shown direct impact on toxicity and efficacy of anticancer treatments. Adaptive immune responses related to (or associated with) check point inhibitor (CPI) administration may have lower intensity later in the day. Notably, emerging evidence suggests that the time-of-day administration of different immunotherapies could have survival implications in different tumor types. Methods: We extracted de-identified data from curated the Real-World database of the Oncoclínicas Group, including 21 community-oncology practices in Brazil with EHR information on time-of-day administration of CPI in patients with advanced NSCLC. Only patients treated with single-agent CPIs with palliative intent (Nivolumab, Pembrolizumab or Atezolizumab) from Jan 2018 through Dec 2021 were analyzed. The primary endpoint was a comparative analysis of the median Time to Treatment Discontinuation (TTD) of CPI stratified according to time-of-day administration using a propensity-score (PS) matching model. On the basis of previous reports, we selected the cutoff of 20% of CPI doses administered after 4:00 pm as the late-day subgroup. Variables included in PS matching were: age (< 60, 60+); line of therapy (1st, 2ndor beyond); gender (male, female), and CPI agent (Pembrolizumab vs. others). Results: From a total of 1,603 patients with advanced NSCLC treated at Oncoclínicas during the study period, 508 received CPI as per inclusion criteria. Median age was 73 years (36-94), 66% were male, 63% received CPI in the 1stline setting, 50% with Pembrolizumab. Overall, 219 CPI infusions (15%) occurred after 4:00 pm and 9% of the patients (n = 43) qualified as late-day infusion subgroup (more than 20% of infusions after 4pm). Median TTD was 4.9 months (CI 95%, 2.83-13.5) in these patients. In the PS matched population with early-day infusions (2:1, n = 86), median TTD was 14 months (CI 95%, 8.87-23.4). Overall, with 73 events in 129 patients, we found a significantly increased risk of treatment discontinuation in the late-day subgroup (HR 1.61, CI95% 1.0-2.6, p = 0.05). With only 33 death events and median follow-up of 11 months, median overall survival was not reached in late-day or early-day subgroups (HR 1.25, CI95% 0.6-2.6, p = 0.5). Conclusions: This preliminary and exploratory real-world data analysis suggests that the time-of-day administration of CPI in patients with advanced NSCLC could have a meaningful impact on patient outcomes, in line with studies conducted in melanoma. This simple and inexpensive intervention merits further exploration in prospective controlled clinical trials.
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van Mackelenbergh MT, Seither F, Möbus V, O'Shaughnessy J, Martin M, Joensuu H, Untch M, Nitz U, Steger GG, Miralles JJ, Barrios CH, Toi M, Bear HD, Muss H, Reimer T, Nekljudova V, Loibl S. Effects of capecitabine as part of neo-/adjuvant chemotherapy - A meta-analysis of individual breast cancer patient data from 13 randomised trials including 15,993 patients. Eur J Cancer 2022; 166:185-201. [PMID: 35305453 DOI: 10.1016/j.ejca.2022.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 01/05/2023]
Abstract
BACKGROUND Despite the large number of patients with early breast cancer (EBC) who have been treated with capecitabine in randomised trials, no individual patient data meta-analysis has been conducted. The primary objective was to examine the effect of capecitabine on disease-free survival (DFS), and the secondary objectives were to analyse distant DFS (DDFS), overall survival (OS), pathological complete response (for neoadjuvant studies) and the interaction between capecitabine-related toxicity and treatment effect. METHODS www. CLINICALTRIALS gov and www.pubmed.ncbi.nlm.nih.gov were searched using the following criteria: use of capecitabine for EBC as adjuvant or neoadjuvant therapy; multicentre randomised trial with >100 patients; recruitment completed, and outcomes available. Required data were available for 13 trials. RESULTS Individual data from 15,993 patients were collected. Cox regression analyses of all included patients revealed that the addition of capecitabine did not alter DFS significantly compared with treatment without capecitabine (hazard ratio [HR] 0.952; 95% CI 0.895-1.012; P value = 0.115). There was also no effect on DFS in the subset of studies where capecitabine was given instead of another drug (HR 1.035; 95% CI 0.945-1.134; P = 0.455). However, capecitabine administered in addition to the standard systemic treatment improved DFS (HR 0.888; 95% CI 0.817-0.965; P = 0.005). An OS improvement was observed in the entire cohort (HR 0.892; 95% CI 0.824-0.965, P = 0.005) and in the subset of capecitabine addition (HR 0.837; 95% CI 0.751, 0.933, P = 0.001). Subgroup analyses revealed that triple-negative breast cancer (TNBC) patients benefitted from treatment with capecitabine overall and in addition to other systemic treatments in terms of DFS and OS. CONCLUSION Capecitabine was able to improve DFS and OS in patients with TNBC and in all patients with EBC when administered in addition to systemic treatment.
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Affiliation(s)
- Marion T van Mackelenbergh
- German Breast Group, Neu-Isenburg, Germany; Department of Gynecology and Obstetrics, Universitätsklinikum Schleswig-Holstein, Kiel, Germany.
| | | | - Volker Möbus
- University Hospital Frankfurt, Frankfurt, Germany
| | - Joyce O'Shaughnessy
- US Oncology Research, Inc., The Woodlands, TX, USA; Texas Oncology/Baylor University Medical Center, Dallas, TX, USA
| | - Miguel Martin
- Instituto de Investigacion Sanitaria Gregorio Marañon, CIBERONC, Universidad Complutense, Madrid, Spain; Spanish Breast Cancer Group, GEICAM, Madrid, Spain
| | - Heikki Joensuu
- Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | | | - Ulrike Nitz
- Breast Center Niederrhein, Evangelical Hospital Johanniter Bethesda, Mönchengladbach, Germany
| | - Guenther G Steger
- Department of Internal Medicine I and Gaston H. Glock Research Centre, Medical University of Vienna, Vienna, Austria
| | | | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Grupo Oncoclinicas, Porto Alegre, Brazil
| | - Masakazu Toi
- Breast Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Harry D Bear
- NRG Oncology and Division of Surgical Oncology, Massey Cancer Center, Virginia Commonwealth University, VCU Health, Richmond, VA, USA
| | - Hyman Muss
- University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Toralf Reimer
- Breast Center, University of Rostock, Rostock, Germany
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20
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Abstract
Breast cancer represents an urgent global priority. While this is a universal issue, and as the burden of the disease is increasing globally, current estimates indicate that in the next couple of decades, much of the incidence and mortality related to breast cancer will be seen in underserved populations. The fragile and ill-prepared healthcare systems in low- and middle-income countries (LMIC) need to address this challenge and find solutions with their limited resources. Significant disparities can be identified in stage at presentation as the ability to detect the disease in earlier stages is compromised in these scenarios leading to worse outcomes associated to late diagnoses. Furthermore, access to healthcare in general and to basic surgical, radiotherapy and systemic care is suboptimal additionally limiting treatment results. With a small portion of their budget allocated to healthcare, LMIC need to make the most of their resources prioritizing cost-effective strategies that could offer the best possible results. Countries that invest in women's health do develop into healthier, more educated, and importantly, more productive societies with benefits seen across generations. Finally, recognition of inequities should stimulate a concerted effort engaging all involved stakeholders to find context-adapted solutions to improve healthcare outcomes.
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Affiliation(s)
- Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG) - Porto Alegre, Brazil Oncoclinicas Group, Porto Alegre, Brazil.
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21
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Smeltzer MP, Scagliotti GV, Wakelee HA, Mitsudomi T, Roy UB, Clark RC, Arndt R, Pruett CD, Kelly KL, Ujhazy P, Johnson ML, Eralp Y, Barrios CH, Barlesi F, Hirsch FR, Bunn PA. International Association for the Study of Lung Cancer (IASLC) Study of the Impact of COVID-19 on International Lung Cancer Clinical Trials. J Thorac Oncol 2022; 17:651-660. [PMID: 35183774 PMCID: PMC8851565 DOI: 10.1016/j.jtho.2022.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Revised: 01/17/2022] [Accepted: 01/21/2022] [Indexed: 11/19/2022]
Abstract
INTRODUCTION To evaluate the effects of the global coronavirus disease 2019 (COVID-19) pandemic on lung cancer trials, we surveyed investigators and collected aggregate enrollment data for lung cancer trials across the world before and during the pandemic. METHODS A Data Collection Survey collected aggregate monthly enrollment numbers from 294 global lung cancer trials for 2019 to 2020. A 64-question Action Survey evaluated the impact of COVID-19 on clinical trials and identified mitigation strategies implemented. RESULTS Clinical trial enrollment declined from 2019 to 2020 by 14% globally. Most reductions in enrollment occurred in April to June where we found significant decreases in individual site enrollment (p = 0.0309). Enrollment was not significantly different in October 2019 to December of 2019 versus 2020 (p = 0.25). The most frequent challenges identified by the Action Survey (N = 172) were fewer eligible patients (63%), decrease in protocol compliance (56%), and suspension of trials (54%). Patient-specific challenges included access to trial site (49%), ability to travel (54%), and willingness to visit the site (59%). The most frequent mitigation strategies included modified monitoring requirements (47%), telehealth visits (45%), modified required visits (25%), mail-order medications (25%), and laboratory (27%) and radiology (21%) tests at nonstudy facilities. Sites that felt the most effective mitigation strategies were telehealth visits (85%), remote patient-reported symptom collection (85%), off-site procedures (85%), and remote consenting (89%). CONCLUSIONS The COVID-19 pandemic created many challenges for lung cancer clinical trials conduct and enrollment. Mitigation strategies were used and, although the pandemic worsened, trial enrollment improved. A more flexible approach may improve enrollment and access to clinical trials, even beyond the pandemic.
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Affiliation(s)
- Matthew P Smeltzer
- Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, Tennessee.
| | - Giorgio V Scagliotti
- A.O.U. San Luigi Gonzaga Hospital, Department of Oncology, University of Torino, Orbassano, Italy
| | | | - Tetsuya Mitsudomi
- Division of Thoracic Surgery, Department of Surgery, Kindai University Faculty of Medicine, Osaka-Sayama, Japan
| | | | | | - Renee Arndt
- Cancer Technology Applications, LLC, San Diego, California
| | | | - Karen L Kelly
- Department of Medicine, Division of Hematology Oncology, University of California Davis Health, Sacramento, California
| | - Peter Ujhazy
- Division of Cancer Treatment and Diagnosis, National Cancer Institute, Rockville, Maryland
| | - Melissa L Johnson
- Sarah Cannon Research Institute, Nashville, Tennessee; Tennessee Oncology, PLLC, Nashville, Tennessee
| | - Yesim Eralp
- Maslak Acibadem Hospital, Acibadem University, Istanbul, Turkey
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG) Oncoclínicas Group, Porto Alegre, Brazil
| | - Fabrice Barlesi
- Department of Medical Oncology, Gustave Roussy, Villejuif, France; Centre de Recherche en Cancérologie de Marseille (CRCM), Centre National de la Recherche Scientifique (CNRS), Institut National de la Santé et de la Recherche Médicale (INSERM), Aix-Marseille University, Marseille, France
| | - Fred R Hirsch
- Center for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Paul A Bunn
- University of Colorado School of Medicine, Aurora, Colorado
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22
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Gennari A, André F, Barrios CH, Cortés J, de Azambuja E, DeMichele A, Dent R, Fenlon D, Gligorov J, Hurvitz SA, Im SA, Krug D, Kunz WG, Loi S, Penault-Llorca F, Ricke J, Robson M, Rugo HS, Saura C, Schmid P, Singer CF, Spanic T, Tolaney SM, Turner NC, Curigliano G, Loibl S, Paluch-Shimon S, Harbeck N. ESMO Clinical Practice Guideline for the diagnosis, staging and treatment of patients with metastatic breast cancer. Ann Oncol 2021; 32:1475-1495. [PMID: 34678411 DOI: 10.1016/j.annonc.2021.09.019] [Citation(s) in RCA: 403] [Impact Index Per Article: 134.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 09/30/2021] [Indexed: 12/29/2022] Open
Affiliation(s)
- A Gennari
- Department of Translational Medicine, University of Piemonte Orientale, Novara, Italy
| | - F André
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif, France
| | - C H Barrios
- Oncology Research Center, Grupo Oncoclínicas, Porto Alegre, Brazil
| | - J Cortés
- International Breast Cancer Center (IBCC), Quironsalud Group, Barcelona, Spain; Scientific Department, Medica Scientia Innovation Research, Valencia, Spain; Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain; Universidad Europea de Madrid, Faculty of Biomedical and Health Sciences, Department of Medicine, Madrid, Spain
| | - E de Azambuja
- Medical Oncology Department, Institute Jules Bordet and l'Université Libre de Bruxelles (U.L.B.), Brussels, Belgium
| | - A DeMichele
- Hematology/Oncology Department, Hospital of the University of Pennsylvania, Philadelphia, USA
| | - R Dent
- Department of Medical Oncology, National Cancer Centre Singapore, Singapore
| | - D Fenlon
- College of Human and Health Sciences, Swansea University-Singleton Park Campus, Swansea, UK
| | - J Gligorov
- Départment d' Oncologie Médicale, Institut Universitaire de Cancérologie AP-HP, Sorbonne Université, Hôpital Tenon, Paris, France
| | - S A Hurvitz
- Department of Medicine/Division of Hematology Oncology, David Geffen School of Medicine, University of California, Los Angeles, USA; Jonsson Comprehensive Cancer Center, Los Angeles, USA
| | - S-A Im
- Department of Internal Medicine, Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - D Krug
- Department of Radiation Oncology, University Hospital Schleswig-Holstein-Campus Kiel, Kiely, Germany
| | - W G Kunz
- Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - S Loi
- Peter MacCallum Cancer Centre, Melbourne, Australia
| | - F Penault-Llorca
- Centre de Lutte Contre le Cancer Jean Perrin, Imagerie Moléculaire et Stratégies Théranostiques, Université Clermont Auvergne, UMR INSERM-UCA, Clermont Ferrand, France
| | - J Ricke
- Breast Cancer Unit, Medical Oncology Department, Gustave Roussy-Cancer Campus, Villejuif, France; Department of Radiology, University Hospital, LMU Munich, Munich, Germany
| | - M Robson
- Medicine Department, Memorial Sloan Kettering Cancer Center, New York, USA
| | - H S Rugo
- Department of Medicine, University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, USA
| | - C Saura
- Breast Cancer Program, Vall d'Hebron University Hospital, Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - P Schmid
- Centre of Experimental Cancer Medicine, Cancer Research UK Barts Centre, Barts and The London School of Medicine and Dentistry, London, UK
| | - C F Singer
- Center for Breast Health and Department of Obstetrics & Gynecology, Medical University of Vienna, Vienna, Austria
| | - T Spanic
- Europa Donna Slovenia, Slovenia, USA
| | | | - N C Turner
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - G Curigliano
- Early Drug Development for Innovative Therapies Division, Istituto Europeo di Oncologia, IRCCS and University of Milano, Milan, Italy
| | - S Loibl
- GBG Forschungs GmbH, Neu-Isenburg, Germany
| | - S Paluch-Shimon
- Sharett Institute of Oncology Department, Hadassah University Hospital & Faculty of Medicine Hebrew University, Jerusalem, Israel
| | - N Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
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23
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Rugo HS, Loi S, Adams S, Schmid P, Schneeweiss A, Barrios CH, Iwata H, Diéras V, Winer EP, Kockx MM, Peeters D, Chui SY, Lin JC, Nguyen-Duc A, Viale G, Molinero L, Emens LA. PD-L1 Immunohistochemistry Assay Comparison in Atezolizumab Plus nab-Paclitaxel-Treated Advanced Triple-Negative Breast Cancer. J Natl Cancer Inst 2021; 113:1733-1743. [PMID: 34097070 PMCID: PMC8634452 DOI: 10.1093/jnci/djab108] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [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: 07/31/2020] [Revised: 01/07/2021] [Accepted: 05/14/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND In the phase III IMpassion130 study, atezolizumab plus nab-paclitaxel (A+nP) showed clinical benefit in advanced or metastatic triple-negative breast cancer patients who were programmed death-ligand 1 (PD-L1)+ (tumor-infiltrating immune cells [IC] ≥1%) using the SP142 immunohistochemistry assay. Here we evaluate 2 other PD-L1 assays for analytical concordance with SP142 and patient-associated clinical outcomes. METHODS Samples from 614 patients (68.1% of intention-to-treat population) were centrally evaluated by immunohistochemistry for PD-L1 status on IC (VENTANA SP142, SP263, Dako 22C3) or as a combined positive score (CPS; 22C3). RESULTS Using SP142, SP263, and 22C3 assays, PD-L1 IC ≥1% prevalence was 46.4% (95% confidence interval [CI] = 42.5% to 50.4%), 74.9% (95% CI = 71.5% to 78.3%), and 73.1% (95% CI = 69.6% to 76.6%), respectively; 80.9% were 22C3 CPS ≥1. At IC ≥1% (+), the analytical concordance between SP142 and SP263 and 22C3 was 69.2% and 68.7%, respectively. Almost all SP142+ cases were captured by other assays (double positive), but several SP263+ (29.6%) or 22C3+ (29.0%) cases were SP142- (single positive). A+nP clinical activity vs placebo+nP in SP263+ and 22C3+ patients (progression-free survival [PFS] hazard ratios [HRs] = 0.64 to 0.68; overall survival [OS] HRs = 0.75 to 0.79) was driven by double-positive cases (PFS HRs = 0.60 to 0.61; OS HRs = 0.71 to 0.75) rather than single-positive cases (PFS HRs = 0.68 to 0.81; OS HRs = 0.87 to 0.95). Concordance for harmonized cutoffs for SP263 (IC ≥4%) and 22C3 (CPS ≥10) to SP142 (IC ≥1%) was subpar (approximately 75%). CONCLUSIONS 22C3 and SP263 assays identified more patients as PD-L1+ (IC ≥1%) than SP142. No inter-assay analytical equivalency was observed. Consistent improved A+nP efficacy was captured by the SP142 PD-L1 IC ≥1% subgroup nested within 22C3 and SP263 PD-L1+ (IC ≥1%) populations.
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Affiliation(s)
- Hope S Rugo
- Department of Medicine (Hematology/Oncology), University of California San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, CA, USA
| | - Sherene Loi
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - Sylvia Adams
- New York University Langone Health, Perlmutter Cancer Center, New York, NY, USA
| | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, UK
| | - Andreas Schneeweiss
- National Center for Tumor Diseases (NCT), Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Carlos H Barrios
- Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Véronique Diéras
- Department of Medical Oncology, Institut Curie, Paris, and Centre Eugène Marquis, Rennes, France
| | | | | | | | | | | | | | - Giuseppe Viale
- Post-graduate Medical School in Pathology, University of Milan, Milan, Italy
- Division of Pathology and Laboratory Medicine, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Leisha A Emens
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA, USA
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24
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Emens LA, Adams S, Barrios CH, Diéras V, Iwata H, Loi S, Rugo HS, Schneeweiss A, Winer EP, Patel S, Henschel V, Swat A, Kaul M, Molinero L, Patel S, Chui SY, Schmid P. Corrigendum to 'First-line atezolizumab plus nab-paclitaxel for unresectable, locally advanced, or metastatic triple-negative breast cancer: IMpassion130 final overall survival analysis': Annals of Oncology 2021; 32: 983-993. Ann Oncol 2021; 32:1650. [PMID: 34740469 DOI: 10.1016/j.annonc.2021.10.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Affiliation(s)
- L A Emens
- University of Pittsburgh Medical Center Hillman Cancer Center and Department of Medicine, Pittsburgh, USA.
| | - S Adams
- Breast Cancer Center, and Department of Medicine, New York University Langone Health, Perlmutter Cancer Center, New York, USA
| | - C H Barrios
- Oncology Clinics Group, Centro de Pesquisa Clínica, HSL, PUCRS, Porto Alegre, Brazil
| | - V Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - H Iwata
- Breast Cancer Oncology Department, Aichi Cancer Center Hospital, Nagoya, Japan
| | - S Loi
- Translational Breast Cancer Genomics and Therapeutics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H S Rugo
- Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco, USA
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - E P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - S Patel
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - V Henschel
- Product Development Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - A Swat
- Product Development Oncology, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - M Kaul
- Product Development Safety, Genentech, Inc., South San Francisco, USA
| | - L Molinero
- Oncology Biomarker Development, Genentech, Inc., South San Francisco, USA
| | - S Patel
- Product Development Data Sciences, Genentech, Inc., South San Francisco, USA
| | - S Y Chui
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - P Schmid
- Department of Cancer Medicine, Barts Cancer Institute, Queen Mary University London, London, UK
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Werutsky G, Barrios CH, Cardona AF, Albergaria A, Valencia A, Ferreira CG, Rolfo C, de Azambuja E, Rabinovich GA, Sposetti G, Arrieta O, Dienstmann R, Rebelatto TF, Denninghoff V, Aran V, Cazap E. Perspectives on emerging technologies, personalised medicine, and clinical research for cancer control in Latin America and the Caribbean. Lancet Oncol 2021; 22:e488-e500. [PMID: 34735818 DOI: 10.1016/s1470-2045(21)00523-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 12/23/2022]
Abstract
Challenges of health systems in Latin America and the Caribbean include accessibility, inequity, segmentation, and poverty. These challenges are similar in different countries of the region and transcend national borders. The increasing digital transformation of health care holds promise of more precise interventions, improved health outcomes, increased efficiency, and ultimately reduced health-care costs. In Latin America and the Caribbean, the adoption of digital health tools is in early stages and the quality of cancer registries, electronic health records, and structured databases are problematic. Cancer research and innovation in the region are limited due to inadequate academic resources and translational research is almost fully dependent on public funding. Regulatory complexity and extended timelines jeopardise the potential improvement in participation in international studies. Emerging technologies, artificial intelligence, big data, and cancer research represent an opportunity to address the health-care challenges in Latin America and the Caribbean collectively, by optimising national capacities, sharing and comparing best practices, and transferring scientific and technical capabilities.
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Affiliation(s)
- Gustavo Werutsky
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil.
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil; Oncology Department, Rio de Janeiro, Brazil
| | - Andres F Cardona
- Thoracic and Brain Tumor Unit, Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia; Foundation for Clinical and Applied Cancer Research (FICMAC), Bogotá, Colombia; Molecular Oncology and Biology Systems Research Group (Fox-G), Universidad el Bosque, Bogotá, Colombia
| | - André Albergaria
- Translational Research & Industry Partnerships Unit, Instituto de Inovação em Saúde (i3S), Porto, Portugal
| | - Alfonso Valencia
- Institución Catalana de Investigación y Estudios Avanzados (ICREA) and Barcelona Supercomputing Center, Barcelona, Spain
| | | | - Christian Rolfo
- Center for Thoracic Oncology, The Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York City, NY, USA
| | - Evandro de Azambuja
- Medical Oncology Department, Institut Jules Bordet and l'Université Libre de Bruxelles, Brussels, Belgium
| | - Gabriel A Rabinovich
- Laboratory of Immunopathology, Institute of Biology and Experimental Medicine, and School of Exact and Natural Sciences, University of Buenos Aires, Buenos Aires, Argentina
| | - Georgina Sposetti
- Instituto de Investigaciones Clinicas Mar del Plata, Buenos Aires, Argentina; Un Ensayo para Mi, Buenos Aires, Argentina
| | - Oscar Arrieta
- Department of Thoracic Oncology, Instituto Nacional de Cancerología (INCan), Mexico City, Mexico
| | - Rodrigo Dienstmann
- Oncoclínicas Precision Medicine and Big Data Initiative, Rio de Janeiro, Brazil
| | | | - Valeria Denninghoff
- University of Buenos Aires - National Council for Scientific and Technical Research (CONICET), Buenos Aires, Argentina
| | - Veronica Aran
- Instituto Estadual do Cérebro Paulo Niemeyer, Rio de Janeiro, Brazil
| | - Eduardo Cazap
- Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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26
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Barrios CH, Werutsky G, Mohar A, Ferrigno AS, Müller BG, Bychkovsky BL, Castro E CJ, Uribe CJ, Villarreal-Garza C, Soto-Perez-de-Celis E, Gutiérrez-Delgado F, Kim JS, Ismael J, Delgado L, Santini LA, Teich N, Chavez PC, Liedke PER, Exman P, Barroso-Sousa R, Stefani SD, Cáceres SAB, Rebelatto TF, Pastrana T, Chavarri-Guerra Y, Vargas Y, Cazap E. Cancer control in Latin America and the Caribbean: recent advances and opportunities to move forward. Lancet Oncol 2021; 22:e474-e487. [PMID: 34735817 DOI: 10.1016/s1470-2045(21)00492-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/03/2021] [Accepted: 08/11/2021] [Indexed: 10/20/2022]
Abstract
The increasing burden of cancer represents a substantial problem for Latin America and the Caribbean. Two Lancet Oncology Commissions in 2013 and 2015 highlighted potential interventions that could advance cancer care in the region by overcoming existing challenges. Areas requiring improvement included insufficient investment in cancer control, non-universal health coverage, fragmented health systems, inequitable concentration of cancer services, inadequate registries, delays in diagnosis or treatment initiation, and insufficient palliative services. Progress has been made in key areas but remains uneven across the region. An unforeseen challenge, the COVID-19 pandemic, strained all resources, and its negative effect on cancer control is expected to continue for years. In this Series paper, we summarise progress in several aspects of cancer control since 2015, and identify persistent barriers requiring commitment of additional resources to reduce the cancer burden in Latin America and the Caribbean.
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Affiliation(s)
- Carlos H Barrios
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil.
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Alejandro Mohar
- Unidad de Epidemiología, Instituto Nacional de Cancerología, Instituto de Investigaciones Biomédicas, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ana S Ferrigno
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Bettina G Müller
- Department of Medical Oncology, Instituto Nacional del Cáncer, Santiago, Chile
| | - Brittany L Bychkovsky
- Division of Cancer Genetics and Prevention, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
| | | | | | - Cynthia Villarreal-Garza
- Breast Cancer Center, Hospital Zambrano Hellion TecSalud, Tecnologico de Monterrey, San Pedro Garza Garcia, Nuevo León, Mexico
| | - Enrique Soto-Perez-de-Celis
- Department of Geriatrics, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Francisco Gutiérrez-Delgado
- Centro de Estudios y Prevención del Cancer Tuxtla Gutiérrez, Chiapas, México; Latin American School of Oncology (ELO), México City, México
| | - Ji Seok Kim
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA; Dewpoint Therapeutics, Boston, MA, USA
| | | | - Lucia Delgado
- Faculty of Medicine, University of Uruguay, Montevideo, Uruguay; Honorary Commission for the Fight Against Cancer, Montevideo, Uruguay
| | - Luiz A Santini
- Center of Strategic Studies of FIOCRUZ (Fundação Oswaldo Cruz), Rio de Janeiro, Brazil
| | - Nelson Teich
- Teich Health Care Consulting, Rio de Janeiro, Brazil
| | - Pamela C Chavez
- Department of Internal Medicine, Advocate Illinois Masonic Medical Center, Chicago, Illinois, USA
| | - Pedro E R Liedke
- Oncology Department, Oncoclinicas Group, Porto Alegre, Brazil; Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil; Department of Oncology, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil; Unidade de Pesquisa Clínica em Oncologia, Porto Alegre, Brazil
| | - Pedro Exman
- Department of Medical Oncology, Hospital Alemão Oswaldo Cruz, São Paulo, Brazil
| | | | | | - Suyapa A Bejarano Cáceres
- Medicine Universidad Católica de Honduras, San Pedro Sula, Honduras; Department of Clinical Oncology, Liga Contra el Cáncer, San Pedro Sula, Honduras
| | | | - Tania Pastrana
- Department of Palliative Medicine, Medical Faculty, RWTH Aachen University, Aachen, Germany
| | - Yanin Chavarri-Guerra
- Department of Hemato-Oncology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubiran, Mexico City, Mexico
| | - Yolanda Vargas
- Unidad de Cuidados Paliativos y Clínica de Alivio del Dolor Oncológico, Instituto Oncológico Nacional, Ciudad de Panamá, Panamá
| | - Eduardo Cazap
- Latin American and Caribbean Society of Medical Oncology (SLACOM), Buenos Aires, Argentina
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Barrios CH. IMMUNE-RELATED TOXICITY: EMERGING CHALLENGES. Breast 2021. [DOI: 10.1016/s0960-9776(21)00507-5] [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: 11/17/2022] Open
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28
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Weis LN, Tolaney SM, Barrios CH, Barroso-Sousa R. Tissue-agnostic drug approvals: how does this apply to patients with breast cancer? NPJ Breast Cancer 2021; 7:120. [PMID: 34518552 PMCID: PMC8437983 DOI: 10.1038/s41523-021-00328-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/20/2021] [Indexed: 02/08/2023] Open
Abstract
Precision medicine has provided new perspectives in oncology, yielding research on the use of targeted therapies across different tumor types, regardless of their site of origin, a concept known as tissue-agnostic indication. Since 2017, the Food and Drug Administration (FDA) has approved the use of three different agents for tumor-agnostic treatment: pembrolizumab (for patients with microsatellite instability or high tumor mutational burden) and larotrectinib and entrectinib (both for use in patients harboring tumors with NTRK fusions). Importantly, the genomic alterations targeted by these agents are uncommon or rare in breast cancer, and little information exists regarding their efficacy in advanced breast cancer. In this review, we discuss the prevalence of these targets in breast cancer, their detection methods, the clinical characteristics of patients whose tumors have these alterations, and available data regarding the efficacy of these agents in breast cancer.
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Affiliation(s)
- Luiza N Weis
- Instituto de Ensino e Pesquisa Hospital Sírio-Libanês, São Paulo-SP, Brazil
| | - Sara M Tolaney
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | | | - Romualdo Barroso-Sousa
- Instituto de Ensino e Pesquisa Hospital Sírio-Libanês, São Paulo-SP, Brazil.
- Oncology Center, Hospital Sírio-Libanês Brasília, Brasília-DF, Brazil.
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29
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Emens LA, Adams S, Barrios CH, Diéras V, Iwata H, Loi S, Rugo HS, Schneeweiss A, Winer EP, Patel S, Henschel V, Swat A, Kaul M, Molinero L, Patel S, Chui SY, Schmid P. Corrigendum to 'First-line atezolizumab plus nab-paclitaxel for unresectable locally advanced or metastatic triple-negative breast cancer: IMpassion130 final overall survival analysis': Annals of Oncology 2021; volume 32: 983-993. Ann Oncol 2021; 32:1308. [PMID: 34353668 DOI: 10.1016/j.annonc.2021.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Affiliation(s)
- L A Emens
- University of Pittsburgh Medical Center Hillman Cancer Center and Department of Medicine, Pittsburgh, USA.
| | - S Adams
- Breast Cancer Center, and Department of Medicine, New York University Langone Health, Perlmutter Cancer Center, New York, USA
| | - C H Barrios
- Oncology Clinics Group, Centro de Pesquisa Clínica, HSL, PUCRS, Porto Alegre, Brazil
| | - V Diéras
- Department of Medical Oncology, Centre Eugène Marquis, Rennes, France
| | - H Iwata
- Breast Cancer Oncology Department, Aichi Cancer Center Hospital, Nagoya, Japan
| | - S Loi
- Translational Breast Cancer Genomics and Therapeutics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - H S Rugo
- Department of Medicine, University of California San Francisco Comprehensive Cancer Center, San Francisco, USA
| | - A Schneeweiss
- National Center for Tumor Diseases, University Hospital and German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - E P Winer
- Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, USA
| | - S Patel
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - V Henschel
- Product Development Data Science, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - A Swat
- Product Development Oncology, F. Hoffmann-La Roche Ltd., Basel, Switzerland
| | - M Kaul
- Product Development Safety, Genentech, Inc., South San Francisco, USA
| | - L Molinero
- Oncology Biomarker Development, Genentech, Inc., South San Francisco, USA
| | - S Patel
- Product Development Data Sciences, Genentech, Inc., South San Francisco, USA
| | - S Y Chui
- Product Development Oncology, Genentech, Inc., South San Francisco, USA
| | - P Schmid
- Department of Cancer Medicine, Barts Cancer Institute, Queen Mary University London, London, UK
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30
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Jassem J, de Marinis F, Giaccone G, Vergnenegre A, Barrios CH, Morise M, Felip E, Oprean C, Kim YC, Andric Z, Mocci S, Enquist I, Komatsubara K, McCleland M, Kuriki H, Villalobos M, Phan S, Spigel DR, Herbst RS. Updated Overall Survival Analysis From IMpower110: Atezolizumab Versus Platinum-Based Chemotherapy in Treatment-Naive Programmed Death-Ligand 1-Selected NSCLC. J Thorac Oncol 2021; 16:1872-1882. [PMID: 34265434 DOI: 10.1016/j.jtho.2021.06.019] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [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: 04/27/2021] [Revised: 06/11/2021] [Accepted: 06/14/2021] [Indexed: 11/25/2022]
Abstract
INTRODUCTION IMpower110 previously revealed significant overall survival (OS) benefit with atezolizumab versus chemotherapy in patients with treatment-naive EGFR- and ALK-negative (wild type [WT]) metastatic NSCLC with high programmed death-ligand 1 (PD-L1) expression (≥50% on tumor cells [TCs] or ≥10% on tumor-infiltrating immune cells [ICs], per SP142 immunohistochemistry assay; p = 0.0106). We present primary OS analyses in lower PD-L1 expression groups and an updated, exploratory analysis in the high PD-L1 expression group. METHODS This open-label, phase 3 trial randomized patients with PD-L1 expression on greater than or equal to 1% of TC or IC to receive atezolizumab or platinum-based chemotherapy. The primary end point was OS, hierarchically tested in PD-L1 expression WT subgroups: first the high PD-L1 expression subgroup, then the high-or-intermediate PD-L1 expression subgroup (≥5% on TC or IC), and then the any PD-L1 expression subgroup (≥1% on TC or IC). RESULTS The any PD-L1 expression WT population included 554 patients (excluded 18 EGFR- or ALK-positive patients). With 17 months' additional follow-up, OS improvement in the atezolizumab versus chemotherapy arm was not statistically significant in high-or-intermediate PD-L1 expression WT patients (n = 328; hazard ratio = 0.87, 95% confidence interval: 0.66-1.14, p = 0.3091; median = 19.9 versus 16.1 mo), precluding formal OS testing in any PD-L1 expression WT patients. Exploratory analysis in high PD-L1 expression WT patients (n = 205) revealed maintained OS benefit in the atezolizumab arm (hazard ratio = 0.76, 95% confidence interval: 0.54-1.09; median = 20.2 versus 14.7 mo). Updated safety data continued to favor atezolizumab. CONCLUSIONS Statistical significance for OS was not revealed in the high-or-intermediate expression WT group, and, as a result, OS in the any PD-L1 expression WT group was not formally tested. No new safety signals were found. This updated analysis of IMpower110 supports using atezolizumab in treatment-naive, metastatic WT NSCLC with high PD-L1 expression.
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Affiliation(s)
| | - Filippo de Marinis
- European Institute of Oncology, Istituto di Ricovero e Cura a Carattere Scientifico, Milan, Italy
| | | | | | - Carlos H Barrios
- Centro de Pesquisa Clínica, Hospital São Lucas, PUCRS, Porto Alegre, Brazil
| | - Masahiro Morise
- Nagoya University Graduate School of Medicine, Nagoya, Japan
| | | | - Cristina Oprean
- Oncomed SRL and Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - Young-Chul Kim
- Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun, South Korea
| | - Zoran Andric
- Clinical Hospital Center Bezanijska Kosa, Belgrade, Serbia
| | | | - Ida Enquist
- Genentech, Inc., South San Francisco, California
| | | | | | | | | | - See Phan
- Genentech, Inc., South San Francisco, California
| | - David R Spigel
- Sarah Cannon Research Institute/Tennessee Oncology, Nashville, Tennessee
| | - Roy S Herbst
- Medical Oncology, Yale Cancer Center, Yale School of Medicine, New Haven, Connecticut.
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Molinero LL, Mittendorf EA, Zhang H, Barrios CH, Saji S, Jung KH, Patel S, Chang CW, Liste-Hermoso M, Chui SY, Harbeck N. Abstract LB162: Evaluation of tumor immune biomarkers with pathologic complete response (pCR) in patients receiving atezolizumab + chemotherapy in early triple negative breast cancer (eTNBC): exploratory analyses from the IMpassion031 study. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-lb162] [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: Biomarkers of tumor immunity have been associated with the clinical activity of immune checkpoint inhibitors in TNBC. IMpassion031 showed improvements in pCR in eTNBC with neoadjuvant atezolizumab (A) plus nab-paclitaxel (nP) followed by A with doxorubicin/cyclophosphamide (AC) in patients (pts) with high-risk primary invasive eTNBC regardless of PD-L1 status (Mittendorf et al, Lancet 2020). The current study evaluated the association of tumor immune biomarkers with A plus chemotherapy pCR rates and on-treatment modulation. Methods: IMpassion031 (NCT03197935) is a Phase III, global, double-blind, randomized trial. Eligible pts (≥18 years old) had previously untreated, stage II-III (cT2-T4d and cN0-N3c) invasive eTNBC. Pts (N=333) were randomized 1:1 to receive A 840 mg or placebo (P) every 2 weeks (q2w) + nP 125 mg/m2 weekly for 12 weeks, followed by A 840 mg or P q2w + doxorubicin 60 mg/m2 q2w and cyclophosphamide 600 mg/m2 q2w for 4 doses, before undergoing surgery. Evaluable samples collected at baseline (N=333 [mandatory]) and on treatment (OT, n=27 [optional]) were assessed for PD-L1 expression (VENTANA SP142) on immune (IC) and tumor (TC) cells, levels of stromal and intratumoral tumor-infiltrating lymphocytes (sTILs, iTILs) and the presence of tertiary lymphoid structures (TLS). Dynamics and association with pCR were also evaluated. Results: PD-L1 IC, PD-L1 TC, sTIL and iTIL levels were balanced between treatment arms. 46% of pts were PD-L1 IC+ (IC≥1%) and 16% of pts were PD-L1 TC+ (TC≥1%); most of the latter were also IC+. PD-L1 IC was weakly correlated with sTILs (r=0.33) or iTILs (r=0.30). pCR increased at higher PD-L1 IC cutoffs regardless of treatment arm and was higher in the A arm (PD-L1 IC<1%: 48%; ≥1% and <5%: 62%; ≥5%: 85%) than the P arm (35%, 40% and 67%, respectively). A numerically higher pCR difference favoring A vs P was observed in PD-L1 TC+ pts (76% vs 55%) vs TC- pts (54% vs 39%). Neither elevated sTILs, iTILs or TLS were associated with increased pCR in the A arm, though these biomarkers were linked to improved pCR in the P arm. Evaluation of OT biopsies suggested that the addition of A to nP elevated PD-L1 IC, TC and iTILs, but not sTILs, while P + nP mildly increased PD-L1 IC but not the other biomarkers tested. Increases in PD-L1 IC and iTILs 2 weeks post-treatment initiation were linked to pCR in A only. Conclusions: Several tumor immune biomarkers were associated with each other and with improved pCR in the IMpassion031 control arm, but only PD-L1 expression on IC or TC was linked to numerically increased pCR rates with A + nP-AC. Preliminary on-treatment data suggest that A plus chemotherapy promotes close contact of lymphocytes with tumor cell nests. Further evaluation of the tumor immune microenvironment in pts treated with A + nP-AC is warranted.
Citation Format: Luciana L. Molinero, Elizabeth A. Mittendorf, Hong Zhang, Carlos H. Barrios, Shigehira Saji, Kyung Hae Jung, Shilpen Patel, Ching-Wei Chang, Mario Liste-Hermoso, Stephen Y. Chui, Nadia Harbeck. Evaluation of tumor immune biomarkers with pathologic complete response (pCR) in patients receiving atezolizumab + chemotherapy in early triple negative breast cancer (eTNBC): exploratory analyses from the IMpassion031 study [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2021; 2021 Apr 10-15 and May 17-21. Philadelphia (PA): AACR; Cancer Res 2021;81(13_Suppl):Abstract nr LB162.
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Affiliation(s)
| | | | - Hong Zhang
- 3Memorial Sloan Kettering Cancer Center, New York, NY
| | | | | | - Kyung Hae Jung
- 6Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | | | | | | | | | - Nadia Harbeck
- 8Breast Center, Ludwig-Maximilians-University (LMU), Ludwig, Germany
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Pavei C, Rosa DD, Bines J, Werutsky G, Barrios CH, Cronemberger E, Simon SD, Queiroz GS, Cordeiro De Lima VC, Freitas-Junior R, Resende HM, Costa SC, Reinert T, Van Eyll BM, Bertoni VD, Neron YV, Lazaretti N, Gomes R, Rebelatto TF, Liedke PER. Sociodemographic and clinicopathologic features of elderly breast cancer patients in Brazil: A sub-analysis of AMAZONA III study (GBCAM 0115). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.e12603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e12603 Background: Breast cancer (BC) is the most common invasive cancer diagnosed in women worldwide. The risk of developing BC increases with age. Studies have shown that approximately up to half of BC cases occur in patients aged 65 years and older. To better understand and characterize elderly patients with BC in Brazil, we performed a sub analysis of AMAZONA III study (ClinicalTrials.gov identifier: NCT02663973). Methods: The AMAZONA III study (GBCAM 0115) is a prospective cohort study that included 2,950 women with newly diagnosed invasive BC from January 2016 to March 2018 in 23 Brazilian sites. For this sub analysis, only BC patients aged 65 years and older were included. To compare sociodemographic and clinicopathologic features we classify patients into two groups: cohort 65 to 75 years of age and cohort 75 years and older. Qualitative variables were described by absolute and relative frequencies and compared with Chi-square test. Results: Of 2,950 BC patients from AMAZONA IIII study, 602 (20.8%) were ≥ 65 years-old and were included in this sub analysis. Most patients (93.1%) had ECOG performance status 0-1, 63.4% were white. In terms of educational level, 68.6% had reported completing primary school or less. At diagnosis, 23.7% of patients had clinical stage (CS) I, 41.9% had CS II, 28.2% had CS III, and 6.2% had CS IV disease. The majority of BC were detected by symptoms and only 34.2% were detected by screening. Regarding pathological characteristics, half of cases were grade 2, 58.7% were hormone receptor positive, 25% were HER-2 positive, and 16.0% were triple negative. When evaluated by subgroup, patients from cohort 75 years and older were more frequently diagnosed at advanced clinical stages and had worse ECOG performance status at diagnosis. There was no statistically significant difference in molecular subtype, tumor grade, and mode of BC detection (Table). Conclusions: Elderly patients commonly had BC detected by symptoms. Patients from cohort 75 years and older are diagnosed more frequently with advanced disease and worse performance status than patients from cohort 65 to 75 years. Strategies to improve BC screening and educational programs among elderly patients are warranted to guarantee accessibility to early BC diagnosis.[Table: see text]
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Affiliation(s)
- Carla Pavei
- Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil
| | | | - Jose Bines
- Instituto Nacional de Câncer, Rio De Janeiro, Brazil
| | | | | | | | | | | | | | | | | | | | - Tomas Reinert
- Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | | | | | - Yeni Verónica Neron
- Centro de Pesquisas Oncológicas-CEPON, Brazilian Group of Gynecological Oncology (EVA), Florianopolis-SC, Brazil
| | | | - Rafaela Gomes
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
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Apolo AB, Powles T, Burotto M, Bourlon MT, Hsieh JJ, Basso U, Shah AY, Suarez C, Porta C, Barrios CH, Gurney H, Kessler ER, Retz M, George S, Escudier B, Zhang J, Simsek B, Scheffold C, Motzer RJ, Choueiri TK. Nivolumab plus cabozantinib (N+C) versus sunitinib (S) for advanced renal cell carcinoma (aRCC): Outcomes by baseline disease characteristics in the phase 3 CheckMate 9ER trial. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.4553] [Citation(s) in RCA: 11] [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] [Indexed: 11/20/2022] Open
Abstract
4553 Background: First-line N+C significantly improved progression-free survival (PFS), overall survival (OS), and objective response rate (ORR) vs S in aRCC patients (pts) in the phase 3 CheckMate 9ER trial, leading to FDA approval of N+C in this setting. A deeper understanding of how baseline disease characteristics may impact clinical outcomes with N+C vs S may inform clinical decision making. Methods: Pts with clear cell aRCC were randomized to N 240 mg IV Q2W + C 40 mg PO QD vs S 50 mg PO QD (4 weeks of 6-week cycles). In this post hoc exploratory analysis, PFS, OS, and ORR were evaluated across pt subgroups defined by baseline IMDC risk status, organ sites of metastases (mets), number of organs with any lesions, or target lesion size. Consistent with primary/secondary efficacy endpoints in ITT pts, PFS and ORR were evaluated per RECIST v1.1 by blinded independent central review in subgroups. Results: Median follow-up in ITT pts was 23.5 months. PFS, OS, and ORR (including complete response [CR]) outcomes are summarized in the table across subgroups: IMDC risk (favorable [FAV], intermediate [I], poor [P]); number of organs with ≥ 1 target/nontarget lesion (T/NT; 1 and ≥ 2); sum of diameters of target lesions (sDTL; < and ≥ median [72.1 mm]), and in pts with liver, bone, or lung mets. The PFS HR favored N+C vs S and median (m) PFS was longer with N+C vs S across all subgroups. The OS HR also favored N+C vs S across most subgroups. ORR ranged from 38%–66% (N+C) vs 10%–44% (S) across subgroups, and CR benefits were seen with N+C in most subgroups. Additional outcomes including landmark OS and response details in subgroups will be reported. Conclusions: Consistent with outcomes in ITT pts, efficacy benefits with N+C vs S were observed regardless of IMDC risk status, organ site of mets, or extent of tumor burden at baseline. These results support N+C as a new first-line treatment option for pts with aRCC. Clinical trial information: NCT03141177. [Table: see text]
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Affiliation(s)
- Andrea B. Apolo
- National Cancer Institute, National Institutes of Health, Bethesda, MD
| | - Thomas Powles
- Barts Cancer Institute, Cancer Research UK Experimental Cancer Medicine Centre, Queen Mary University of London, Royal Free National Health Service Trust, London, United Kingdom
| | | | - Maria Teresa Bourlon
- Urologic Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, DF, Mexico
| | - James J Hsieh
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | | | | | - Cristina Suarez
- Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | | | - Howard Gurney
- Westmead Hospital and Macquarie University, Sydney, NSW, Australia
| | | | - Margitta Retz
- Rechts der Isar Medical Center, Technical University Munich, Munich, Germany
| | - Saby George
- Roswell Park Comprehensive Cancer Center, Buffalo, NY
| | | | | | | | | | | | - Toni K. Choueiri
- Lank Center for Genitourinary Oncology, Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and Harvard Medical School, Boston, MA
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Dienstmann R, Menezes M, Costa e Silva M, Cruz H, Paes R, Alves da Silva J, Messias ACR, De Marchi P, Canedo JA, Melo ACD, Jácome AA, Reinert T, Ferreira BSF, Mathias C, Barrios CH, Ferreira CGM, Ferrari BL. Machine learning prediction of COVID-19 mortality in cancer patients. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1558 Background: COVID-19 is a challenge for clinical decision-making in cancer patients and the allocation of healthcare resources. An accurate prognosis prediction to effectively triage patients is needed, especially in the community oncology practice. Methods:Nationwide cohort from Oncoclínicas Brazil was used to validate previously developed multivariable logistic regression (mLR) model (Ferrari et al, JCO GO 2021) and to construct a machine learning Random Forest (RF) algorithm as predictor of 30-day mortality after SARS-CoV-2 detection by RT-PCR in cancer patients diagnosed in an outpatient setting. To find the most important baseline clinical determinants of early COVID-19-related death via Gini index, a RF with 100,000 trees was trained in 75% of the dataset, and the performance was assessed in the remaining 25%. We then compared the accuracy of different models in terms of sensitivity, specificity and area under the receiver operating characteristics curves (AUC). Results:From March to December 2020, 533 patients with COVID-19 were prospectively registered in the database. Median age was 60 years (19-93) and 67% were female. Most frequent cancers were breast in 34%, hematological in 16%, and gastrointestinal in 15%. Comorbidities were common (52%), as was current/former smoking history (17%). Most patients were on active systemic therapy or radiotherapy (84%) in the advanced or metastatic disease setting (55%). The overall mortality rate was 15% (CI95% 12%-18%). We validated the original mLR model trained in the first 198 patients: management in a non-curative setting (odds ratio [OR] 3.7), age ≥ 60 years (OR 2.3), and current/former smoking (OR 1.9) were significant predictors of death in the expanded cohort. Presence of comorbidities (OR 1.9) also defined poor outcome in the updated mLR model, which yielded low sensitivity (74%), specificity (68%) and AUC (0.78). With RF modeling, the most significant predictors of 30-day death after COVID-19 (in decreasing order) were older age, treatment of advanced or metastatic disease, tumor type (respiratory tract, brain and unknown primary cancers had higher mortality), COVID-related symptom burden at baseline evaluation and treatment regimen (immunotherapy combinations had higher mortality). The RF model demonstrated high sensitivity (89%), specificity (88%) and AUC (0.96). Conclusions:The results highlight the possibility that machine learning algorithms are able to predict early mortality after COVID-19 in cancer patients with high accuracy. The proposed prediction model may be helpful in the prompt identification of high-risk patients based on clinical features alone, without having to wait for the results of additional tests such as laboratory or radiologic studies. It can also help prioritize medical resources and redefine vaccination strategies. A web-based mortality risk calculator will be created for clinical decision support.
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Emens LA, Goldstein LD, Schmid P, Rugo HS, Adams S, Barrios CH, Schneeweiss A, Dieras V, Iwata H, Chang CW, Koeppen H, Chui SY, Loi S, Molinero L. The tumor microenvironment (TME) and atezolizumab + nab-paclitaxel (A+nP) activity in metastatic triple-negative breast cancer (mTNBC): IMpassion130. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1006] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1006 Background: IMpassion130 was the first randomized phase 3 study to show clinical benefit of cancer immunotherapy (CIT) in untreated PD-L1+ mTNBC. Enhanced A + nP efficacy vs placebo (P) + nP was seen in pts with a richer immune TME but was confined to PD-L1 IC+ pts (PD-L1–expressing immune cells on ≥1% of tumor area; Emens JNCI 2021). While TNBC molecular subtyping and CD8 localization are prognostic in early TNBC, it is unknown whether these features are associated with CIT benefit in mTNBC. This exploratory analysis aimed to identify TME components associated with A + nP efficacy in IMpassion130. Methods: IHC was used to assess PD-L1 status (VENTANA SP142) and immune phenotypes (inflamed/excluded/desert per CD8 stromal/intratumoral localization; Mariathasan Nature 2018). RNA-seq was used for molecular subtyping (Burstein CCR 2015) and pathway analyses (MSigDB Hallmark). Cox regression was used to compare PFS/OS between A + nP vs P + nP, adjusted for prior taxanes, liver mets. Results: Sample classification and PD-L1 distribution are shown (Table). Improved PFS with A + nP vs P + nP was seen in PD-L1 IC+ inflamed and excluded tumors, but improved OS was limited to PD-L1 IC+ inflamed tumors. PD-L1 IC+ basal-like immune activated (BLIA) and immune suppressed (BLIS) subgroups derived PFS benefit, but OS benefit was limited to PD-L1 IC+ BLIA subgroups. In PD-L1 IC+ pts, pathway analysis identified proliferation/DNA damage repair (basal-like tumor features) and angiogenesis/ER response (higher in luminal androgen receptor [LAR]/ mesenchymal [MES] tumors) were associated with improved and reduced PFS, respectively. Conclusions: PD-L1 IC+ immune-inflamed tumors and PD-L1 IC+ BLIA tumors show highest CIT sensitivity, and LAR tumors may be resistant to CIT. These data warrant further study and validation. Clinical trial information: NCT02425891 .[Table: see text]
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Affiliation(s)
- Leisha A. Emens
- University of Pittsburgh Medical Center Hillman Cancer Center, Pittsburgh, PA
| | | | - Peter Schmid
- Barts Cancer Institute, Queen Mary University of London, London, United Kingdom
| | - Hope S. Rugo
- University of California, San Francisco, San Francisco, CA
| | - Sylvia Adams
- New York University Cancer Institute, New York, NY
| | | | - Andreas Schneeweiss
- University Hospital and German Cancer Research Center Heidelberg, Heidelberg, Germany
| | - Veronique Dieras
- Department of Medical Oncology, Centre Eugene Marquis, Rennes, France
| | | | | | | | | | - Sherene Loi
- Peter MacCallum Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
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Wuerstlein R, Ellis P, Montemurro F, Antón Torres A, Delaloge S, Zhang Q, Wang X, Wang S, Zhimin S, Li H, Rachman A, Vongsaisuwon M, Liu H, Fear S, Pena-Murillo C, Barrios CH. Safety of trastuzumab emtansine (T-DM1) in patients (pts) with HER2-positive locally advanced or metastatic breast cancer (mBC): Final results from KAMILLA Cohorts 1 (global) and 2 (Asia). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.1039] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
1039 Background: KAMILLA is an open-label, single-arm, phase 3b safety study of T-DM1 in pts with HER2-positive advanced BC (NCT01702571). The treated (safety) population of KAMILLA comprises 2 cohorts: a larger global Cohort 1 (n=2002) and a smaller Asia Cohort 2 (n=181 [China, n=154; Thailand, n=15; Indonesia, n=12]). Here we report results from Cohort 2 in the context of those previously reported for Cohort 1. Methods: Pts had HER2-positive, locally advanced or mBC with progression after chemotherapy and anti-HER2 therapy or ≤6 months (mo) of completing adjuvant therapy. T-DM1 3.6 mg/kg was given intravenously every 3 weeks until disease progression, consent withdrawal, or unacceptable toxicity. Primary endpoints were grade ≥3 (G≥3) adverse events of primary interest (AEPIs), specifically hepatic events, allergic reactions, thrombocytopenia (TCP), and hemorrhage events; all other G≥3 treatment-related AEs (TRAEs); and all-grade pneumonitis. Results: As of 31 July 2019,KAMILLA enrolled 2185 pts (Cohort 1, n=2003; Cohort 2, n=182), of which 2002 and 181 in each cohort, respectively, received ≥1 study dose and were included in the safety population. Baseline characteristics were generally similar between cohorts. Median (range) T-DM1 exposure was 5.6 mo (0–46) for Cohort 1 and 5.0 mo (0–31) for Cohort 2. The overall G≥3 AEPI rate was higher in Cohort 2 vs Cohort 1 (Table), mostly driven by a higher G≥3 TCP rate in Cohort 2. In Cohort 2, G≥3 TCP (the most frequently reported G≥3 AEPI) did not appear to be associated with G≥3 hemorrhagic events — the majority of G≥3 TCP events (128/138) fully resolved, with a duration of ≤15 days for 98/138 of these events. G≥3 TRAE rates were 18.4% in Cohort 1 and 48.6% in Cohort 2, the latter mainly due to TCP and platelet count decreased; any-grade pneumonitis rates were 1.0% and 2.2%, respectively. No other safety signals were identified. Median progression-free survival and overall survival were similar for both cohorts (Table). Conclusions: These data confirm prior observations in an Asian subgroup of the phase 3 EMILIA trial of T-DM1 in pts with previously treated mBC. Although the G≥3 TCP rate was higher in the Asia cohort, the majority of these events resolved fully. OS and PFS were similar in both cohorts. These data reinforce the favorable T-DM1 benefit-risk profile in mBC. Clinical trial information: NCT01702571 .[Table: see text]
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Affiliation(s)
- Rachel Wuerstlein
- University Hospital Munich, Department of Obstetrics and Gynecology, Breast Center and CCC Munich, LMU, Munich, Germany
| | - Paul Ellis
- Guy’s Hospital and Sarah Cannon Research Institute, London, United Kingdom
| | - Filippo Montemurro
- Fondazione del Piemonte per l’Oncologia Candiolo Cancer Center, Candiolo, Italy
| | | | | | - Qingyuan Zhang
- Harbin Medical University Cancer Hospital, Harbin, China
| | | | - Shusen Wang
- Sun Yet-sen University Cancer Center, Guangzhou, China
| | - Shao Zhimin
- Fudan University Shanghai Cancer Center, Shanghai, China
| | | | | | | | | | - Simon Fear
- F. Hoffmann-La Roche, Basel, Switzerland
| | | | - Carlos H. Barrios
- Oncology Research Center HSL, PUCRS, Latin American Cooperative Oncology Group, Porto Alegre, Brazil
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Turner NC, Jhaveri KL, Bardia A, Niikura N, Dieras V, Barrios CH, Im SA, Mueller V, Bellet M, Chang CW, Ross GA, Patre M, Loi S. persevERA Breast Cancer (BC): Phase III study evaluating the efficacy and safety of giredestrant (GDC-9545) + palbociclib versus letrozole + palbociclib in patients (pts) with estrogen-receptor-positive, HER2-negative locally advanced or metastatic BC (ER+/HER2– LA/mBC). J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.15_suppl.tps1103] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
TPS1103 Background: Modulating estrogen synthesis and/or ER activity is the mainstay of treatment for pts with ER+ BC. Despite substantial progress, many pts experience relapse during/after adjuvant endocrine therapy. However, even though resistant to aromatase inhibitors (AIs) or tamoxifen, growth and survival of the majority of tumors are thought to remain dependent on ER signaling. Therefore, pts with ER+ BC can still respond to second- or third-line endocrine treatment after progression on prior therapy (Di Leo 2010; Baselga 2012). Therapeutic resistance can arise from mutations in ESR1, which can drive estrogen-independent transcription and proliferation. The highly potent, non-steroidal oral selective ER degrader giredestrant achieves robust ER occupancy and is active regardless of ESR1 mutation status. Phase I data indicate that giredestrant is well tolerated, with encouraging activity as a single agent and in combination with the CDK4/6 inhibitor palbociclib (Lim 2020). Single-agent activity was observed after prior treatment with fulvestrant and/or a CDK4/6 inhibitor (Jhaveri 2019). Methods: persevERA BC (NCT04546009) is a double-blind, placebo-controlled, randomized, multicenter phase III study designed to evaluate the efficacy and safety of first-line giredestrant + palbociclib in pts with ER+/HER2– LA/mBC. Randomization: 1:1 to either giredestrant (30 mg PO) plus letrozole placebo QD or letrozole (2.5 mg PO) plus giredestrant placebo QD on Days 1–28 of each 28-day cycle, with palbociclib (125 mg PO QD) on Days 1–21 of each 28-day cycle. Men and premenopausal women will receive an LHRH agonist. Eligibility: females or males ≥18 years old with measurable disease or evaluable bone disease and no prior treatment for advanced disease. Pts who received prior fulvestrant or who have relapsed within 12 months of completion of (neo)adjuvant therapy with an AI and/or prior therapy with CDK4/6 inhibitor are not eligible; relapse during tamoxifen therapy but > 24 months after the start of tamoxifen therapy is allowed. Stratification: site of disease, disease-free interval since the end of (neo)adjuvant therapy, menopausal status, and geographic region. Primary efficacy endpoint: progression-free survival (determined locally by the investigator per RECIST v1.1). Secondary endpoints include overall survival, objective response rate, duration of response, clinical benefit rate, QoL, and safety. Enrollment is open (first patient in: Oct 9, 2020); target recruitment is 978 pts across all sites in a global enrollment phase. After completion of the global enrollment, additional pts may be enrolled in China. Clinical trial information: NCT04546009 .
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Affiliation(s)
| | | | - Aditya Bardia
- Massachusetts General Hospital Cancer Center, Boston, MA
| | | | | | | | - Seock-Ah Im
- Seoul National University College of Medicine, Seoul, South Korea
| | | | - Meritxell Bellet
- Vall d’Hebron University Hospital and Vall d’Hebron Institute of Oncology, Barcelona, Spain
| | | | | | | | - Sherene Loi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
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Barrios CH, Mano MS. Is Independent Clinical Research Possible in Low- and Middle-Income Countries? A Roadmap to Address Persistent and New Barriers and Challenges. Am Soc Clin Oncol Educ Book 2021; 41:1-10. [PMID: 33830826 DOI: 10.1200/edbk_321335] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cancer is an increasing and significant problem for both high- and low- and middle-income countries. Basic, translational, and clinical research efforts have been instrumental in generating the outstanding improvements we have witnessed over the last few decades, answering important questions, and improving patient outcomes. Arguably, a substantial portion of currently ongoing research is sponsored by the pharmaceutical industy and specifically addresses questions under industry interests, most of which apply to high-income countries, leaving behind problems related to the much larger and underserved population of patients with cancer in low- and middle-income countries. In this scenario, discussing independent academic research is an important challenge, particularly for these countries. Although different countries and institutions face different problems while establishing independent research agendas, some generalizable barriers can be identified. A solid regulatory and ethical framework, a strong and sustainable technical supporting infrastructure, and motivated and experienced investigators are all paramount to build a viable and productive academic research program. Securing funding for research, although not the only hurdle, is certainly one of the most basic hurdles to overcome. Noticeably, and as an added impediment, public and governmental support for cancer research has been decreasing in high-income countries and is almost nonexistent in the rest of the world. We propose an initial careful diagnostic assessment of the research resource scenario of each institution/country and adjustment of the strategic development plan according to four different research resource restriction levels. Although not necessarily applicable to all situations, this model can be helpful if adjusted to each local or regional situation.
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Affiliation(s)
- Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, PUCRS, Oncoclínicas Group, Porto Alegre, Brazil
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Lara Gongora AB, Werutsky G, Jardim DL, Nogueira-Rodrigues A, Barrios CH, Mathias C, Maluf F, Riechelmann R, Fraga M, Gomes H, William WN, Yamada CAF, de Castro Jr G, Rosa DD, de Melo AC, Sala R, Bustamante E, Bretel D, Arrieta O, Cardona AF, Bastos DA. Impact of the COVID-19 Pandemic on Oncology Clinical Research in Latin America (LACOG 0420). JCO Glob Oncol 2021; 7:649-658. [PMID: 33956499 PMCID: PMC8162498 DOI: 10.1200/go.20.00663] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/01/2021] [Accepted: 04/06/2021] [Indexed: 01/08/2023] Open
Abstract
PURPOSE COVID-19 has affected cancer care worldwide. Clinical trials are an important alternative for the treatment of oncologic patients, especially in Latin America, where trials can be the only opportunity for some of them to access novel and, sometimes, standard treatments. METHODS This was a cross-sectional study, in which a 22-question survey regarding the impact of the COVID-19 pandemic on oncology clinical trials was sent to 350 representatives of research programs in selected Latin American institutions, members of the Latin American Cooperative Oncology Group. RESULTS There were 90 research centers participating in the survey, with 70 of them from Brazil. The majority were partly private or fully private (n = 77; 85.6%) and had confirmed COVID-19 cases at the institution (n = 57; 63.3%). Accruals were suspended at least for some studies in 80% (n = 72) of the responses, mostly because of sponsors' decision. Clinical trials' routine was affected by medical visits cancelation, reduction of patients' attendance, reduction of other specialties' availability, and/or alterations on follow-up processes. Formal COVID-19 mitigation policies were adopted in 96.7% of the centers, including remote monitoring and remote site initiation visits, telemedicine visits, reduction of research team workdays or home office, special consent procedures, shipment of oral drugs directly to patients' home, and increase in outpatient diagnostic studies. Importantly, some of these changes were suggested to be part of future oncology clinical trials' routine, particularly the ones regarding remote methods, such as telemedicine. CONCLUSION To our knowledge, this was the first survey to evaluate the impact of COVID-19 on Latin American oncology clinical trials. The results are consistent with surveys from other world regions. These findings may endorse improvements in clinical trials' processes and management in the postpandemic period.
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Affiliation(s)
- Aline B. Lara Gongora
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Gustavo Werutsky
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Denis L. Jardim
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
| | - Angelica Nogueira-Rodrigues
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Brazilian Group of Gynecologic Oncology (EVA), Belo Horizonte, Brazil
- Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Carlos H. Barrios
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
| | - Clarissa Mathias
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Núcleo de Oncologia da Bahia (NOB)/Oncoclínicas, Salvador, Brazil
- Sociedade Brasileira de Oncologia Clínica (SBOC), São Paulo, Brazil
| | - Fernando Maluf
- Hospital Sírio-Libanês, São Paulo, Brazil
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Rachel Riechelmann
- A.C. Camargo Cancer Center, São Paulo, Brazil
- Brazilian Gastrointestinal Tumors Group (GTG), Porto Alegre, Brazil
| | - Maurício Fraga
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Universidade Federal de Santa Maria (UFSM), Santa Maria, Brazil
| | - Henry Gomes
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Instituto Nacional de Enfermedades Neoplasicas (INEN), Lima, Peru
| | - William N. William
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil
- Brazilian Group of Thoracic Oncology (GBOT), Porto Alegre, Brazil
| | - Camilla A. F. Yamada
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Beneficência Portuguesa de São Paulo, São Paulo, Brazil
| | - Gilberto de Castro Jr
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
- Brazilian Group of Thoracic Oncology (GBOT), Porto Alegre, Brazil
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
| | - Daniela D. Rosa
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Brazilian Group of Breast Cancer Studies (GBECAM), Porto Alegre, Brazil
- Hospital Moinhos de Vento, Porto Alegre, Brazil
| | - Andreia C. de Melo
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Brazilian Group of Gynecologic Oncology (EVA), Belo Horizonte, Brazil
- Instituto Nacional de Câncer (INCA), Rio de Janeiro, Brazil
| | - Raul Sala
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Grupo Argentino de Investigación Clínica en Oncología, Rosario, Argentina
| | - Eva Bustamante
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Chilean Cooperative Group for Oncologic Research (GOCCHI), Santiago, Chile
| | - Denisse Bretel
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Grupo de Estudios Clínicos Oncológicos Peruano (GECOPERU), Lima, Peru
| | - Oscar Arrieta
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Instituto Nacional de Cancerología, Ciudad del México, México City, México
| | - Andrés F. Cardona
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Clinical and Translational Oncology Group, Clínica del Country, Bogotá, Colombia
| | - Diogo A. Bastos
- Latin American Cooperative Oncology Group (LACOG), Porto Alegre, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
- Instituto do Câncer do Estado de São Paulo (ICESP), São Paulo, Brazil
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Moreno-Aspitia A, Holmes EM, Jackisch C, de Azambuja E, Boyle F, Hillman DW, Korde L, Fumagalli D, Izquierdo MA, McCullough AE, Wolff AC, Pritchard KI, Untch M, Guillaume S, Ewer MS, Shao Z, Sim SH, Aziz Z, Demetriou G, Mehta AO, Andersson M, Toi M, Lang I, Xu B, Smith IE, Barrios CH, Baselga J, Gelber RD, Piccart-Gebhart M. Updated results from the international phase III ALTTO trial (BIG 2-06/Alliance N063D). Eur J Cancer 2021; 148:287-296. [PMID: 33765513 DOI: 10.1016/j.ejca.2021.01.053] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 01/14/2021] [Accepted: 01/24/2021] [Indexed: 01/03/2023]
Abstract
AIM To present the pre-specified analyses of >5-years follow-up of the Phase III ALTTO trial. PATIENTS AND METHODS 8381 patients with stage I-III HER2 positive breast cancer randomised to chemotherapy plus 1-year of trastuzumab (T), oral lapatinib (L; no longer evaluated), trastuzumab followed by lapatinib (T→L), and lapatinib + trastuzumab (L+T). The primary endpoint was disease-free survival (DFS). A secondary analysis examined DFS treatment effects by hormone receptor status, nodal status and chemotherapy timing; time to recurrence; overall survival (OS) and safety (overall and cardiac). RESULTS At a median follow-up of 6.9 years, 705 DFS events for L+T versus T were observed. Hazard Ratio (HR) for DFS was 0.86 (95% CI, 0.74-1.00) for L+T versus T and 0.93 (95% CI, 0.81-1.08) for T→L versus T. The 6-year DFS were 85%, 84%, and 82% for L+T, T→L, and T, respectively. HR for OS was 0.86 (95% CI, 0.70-1.06) for L+T versus T and 0.88 (95% CI, 0.71-1.08) for T→L versus T. The 6-year OS were 93%, 92%, and 91% for L+T, T→L, and T, respectively. Subset analyses showed a numerically better HR for DFS in favour of L+T versus T for the hormone-receptor-negative [HR 0.80 (95% CI, 0.64-1.00; 6-yr DFS% = 84% versus 80%)] and the sequential chemotherapy [HR 0.83 (95% CI, 0.69-1.00; 6-yr DFS% = 83% versus79%)] subgroups. CONCLUSION T+L did not significantly improve DFS and OS over T alone, both with chemotherapy, and, therefore, cannot be recommended for adjuvant treatment of early-stage HER2-positive breast cancer. TRIAL REGISTRATION clinicaltrials.gov Identifier NCT00490139.
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Affiliation(s)
| | - Eileen M Holmes
- Dundee Epidemiology and Statistics Unit, University of Dundee, Dundee, UK
| | - Christian Jackisch
- Department of Gynecology and Obstetrics, Sana Klinikum Offenbach GmbH, Offenbach am Main, Germany
| | - Evandro de Azambuja
- Institute Jules Bordet and l' Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Frances Boyle
- Patricia Ritchie Centre for Cancer Care and Research, University of Sydney, Sydney, Australia
| | - David W Hillman
- Alliance Statistics and Data Center, Mayo Clinic, Rochester, MN, USA
| | - Larissa Korde
- Cancer Therapy Evaluation Program, Division of Cancer Treatment and Diagnosis, National Cancer Institute, Bethesda, MD, USA
| | | | | | - Ann E McCullough
- Division of Anatomic Pathology, Mayo Clinic, Scottsdale, AZ, USA
| | | | | | | | - Sébastien Guillaume
- Institute Jules Bordet and l' Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - Michael S Ewer
- MD Anderson Cancer Center, University of Texas, Houston, TX, USA
| | - Zhimin Shao
- Fudan University Shanghai Cancer Center, Shanghai, People's Republic of China
| | - Sung Hoon Sim
- Center for Breast Cancer, National Cancer Centre, Gyeonggi-do, South Korea
| | - Zeba Aziz
- Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Ajay O Mehta
- Central India Cancer Research Institute, Nagpur, Maharashtra, India
| | | | - Masakazu Toi
- Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Istvan Lang
- National Institute of Oncology, Budapest, Hungary
| | - Binghe Xu
- National Cancer Center/Cancer Hospital, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, People's Republic of China
| | - Ian E Smith
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Carlos H Barrios
- Latin American Cooperative Oncology Group (LACOG), Oncoclínicas, Porto Alegre, Brazil
| | - Jose Baselga
- Oncology Research and Development, Astra-Zeneca, Cambridge, UK
| | - Richard D Gelber
- Dana-Farber Cancer Institute, Harvard Medical School, Harvard TH Chan School of Public Health and Frontier Science Technology Research Foundation, Boston, MA, USA
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Owonikoko TK, Park K, Govindan R, Ready N, Reck M, Peters S, Dakhil SR, Navarro A, Rodríguez-Cid J, Schenker M, Lee JS, Gutierrez V, Percent I, Morgensztern D, Barrios CH, Greillier L, Baka S, Patel M, Lin WH, Selvaggi G, Baudelet C, Baden J, Pandya D, Doshi P, Kim HR. Nivolumab and Ipilimumab as Maintenance Therapy in Extensive-Disease Small-Cell Lung Cancer: CheckMate 451. J Clin Oncol 2021; 39:1349-1359. [PMID: 33683919 PMCID: PMC8078251 DOI: 10.1200/jco.20.02212] [Citation(s) in RCA: 127] [Impact Index Per Article: 42.3] [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: 12/31/2022] Open
Abstract
In extensive-disease small-cell lung cancer (ED-SCLC), response rates to first-line platinum-based chemotherapy are robust, but responses lack durability. CheckMate 451, a double-blind phase III trial, evaluated nivolumab plus ipilimumab and nivolumab monotherapy as maintenance therapy following first-line chemotherapy for ED-SCLC.
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Affiliation(s)
| | - Keunchil Park
- Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea
| | - Ramaswamy Govindan
- Alvin J Siteman Cancer Center at Washington University School of Medicine, St Louis, MO
| | - Neal Ready
- Duke University Medical Center, Durham, NC
| | - Martin Reck
- Department of Thoracic Oncology, Airway Research Center North, German Center for Lung Research, LungClinic, Grosshansdorf, Germany
| | - Solange Peters
- Oncology Department, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Alejandro Navarro
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology (VHIO), Barcelona, Spain
| | - Jerónimo Rodríguez-Cid
- Centro Oncológico, Médica Sur-Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | | | - Jong-Seok Lee
- Seoul National University Bundang Hospital, Seongnam, South Korea
| | | | | | - Daniel Morgensztern
- Alvin J Siteman Cancer Center at Washington University School of Medicine, St Louis, MO
| | - Carlos H Barrios
- Oncology Research Center, Hospital São Lucas, Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Laurent Greillier
- Aix Marseille Univ, APHM, INSERM, CNRS, CRCM, Hôpital Nord, Multidisciplinary Oncology and Therapeutic Innovations Department, Marseille, France
| | - Sofia Baka
- Interbalkan European Medical Center, Thessaloniki, Greece
| | - Miten Patel
- Cancer Specialists of North Florida, Jacksonville, FL
| | | | | | | | | | | | | | - Hye Ryun Kim
- Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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Motzer RJ, Choueiri TK, Powles T, Burotto M, Bourlon MT, Hsieh JJ, Maruzzo M, Shah AY, Suarez C, Barrios CH, Richardet ME, Porta C, Goh JC, Tomita Y, Bedke J, Zhang J, Simsek B, Scheffold C, Gupta S, Apolo AB. Nivolumab + cabozantinib (NIVO+CABO) versus sunitinib (SUN) for advanced renal cell carcinoma (aRCC): Outcomes by sarcomatoid histology and updated trial results with extended follow-up of CheckMate 9ER. J Clin Oncol 2021. [DOI: 10.1200/jco.2021.39.6_suppl.308] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
308 Background: First-line NIVO+CABO met primary and secondary efficacy endpoints by improving progression-free survival (PFS; HR 0.51, P < 0.0001), overall survival (OS; HR 0.60, P = 0.0010), and objective response rate (ORR; 55.7% vs 27.1%; P < 0.0001) vs SUN in patients (pts) with aRCC in CheckMate 9ER (Choueiri et al. ESMO 2020). Efficacy benefits with NIVO+CABO vs SUN were consistent across prespecified subgroups including by IMDC risk group, and regardless of tumor PD-L1 expression (database lock for primary analysis, March 30, 2020). Updated analyses are needed to establish durability of benefit with first-line NIVO+CABO and assess outcomes in aRCC pts with sarcomatoid features (sRCC)—an aggressive histologic subtype associated with poor prognoses. Methods: In this phase III open-label trial, adults with confirmed aRCC (with a clear cell component including those with sRCC) were randomized 1:1 (stratified by IMDC risk score, tumor PD-L1 expression, geographic region) to NIVO 240 mg IV Q2W + CABO 40 mg PO QD vs SUN 50 mg PO (4 weeks of 6-week cycles). The primary endpoint was RECIST v1.1-defined PFS by blinded independent central review (BICR) in all randomized (intent-to-treat [ITT]) pts; secondary endpoints included OS, ORR by BICR, and safety. Pts with and without sRCC were identified by local pathology report, and outcomes in these pts were evaluated via prespecified supportive subset analyses. Results: The presence of sRCC was assessed in ITT pts (N = 651) at enrollment. Overall, 75 (11.5%) pts had sRCC and 557 (85.6%) did not; sRCC status was not reported in 19 pts (2.9%). Overall, 34 vs 41 pts with sRCC were randomized to NIVO+CABO vs SUN, respectively. At a median follow-up of 18.1 months, NIVO+CABO improved PFS, OS, and ORR in sRCC pts vs SUN (Table). Notable PFS, OS, and ORR benefits were observed with NIVO+CABO vs SUN in the subgroup of pts without sRCC. Median PFS was doubled, the risk of death was lower, and ORR was consistently higher with NIVO+CABO vs SUN regardless of sarcomatoid status. Key updated PFS, OS, response, and safety outcomes in the ITT population and in pts with and without sRCC will be reported with additional follow-up based on a September 10, 2020 database lock. Conclusions: NIVO+CABO demonstrated improved efficacy and prolonged survival vs SUN in previously untreated aRCC pts regardless of sarcomatoid status. Updated results with extended follow-up will assess the durability of outcomes in this trial. Clinical trial information: NCT03141177 . [Table: see text]
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Affiliation(s)
| | - Toni K. Choueiri
- Dana-Farber Cancer Institute and Harvard Medical School, Boston, MA
| | - Thomas Powles
- Barts Cancer Centre, Queen Mary University of London, London, United Kingdom
| | | | - Maria Teresa Bourlon
- Urologic Oncology Clinic, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, DF, Mexico
| | - James J Hsieh
- Siteman Cancer Center, Washington University School of Medicine, St. Louis, MO
| | - Marco Maruzzo
- Medical Oncology Unit 1, Department of Oncology, Istituto Oncologico Veneto IOV IRCCS, Padua, Italy
| | | | - Cristina Suarez
- Vall d'Hebron Institute of Oncology (VHIO), Hospital Universitari Vall d´Hebron, Vall d´Hebron Barcelona Hospital Campus, Barcelona, Spain
| | | | | | | | - Jeffrey C. Goh
- Royal Brisbane and Women's Hospital, Herston and University of Queensland, St. Lucia, QLD, Australia
| | - Yoshihiko Tomita
- Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Jens Bedke
- Eberhand Karls University Tübingen, Tübingen, Germany
| | | | | | | | | | - Andrea B. Apolo
- National Cancer Institute, National Institutes of Health, Bethesda, MD
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Reinert T, Sartori GP, Souza AAB, Pellegrini R, Rosa ML, Rossatto N, Coelho GP, Litvin IE, Zerwes F, Millen E, Cavalcante FP, Frasson AL, Graudenz MS, Barrios CH. Abstract PS4-22: Prevalence of HER2-low and HER2-zero subgroups and correlation with response to neoadjuvant chemotherapy (NACT) in patients with HER2-negative breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps4-22] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
INTRODUCTION Current definition of HER2-positive BC follows ASCO/CAP guidelines using immunohistochemistry (IHC) and/or in situ hybridization (ISH)-based techniques. However, HER2 expression can be variable in cells that lack ERBB2 amplification. For example, HER2-negative tumors can express some level of HER2 protein by IHC (i.e. 1+ or 2+ and a negative ISH result) and are identified as HER2-low. Others have no expression and are considered HER2-zero. Innovative therapies have shown promising activity in patients in HER2-low BC. The aim of this study is to evaluate the association of HER2-low and HER2-zero status with response to NACT in HER2-negative BC. METHODS Retrospective cohort of patients with HER2-negative BC treated with NACT in four institutions in Brazil. Protocols of diagnosis, treatment and follow-up were standardized and based on international guidelines. Tumors with HER2 IHC score 0 were classified as HER2-zero whereas tumors with HER2 score 1+ and those with HER2 score 2+ with FISH-negative were classified as HER2-low. Patients were treated with anthracycline- and taxane- based chemotherapy. The following clinicopathological data were evaluated, when available: age, ER, Ki67, tumor size, lymph node (LN) status and response to NACT according to pCR status and residual cancer burden (RCB) index. Primary objective was to evaluate the prevalences and compare pCR rates among HER2-zero and HER2-low cases. Secondary objectives were to perform the same comparison within the HR-positive (HR+) and HR-negative subgroups. Pearsons chi squared tests were performed and a p value of <0.05 was considered statistically significant. RESULTS 331 patients were included in this analysis. 63% were HR+and 37% were TNBC. 50% were HER2-zero and 50% HER-low (36% HER2 IHC 1+ and 14% HER2 IHC 2+/FISH-negative). Median age, initial tumor size, clinical LN status and Ki67 expression were similar among HER2-zero and HER2-low subgroups. In HR+ tumors, 42% (86/207) were HER2-zero and 58% (121/207) were HER2-low. In TNBC, 63% (78/124) were HER2-zero and 37% (46/124) were HER2-low (p<0.001, Pearsons chi squared test). The pCR rate was 26% (85/331) in the entire cohort. As expected, there was a higher rate of pCR in TNBC vs HR+ (50% vs 11%, p<0.001). We found a statistically significant difference in the pCR rates when comparing the HER2-zero versus HER2-low subgroups (31% vs 20%, p=0.03). However, this difference is mostly related to an imbalance between groups (HER2-zero subgroups had a higher proportion of TNBC). Among HR+ tumors, there was no difference in the pCR rates between HER2-zero and HER2-low subgroups (8% vs 13%, p=0.35). In TNBC, we identified an interesting but non-statistically significant difference in pCR in HER2-zero vs. HER2-low tumors (56% vs. 39%, p=0.09). In the TNBC cohort we identified a non-statistically significant difference in RCB 0-I in HER2-zero vs. HER2-low tumors (p=0.06). With a 30 month median follow-up, PFS and OS data are immature. CONCLUSION The distribution of HER2-zero and HER2-low cases is different in HR+ and TNBC. HER2-low is more frequent in HR+ and HER2-zero in TNBC. We identified a higher pCR rate in HER2-zero compared to HER2-low tumors, even though this difference is associated with an imbalance between the two groups. Still, we identified a trend to higher pCR rate in HER2-zero compared to HER2-low tumors even within the TNBC subgroup. Identification of HER2-low and HER2-zero tumors may have clinical implications that should be further explored.
Citation Format: Tomas Reinert, Guilherme Parisotto Sartori, Alessandra AB Souza, Rodrigo Pellegrini, Mahira L Rosa, Nathalia Rossatto, Guilherme P Coelho, Isnard E Litvin, Felipe Zerwes, Eduardo Millen, Francisco P Cavalcante, Antonio L Frasson, Marcia S Graudenz, Carlos H Barrios. Prevalence of HER2-low and HER2-zero subgroups and correlation with response to neoadjuvant chemotherapy (NACT) in patients with HER2-negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS4-22.
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Mittendorf E, Harbeck N, Zhang H(A, Saji S, Jung KH, Patel S, Patel S, Duc AN, Liste-Hermoso M, Chui SY, Barrios CH. Abstract PD12-11: Patient-reported outcomes from the Phase III IMpassion031 trial of neoadjuvant atezolizumab + chemotherapy in early triple-negative breast cancer. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-pd12-11] [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: 11/16/2022]
Abstract
Abstract
Background: In the IMpassion031 study (NCT03197935) of patients (N = 333) with invasive stage II or III early triple-negative breast cancer (eTNBC), neoadjuvant treatment with atezolizumab vs placebo, each combined with nab-paclitaxel followed by doxorubicin + cyclophosphamide, significantly improved pathologic complete response in the intent-to-treat population. Patient-reported outcomes (PROs) were collected to document patient perspectives on overall treatment burden and clinical benefit of atezolizumab + chemotherapy for neoadjuvant treatment of eTNBC. Methods: Patients received either atezolizumab 840 mg or placebo every 2 weeks (q2w) with nab-paclitaxel 125 mg/m2 every week for 12 weeks followed by atezolizumab 840 mg or placebo q2w with doxorubicin 60 mg/m2 + cyclophosphamide 600 mg/m2 q2w for 4 cycles. After surgery, patients in the atezolizumab arm were unblinded and continued to receive atezolizumab 1200 mg every 3 weeks for 11 doses, while patients in the control arm did not receive any study treatment. Patients completed the EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) and single-item GP5 from the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at baseline and day 1 of each cycle of neoadjuvant and adjuvant treatment, at end of treatment and during follow-up every 3 months during year 1, every 6 months during years 2-3, and then annually. Mean and mean change from baseline scores (with changes ≥ 10 considered clinically meaningful) in function (role and physical) and global health status/health-related quality of life (GHS/HRQoL) were predefined secondary endpoints. Mean and mean change from baseline scores in disease and treatment-related symptoms, as well as an assessment of overall side-effect bother, were exploratory endpoints. Expected results: The PROs will be compared between the atezolizumab and placebo arms to assess overall treatment burden and the effect of adding atezolizumab to neoadjuvant chemotherapy for the treatment of eTNBC.
Citation Format: Elizabeth Mittendorf, Nadia Harbeck, Hong (Amy) Zhang, Shigehira Saji, Kyung Hae Jung, Sheetal Patel, Shilpen Patel, Anh Nguyen Duc, Mario Liste-Hermoso, Stephen Y Chui, Carlos H Barrios. Patient-reported outcomes from the Phase III IMpassion031 trial of neoadjuvant atezolizumab + chemotherapy in early triple-negative breast cancer [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PD12-11.
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Affiliation(s)
| | - Nadia Harbeck
- 2Breast Center, Ludwig-Maximilians-University (LMU), Munich, Germany
| | | | | | - Kyung Hae Jung
- 5University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea, Republic of
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Mittendorf EA, Harbeck N, Zhang H, Saji S, Jung KH, Patel S, Patel S, Duc AN, Liste-Hermoso M, Chui SY, Barrios CH. Abstract GS3-02: Patient-reported outcomes (PROs) from the Ph 3 IMpassion031 trial of neoadjuvant (NA) atezolizumab + chemo in early triple-negative breast cancer (eTNBC). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-gs3-02] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: In IMpassion031 (NCT03197935), patients (pts) (N = 333) with invasive stage II or III eTNBC who received NA treatment (tx) with atezolizumab (A) + nab-paclitaxel (nP) followed by doxorubicin + cyclophosphamide (AC; A-chemo) had significantly improved pathologic complete response (pCR, primary endpoint) regardless of PD-L1 status vs placebo (P) with nP and AC (P-chemo). Balancing efficacy and toxicity is key in this potentially curable eTNBC setting. PROs were collected to comprehensively assess tx burden from the pts’ perspective, inform clinical benefit and decision-making and address the lack of pt-reported data in this setting. Methods: Pts received double-blind A 840 mg or P every 2 weeks (q2w) with nP 125 mg/m2 once weekly for 12 wk followed by A 840 mg or P q2w with AC q2w for 4 doses. After surgery and pathological evaluation, pts in the A-chemo arm received open-label A 1200 mg every 3 weeks for 11 doses. The P-chemo arm was observed. To capture pts’ experience of tx-related symptoms, associated bother, and impact on day-to-day functioning and health-related quality of life (HRQoL), pts completed the EORTC Quality of Life Questionnaire Core 30 (QLQ-C30) and single-item GP5 from the Functional Assessment of Cancer Therapy-General (FACT-G) questionnaire at baseline (BL) and day (D)1 of each cycle (C) of NA and adjuvant (adj) tx, at end of tx and in follow-up every 3 mo (year 1), every 6 mo (years 2-3), then annually. Mean and mean change from BL scores (≥ 10-point change considered clinically meaningful) by C and between tx arms in the QLQ-C30 function (role and physical) and global health status/QoL scales were predefined secondary endpoints. Mean and mean change from BL scores in tx-related symptoms, as well as an assessment of tx side-effect bother, were exploratory endpoints. Results: QLQ-C30 completion rates (ITT) in both arms were 100% at BL and > 90% in the NA phase and > 89% in the adj phase through C16. GP5 completion rates in both arms were > 98% at BL (C2D1) and > 88% in the NA and adj phases. BL mean [95% CI] values were high for physical function (A-chemo, 91 [89-93]; P-chemo, 90 [88-92]), role function (A-chemo, 89 [86-93]; P-chemo, 89 [86-92]), and HRQoL (A-chemo, 79 [76-82]; P-chemo, 76 [73-79]). Physical and role function, and HRQoL mean values were similar between arms across on-tx assessments to C16 and through follow up. Mean change from BL values for physical and role function, and HRQoL were similar between arms and of the same magnitude. In both arms mean physical function had a clinically meaningful decline during the NA period from C3 to C5, rebounding in the adj period, and stabilizing starting C7. In both arms mean role function had a clinically meaningful decline in the NA period from C2 (A-chemo) or C3 (P-chemo) to C5, rebounding in the adj period, and stabilizing at C9 in the P-chemo arm only. In both arms mean HRQoL had a clinically meaningful decline in the NA period from C3 to C5, rebounding in the adj period and stabilizing from C6. Tx symptoms of fatigue, diarrhea, nausea, and vomiting in the NA period worsened through C5 in both arms with trends in mean and mean change from BL values similar to the functional and HRQoL data. In the adj period, mean symptom scores in both arms through C16 were similar to BL except for fatigue. 65% (A-chemo) and 66% (P-chemo) of pts reported their level of bother with tx side effects to be “somewhat” or “quite a bit” by C5. During the adj period, no added side-effect bother was experienced by pts receiving A compared with the P-chemo arm under observation, with a similar % of pts in each arm reporting being bothered “somewhat,” “quite a bit,” or “very much” by C16. Conclusions: Adding A to nP-AC improved pCR without added tx burden to pts. These results address the paucity of PRO data informing clinical benefit and decision-making in this potentially curable setting.
Citation Format: Elizabeth A. Mittendorf, Nadia Harbeck, Hong Zhang, Shigehira Saji, Kyung Hae Jung, Sheetal Patel, Shilpen Patel, Anh Nguyen Duc, Mario Liste-Hermoso, Stephen Y. Chui, Carlos H. Barrios. Patient-reported outcomes (PROs) from the Ph 3 IMpassion031 trial of neoadjuvant (NA) atezolizumab + chemo in early triple-negative breast cancer (eTNBC) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr GS3-02.
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Affiliation(s)
| | - Nadia Harbeck
- 2Breast Center, Ludwig-Maximilians-University (LMU), Munich, Germany
| | - Hong Zhang
- 3Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Kyung Hae Jung
- 5Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea, Republic of
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Werutsky G, Villareal-Garza C, Gomez H, Donaire JM, Bines J, Fein L, Carrizo MN, Zaffaroni F, Filho PRN, Barrios CH. Abstract OT-10-01: A study to observe patients characteristics, treatment patterns and outcomes in patients with newly diagnosed breast cancer in Latin America - LATINA breast (LACOG 0615/ MO39485). Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ot-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: Breast cancer (BC) is the most common malignancy and one of the leading causes of cancer death in Latin American women, with an estimated age-standardized annual incidence of 38.3 and 56.8 and mortality rates of 10.1 and 13.4 cases per 100,000 females, in Central and South America respectively. However, BC incidence in Latin America (LATAM)is largely underestimated and lacks updated information. Furthermore, the shortage and quality of cancer registry data hinders a more reliable assessment of treatment and outcomes for these patients. The goals of LATINA Breast study is to build an electronic platform/database to allow a standardized collection of epidemiological data of BC in LATAMin addition to describe real world data on patients characteristics, treatment patterns and outcomes of this population. Methods: LATINA Breast (LACOG 0615) is a prospective, international, multicentre and non-interventional study of primary data collection designed to describe the diagnosis, oncologic treatment and outcomes of patients with BC in LATAM. Patients aged ≥ 18 years with stage I to IV newly diagnosed BC (i.e. <12 months since site activation) will be considered eligible for inclusion.Patient data will be collected from medical records at diagnosis and every 6 months for up to 5 years of follow-up. At baseline, data on socioeconomic, demographic, medical history and BC clinicopathological characteristics will be collected. Thereafter, information regarding treatment patterns, sequencing, response to treatment, adverse events, disease relapse/ progression and overall survival will be collected at each time-point. This study has a planned sample size of a minimum of 2.200 to a maximum of 4.500 patients accrued from approximately 30 sites in 10 LATAM countries: Argentina, Brazil, Cuba, Colombia, Chile, Dominican Republic, Ecuador, Mexico, Peru and Uruguay. The expected number of patients per country is based on age-standardize BC incidence rate by GLOBOCAN 2012 and not in a formal statistical estimation.Co-primary endpoints are (1) to describe patients’ characteristics, prevalence of BC subtypes at diagnosis, local and systemic treatment patterns and outcomes; (2) to build an electronic platform/database of epidemiological data of BC in LATAM. Secondary endpoints are to evaluate regional differences in treatment strategies, to describe treatment efficacy parameters such as locoregional relapse, invasive disease-free survival, progression-free survival, overall survival and to evaluate treatment safety. The trial is registered at clinicaltrials.gov NCT04158258.Results The first site was activated for patient accrual on February 13, 2020, in Argentina. As of July 6, 2020, a total of 243 patients have been included in Argentina (n=81), Brazil (n=123), Colombia (n=37), and Guatemala (n=2) within 19 active sites. Regulatory approval and activation are ongoing in the other countries. Recruitment is estimated to last until December 2021 to achieve the planned sample size. Patients will be followed-up for 5 years, therefore we estimate the last follow-up data collection in December 2026. ConclusionLATINA Breast is the first multinational, prospective cohort study of BC in Latin America that will generate detailed information on diagnosis, treatment and outcome in real-world clinical practice. It will address important gaps in BC management and will likely single out some of the main inequities in this large and diverse population of BC patients and consequently support strategies for the improvement of BC cancer care in LATAM.
Citation Format: Gustavo Werutsky, Cynthia Villareal-Garza, Henry Gomez, Juan Manuel Donaire, José Bines, Luis Fein, Mariano Nicolas Carrizo, Facundo Zaffaroni, Paulo Ricardo Nunes Filho, Carlos H Barrios. A study to observe patients characteristics, treatment patterns and outcomes in patients with newly diagnosed breast cancer in Latin America - LATINA breast (LACOG 0615/ MO39485) [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr OT-10-01.
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Affiliation(s)
- Gustavo Werutsky
- 1Latin American Cooperative Oncology Group, Porto Alegre, Brazil
| | - Cynthia Villareal-Garza
- 2Centro de Cáncer de Mama del Hospital Zambrano Hellion, TecSalud – Tecnológico de Monterrey, Monterrey, Mexico
| | - Henry Gomez
- 3Grupo de Estudios Clínicos Oncológicos Peruanos (GECOPERU), Lima, Peru
| | | | - José Bines
- 5Instituto Nacional do Cancer (INCA), Rio de Janeiro, Brazil
| | - Luis Fein
- 6Grupo Argentino de Investigación Clínica en Oncología (GAICO), Rosario, Argentina
| | | | | | | | - Carlos H Barrios
- 1Latin American Cooperative Oncology Group, Porto Alegre, Brazil
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Emens LA, Molinero L, Loi S, Rugo HS, Schneeweiss A, Diéras V, Iwata H, Barrios CH, Nechaeva M, Nguyen-Duc A, Chui SY, Husain A, Winer EP, Adams S, Schmid P. Atezolizumab and nab-Paclitaxel in Advanced Triple-Negative Breast Cancer: Biomarker Evaluation of the IMpassion130 Study. J Natl Cancer Inst 2021; 113:1005-1016. [PMID: 33523233 PMCID: PMC8328980 DOI: 10.1093/jnci/djab004] [Citation(s) in RCA: 152] [Impact Index Per Article: 50.7] [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: 06/30/2020] [Revised: 11/04/2020] [Accepted: 01/26/2021] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Understanding the impact of the tumor immune microenvironment and BRCA1/2-related DNA repair deficiencies on the clinical activity of immune checkpoint inhibitors may help optimize both patient and treatment selection in metastatic triple-negative breast cancer. In this substudy from the phase 3 IMpassion130 trial, immune biomarkers and BRCA1/2 alterations were evaluated for association with clinical benefit with atezolizumab and nab-paclitaxel (A+nP) vs placebo and nP in unresectable (P+nP) locally advanced or metastatic triple-negative breast cancer. METHODS Patients were randomly assigned 1:1 to nab-paclitaxel 100 mg/m2 (days 1, 8, and 15 of a 28-day cycle) and atezolizumab 840 mg every 2 weeks or placebo until progression or toxicity. Progression-free survival and overall survival were evaluated based on programmed death-ligand 1 (PD-L1) expression on immune cells (IC) and tumor cells, intratumoral CD8, stromal tumor-infiltrating lymphocytes, and BRCA1/2 mutations. RESULTS PD-L1 IC+ in either primary or metastatic tumor tissue was linked to progression-free survival and overall survival benefit with A+nP. PD-L1 IC+ low (26.9%; 243 of 902 patients) and high (13.9%; 125 of 902 patients) populations had improved outcomes that were comparable. Intratumoral CD8 and stromal tumor-infiltrating lymphocytes positivity (sTIL+) were associated with PD-L1 IC+ status; improved outcomes were observed with A+nP vs P+nP only in CD8+ and sTIL+ patients who were also PD-L1 IC+. BRCA1/2 mutations (occurring in 14.5% [89 of 612 patients]) were not associated with PD-L1 IC status, and PD-L1 IC+ patients benefited from A+nP regardless of BRCA1/2 mutation status. CONCLUSIONS Although A+nP was more efficacious in patients with richer tumor immune microenvironment, clinical benefit was only observed in patients whose tumors were PD-L1 IC+.
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Affiliation(s)
- Leisha A Emens
- University of Pittsburgh Medical Center, Hillman Cancer Center/Magee Women's Hospital, Pittsburgh, PA, USA
| | - Luciana Molinero
- Oncology Biomarkers Development, Genentech, Inc, South San Francisco, CA, USA
| | - Sherene Loi
- Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - Hope S Rugo
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Andreas Schneeweiss
- National Center for Tumor Diseases, Heidelberg University Hospital and German Cancer Research Center, Heidelberg, Germany
| | - Véronique Diéras
- Department of Medical Oncology, Institut Curie, Paris, and Centre Eugene Marquis, Rennes, France
| | - Hiroji Iwata
- Breast Oncology, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Carlos H Barrios
- Centro de Pesquisa em Oncologia, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Marina Nechaeva
- Oncology, Arkhangelsk Regional Clinical Oncology Dispensary, Arkhangelsk, Russia
| | | | - Stephen Y Chui
- Product Development, Genentech, Inc, South San Francisco, CA, USA
| | - Amreen Husain
- Product Development, Genentech, Inc, South San Francisco, CA, USA
| | | | - Sylvia Adams
- Perlmutter Cancer Center, New York University School of Medicine, New York, NY, USA
| | - Peter Schmid
- Centre for Experimental Cancer Medicine, Barts Cancer Institute, Queen Mary University of London, London, UK
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Chan A, Moy B, Mansi J, Ejlertsen B, Holmes FA, Chia S, Iwata H, Gnant M, Loibl S, Barrios CH, Somali I, Smichkoska S, Martinez N, Alonso MG, Link JS, Mayer IA, Cold S, Murillo SM, Senecal F, Inoue K, Ruiz-Borrego M, Hui R, Denduluri N, Patt D, Rugo HS, Johnston SR, Bryce R, Zhang B, Xu F, Wong A, Martin M. Final Efficacy Results of Neratinib in HER2-positive Hormone Receptor-positive Early-stage Breast Cancer From the Phase III ExteNET Trial. Clin Breast Cancer 2021; 21:80-91.e7. [DOI: 10.1016/j.clbc.2020.09.014] [Citation(s) in RCA: 73] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 11/25/2022]
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Ferrari BL, Ferreira CG, Menezes M, De Marchi P, Canedo J, de Melo AC, Jácome AA, Reinert T, Paes RD, Sodré B, Barrios CH, Dienstmann R. Determinants of COVID-19 Mortality in Patients With Cancer From a Community Oncology Practice in Brazil. JCO Glob Oncol 2021; 7:46-55. [PMID: 33434066 PMCID: PMC8081500 DOI: 10.1200/go.20.00444] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/11/2020] [Accepted: 11/09/2020] [Indexed: 12/23/2022] Open
Abstract
PURPOSE The COVID-19 pandemic remains a public health emergency of global concern. Determinants of mortality in the general population are now clear, but specific data on patients with cancer remain limited, particularly in Latin America. MATERIALS AND METHODS A longitudinal multicenter cohort study of patients with cancer and confirmed COVID-19 from Oncoclínicas community oncology practice in Brazil was conducted. The primary end point was all-cause mortality after isolation of the SARS-CoV-2 by Real-Time Polymerase Chain Reaction (RT-PCR) in patients initially diagnosed in an outpatient environment. We performed univariate and multivariable logistic regression analysis and recursive partitioning modeling to define the baseline clinical determinants of death in the overall population. RESULTS From March 29 to July 4, 2020, 198 patients with COVID-19 were prospectively registered in the database, of which 167 (84%) had solid tumors and 31 (16%) had hematologic malignancies. Most patients were on active systemic therapy or radiotherapy (77%), largely for advanced or metastatic disease (64%). The overall mortality rate was 16.7% (95% CI, 11.9 to 22.7). In univariate models, factors associated with death after COVID-19 diagnosis were age ≥ 60 years, current or former smoking, coexisting comorbidities, respiratory tract cancer, and management in a noncurative setting (P < .05). In multivariable logistic regression and recursive partitioning modeling, only age, smoking history, and noncurative disease setting remained significant determinants of mortality, ranging from 1% in cancer survivors under surveillance or (neo)adjuvant therapy to 60% in elderly smokers with advanced or metastatic disease. CONCLUSION Mortality after COVID-19 in patients with cancer is influenced by prognostic factors that also affect outcomes of the general population. Fragile patients and smokers are entitled to active preventive measures to reduce the risk of SARS-CoV-2 infection and close monitoring in the case of exposure or COVID-19-related symptoms.
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Cortes J, Cescon DW, Rugo HS, Nowecki Z, Im SA, Yusof MM, Gallardo C, Lipatov O, Barrios CH, Holgado E, Iwata H, Masuda N, Otero MT, Gokmen E, Loi S, Guo Z, Zhao J, Aktan G, Karantza V, Schmid P. Pembrolizumab plus chemotherapy versus placebo plus chemotherapy for previously untreated locally recurrent inoperable or metastatic triple-negative breast cancer (KEYNOTE-355): a randomised, placebo-controlled, double-blind, phase 3 clinical trial. Lancet 2020; 396:1817-1828. [PMID: 33278935 DOI: 10.1016/s0140-6736(20)32531-9] [Citation(s) in RCA: 844] [Impact Index Per Article: 211.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Revised: 08/25/2020] [Accepted: 09/16/2020] [Indexed: 12/21/2022]
Abstract
BACKGROUND Pembrolizumab monotherapy showed durable antitumour activity and manageable safety in patients with metastatic triple-negative breast cancer. We aimed to examine whether the addition of pembrolizumab would enhance the antitumour activity of chemotherapy in patients with metastatic triple-negative breast cancer. METHODS In this randomised, placebo-controlled, double-blind, phase 3 trial, done in 209 sites in 29 countries, we randomly assigned patients 2:1 with untreated locally recurrent inoperable or metastatic triple-negative breast cancer using a block method (block size of six) and an interactive voice-response system with integrated web-response to pembrolizumab (200 mg) every 3 weeks plus chemotherapy (nab-paclitaxel; paclitaxel; or gemcitabine plus carboplatin) or placebo plus chemotherapy. Randomisation was stratified by type of on-study chemotherapy (taxane or gemcitabine-carboplatin), PD-L1 expression at baseline (combined positive score [CPS] ≥1 or <1), and previous treatment with the same class of chemotherapy in the neoadjuvant or adjuvant setting (yes or no). Eligibility criteria included age at least 18 years, centrally confirmed triple-negative breast cancer; at least one measurable lesion; provision of a newly obtained tumour sample for determination of triple-negative breast cancer status and PD-L1 status by immunohistochemistry at a central laboratory; an Eastern Cooperative Oncology Group performance status score 0 or 1; and adequate organ function. The sponsor, investigators, other study site staff (except for the unmasked pharmacist), and patients were masked to pembrolizumab versus saline placebo administration. In addition, the sponsor, the investigators, other study site staff, and patients were masked to patient-level tumour PD-L1 biomarker results. Dual primary efficacy endpoints were progression-free survival and overall survival assessed in the PD-L1 CPS of 10 or more, CPS of 1 or more, and intention-to-treat populations. The definitive assessment of progression-free survival was done at this interim analysis; follow-up to assess overall survival is continuing. For progression-free survival, a hierarchical testing strategy was used, such that testing was done first in patients with CPS of 10 or more (prespecified statistical criterion was α=0·00411 at this interim analysis), then in patients with CPS of 1 or more (α=0·00111 at this interim analysis, with partial alpha from progression-free survival in patients with CPS of 10 or more passed over), and finally in the intention-to-treat population (α=0·00111 at this interim analysis). This study is registered with ClinicalTrials.gov, NCT02819518, and is ongoing. FINDINGS Between Jan 9, 2017, and June 12, 2018, of 1372 patients screened, 847 were randomly assigned to treatment, with 566 patients in the pembrolizumab-chemotherapy group and 281 patients in the placebo-chemotherapy group. At the second interim analysis (data cutoff, Dec 11, 2019), median follow-up was 25·9 months (IQR 22·8-29·9) in the pembrolizumab-chemotherapy group and 26·3 months (22·7-29·7) in the placebo-chemotherapy group. Among patients with CPS of 10 or more, median progression-free survival was 9·7 months with pembrolizumab-chemotherapy and 5·6 months with placebo-chemotherapy (hazard ratio [HR] for progression or death, 0·65, 95% CI 0·49-0·86; one-sided p=0·0012 [primary objective met]). Median progression-free survival was 7·6 and 5·6 months (HR, 0·74, 0·61-0·90; one-sided p=0·0014 [not significant]) among patients with CPS of 1 or more and 7·5 and 5·6 months (HR, 0·82, 0·69-0·97 [not tested]) among the intention-to-treat population. The pembrolizumab treatment effect increased with PD-L1 enrichment. Grade 3-5 treatment-related adverse event rates were 68% in the pembrolizumab-chemotherapy group and 67% in the placebo-chemotherapy group, including death in <1% in the pembrolizumab-chemotherapy group and 0% in the placebo-chemotherapy group. INTERPRETATION Pembrolizumab-chemotherapy showed a significant and clinically meaningful improvement in progression-free survival versus placebo-chemotherapy among patients with metastatic triple-negative breast cancer with CPS of 10 or more. These findings suggest a role for the addition of pembrolizumab to standard chemotherapy for the first-line treatment of metastatic triple-negative breast cancer. FUNDING Merck Sharp & Dohme Corp, a subsidiary of Merck & Co, Inc.
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Affiliation(s)
- Javier Cortes
- International Breast Cancer Center, Quiron Group, Madrid and Barcelona, Spain; Vall d'Hebron Institute of Oncology, Barcelona, Spain.
| | | | - Hope S Rugo
- University of California San Francisco Comprehensive Cancer Center, San Francisco, CA, USA
| | - Zbigniew Nowecki
- Maria Sklodowska-Curie Memorial Cancer Centre and Institute of Oncology, Warsaw, Poland
| | - Seock-Ah Im
- Seoul National University Hospital, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
| | | | | | - Oleg Lipatov
- Republican Clinical Oncology Dispensary, Republic of Bashkortostan, Russia
| | - Carlos H Barrios
- Oncology Research Unit, Hospital São Lucas, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Esther Holgado
- International Breast Cancer Center, Quiron Group, Madrid and Barcelona, Spain; Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | | | - Norikazu Masuda
- National Hospital Organization, Osaka National Hospital, Osaka, Japan
| | | | | | - Sherene Loi
- Peter McCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | | | - Peter Schmid
- Barts Cancer Institute, Centre for Experimental Cancer Medicine and Queen Mary University of London, London, UK
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