1
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Hershman DL, Bansal A, Sullivan SD, Barlow WE, Arnold KB, Watabayashi K, Bell-Brown A, Le-Lindqwister NA, Dul CL, Brown-Glaberman UA, Behrens RJ, Vogel V, Alluri N, Ramsey SD. A Pragmatic Cluster-Randomized Trial of a Standing Order Entry Intervention for Colony-Stimulating Factor Use Among Patients at Intermediate Risk for Febrile Neutropenia. J Clin Oncol 2023; 41:590-598. [PMID: 36228177 PMCID: PMC9870230 DOI: 10.1200/jco.22.01258] [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: 05/30/2022] [Revised: 08/12/2022] [Accepted: 08/22/2022] [Indexed: 01/27/2023] Open
Abstract
PURPOSE Primary prophylactic colony-stimulating factors (PP-CSFs) are prescribed to reduce febrile neutropenia (FN) but their benefit for intermediate FN risk regimens is uncertain. Within a pragmatic, randomized trial of a standing order entry (SOE) PP-CSF intervention, we conducted a substudy to evaluate the effectiveness of SOE for patients receiving intermediate-risk regimens. METHODS TrACER was a cluster randomized trial where practices were randomized to usual care or a guideline-based SOE intervention. In the primary study, sites were randomized 3:1 to SOE of automated PP-CSF orders for high FN risk regimens and alerts against PP-CSF use for low-risk regimens versus usual care. A secondary 1:1 randomization assigned 24 intervention sites to either SOE to prescribe or an alert to not prescribe PP-CSF for intermediate-risk regimens. Clinicians were allowed to over-ride the SOE. Patients with breast, colorectal, or non-small-cell lung cancer were enrolled. Mixed-effect logistic regression models were used to test differences between randomized sites. RESULTS Between January 2016 and April 2020, 846 eligible patients receiving intermediate-risk regimens were registered to either SOE to prescribe (12 sites: n = 542) or an alert to not prescribe PP-CSF (12 sites: n = 304). Rates of PP-CSF use were higher among sites randomized to SOE (37.1% v 9.9%, odds ratio, 5.91; 95% CI, 1.77 to 19.70; P = .0038). Rates of FN were low and identical between arms (3.7% v 3.7%). CONCLUSION Although implementation of a SOE intervention for PP-CSF significantly increased PP-CSF use among patients receiving first-line intermediate-risk regimens, FN rates were low and did not differ between arms. Although this guideline-informed SOE influenced prescribing, the results suggest that neither SOE nor PP-CSF provides sufficient benefit to justify their use for all patients receiving first-line intermediate-risk regimens.
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Affiliation(s)
| | | | - Sean D. Sullivan
- Fred Hutchinson Cancer Research Center, Seattle, WA
- University of Washington, Seattle, WA
| | - William E. Barlow
- Fred Hutchinson Cancer Research Center, Seattle, WA
- SWOG Statistics and Data Management Center, Seattle, WA
| | - Kathryn B. Arnold
- Fred Hutchinson Cancer Research Center, Seattle, WA
- SWOG Statistics and Data Management Center, Seattle, WA
| | | | | | | | - Carrie L. Dul
- Ascension Saint John Hospital (Michigan Cancer Research Consortium NCORP), Detroit, MI
| | - Ursa A. Brown-Glaberman
- University of New Mexico Cancer Center (New Mexico Minority Underserved NCORP), Albuquerque, NM
| | - Robert J. Behrens
- Med Onc & Hem Assoc-Des Moines (Iowa-Wide Oncology Research Coalition NCORP), Des Moines, IA
| | - Victor Vogel
- Geisinger Medical Center (Geisinger Cancer Institute NCORP), Danville, PA
| | - Nitya Alluri
- Saint Luke's Cancer Institute—Boise (Pacific Cancer Research Consortium NCORP), Boise, ID
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2
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Ramsey SD, Bansal A, Sullivan SD, Lyman GH, Barlow WE, Arnold KB, Watabayashi K, Bell-Brown A, Kreizenbeck K, Le-Lindqwister NA, Dul CL, Brown-Glaberman UA, Behrens RJ, Vogel V, Alluri N, Hershman DL. Effects of a Guideline-Informed Clinical Decision Support System Intervention to Improve Colony-Stimulating Factor Prescribing: A Cluster Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2238191. [PMID: 36279134 PMCID: PMC9593234 DOI: 10.1001/jamanetworkopen.2022.38191] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
IMPORTANCE Colony-stimulating factors are prescribed to patients undergoing chemotherapy to reduce the risk of febrile neutropenia. Research suggests that 55% to 95% of colony-stimulating factor prescribing is inconsistent with national guidelines. OBJECTIVE To examine whether a guideline-based standing order for primary prophylactic colony-stimulating factors improves use and reduces the incidence of febrile neutropenia. DESIGN, SETTING, AND PARTICIPANTS This cluster randomized clinical trial, the Trial Assessing CSF Prescribing Effectiveness and Risk (TrACER), involved 32 community oncology clinics in the US. Participants were adult patients with breast, colorectal, or non-small cell lung cancer initiating cancer therapy and enrolled between January 2016 and April 2020. Data analysis was performed from July to October 2021. INTERVENTIONS Sites were randomized 3:1 to implementation of a guideline-based primary prophylactic colony-stimulating factor standing order system or usual care. Automated orders were added for high-risk regimens, and an alert not to prescribe was included for low-risk regimens. Risk was based on National Comprehensive Cancer Network guidelines. MAIN OUTCOMES AND MEASURES The primary outcome was to find an increase in colony-stimulating factor use among high-risk patients from 40% to 75%, a reduction in use among low-risk patients from 17% to 7%, and a 50% reduction in febrile neutropenia rates in the intervention group. Mixed model logistic regression adjusted for correlation of outcomes within a clinic. RESULTS A total of 2946 patients (median [IQR] age, 59.0 [50.0-67.0] years; 2233 women [77.0%]; 2292 White [79.1%]) were enrolled; 2287 were randomized to the intervention, and 659 were randomized to usual care. Colony-stimulating factor use for patients receiving high-risk regimens was high and not significantly different between groups (847 of 950 patients [89.2%] in the intervention group vs 296 of 309 patients [95.8%] in the usual care group). Among high-risk patients, febrile neutropenia rates for the intervention (58 of 947 patients [6.1%]) and usual care (13 of 308 patients [4.2%]) groups were not significantly different. The febrile neutropenia rate for patients receiving high-risk regimens not receiving colony-stimulating factors was 14.9% (17 of 114 patients). Among the 585 patients receiving low-risk regimens, colony-stimulating factor use was low and did not differ between groups (29 of 457 patients [6.3%] in the intervention group vs 7 of 128 patients [5.5%] in the usual care group). Febrile neutropenia rates did not differ between usual care (1 of 127 patients [0.8%]) and the intervention (7 of 452 patients [1.5%]) groups. CONCLUSIONS AND RELEVANCE In this cluster randomized clinical trial, implementation of a guideline-informed standing order did not affect colony-stimulating factor use or febrile neutropenia rates in high-risk and low-risk patients. Overall, use was generally appropriate for the level of risk. Standing order interventions do not appear to be necessary or effective in the setting of prophylactic colony-stimulating factor prescribing. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02728596.
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Affiliation(s)
- Scott D. Ramsey
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Aasthaa Bansal
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle
| | - Sean D. Sullivan
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- The Comparative Health Outcomes, Policy, and Economics Institute, School of Pharmacy, University of Washington, Seattle
| | - Gary H. Lyman
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- School of Medicine, University of Washington, Seattle
| | - William E. Barlow
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- SWOG Statistics and Data Management Center, Seattle, Washington
| | - Kathryn B. Arnold
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
- SWOG Statistics and Data Management Center, Seattle, Washington
| | - Kate Watabayashi
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Ari Bell-Brown
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Karma Kreizenbeck
- Hutchinson Institute for Cancer Outcomes Research, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Nguyet A. Le-Lindqwister
- Illinois CancerCare–Peoria (Heartland Cancer Research National Cancer Institute Community Oncology Research Program), Peoria
| | - Carrie L. Dul
- Ascension St John Hospital (Michigan Cancer Research Consortium National Cancer Institute Community Oncology Research Program), Detroit
| | - Ursa A. Brown-Glaberman
- University of New Mexico Cancer Center (New Mexico Minority Underserved National Cancer Institute Community Oncology Research Program, Albuquerque
| | - Robert J. Behrens
- Medical Oncology and Hematology Associates–Des Moines (Iowa-Wide Oncology Research Coalition National Cancer Institute Community Oncology Research Program), Des Moines
| | - Victor Vogel
- Geisinger Medical Center (Geisinger Cancer Institute National Cancer Institute Community Oncology Research Program), Danville, Pennsylvania
| | - Nitya Alluri
- St Luke’s Cancer Institute–Boise (Pacific Cancer Research Consortium National Cancer Institute Community Oncology Research Program), Boise, Idaho
| | - Dawn L. Hershman
- Department of Medicine and Epidemiology, Columbia University, New York, New York
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Whitworth PW, Beitsch PD, Murray MK, Richards PD, Mislowsky A, Dul CL, Pellicane JV, Baron PL, Rahman RL, Lee LA, Dupree BB, Kelemen PR, Ashikari AY, Budway RJ, Lopez-Penalver C, Dooley W, Wang S, Dauer P, Menicucci AR, Yoder EB, Finn C, Blumencranz LE, Audeh W. Genomic Classification of HER2-Positive Patients With 80-Gene and 70-Gene Signatures Identifies Diversity in Clinical Outcomes With HER2-Targeted Neoadjuvant Therapy. JCO Precis Oncol 2022; 6:e2200197. [PMID: 36108259 PMCID: PMC9489196 DOI: 10.1200/po.22.00197] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The prospective Neoadjuvant Breast Registry Symphony Trial compared the 80-gene molecular subtyping signature with clinical assessment by immunohistochemistry and/or fluorescence in situ hybridization in predicting pathologic complete response (pCR) and 5-year outcomes in patients with early-stage breast cancer.
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Affiliation(s)
- Pat W Whitworth
- Nashville Breast Center, Nashville, TN.,Targeted Medical Education, Cupertino, CA
| | - Peter D Beitsch
- Targeted Medical Education, Cupertino, CA.,Dallas Surgical Group, Dallas, TX
| | - Mary K Murray
- Akron General Medical Center, Akron, OH.,Cleveland Clinic Akron General, Akron, OH
| | | | - Angela Mislowsky
- Tidelands Health, Coastal Carolina Breast Center, Murrells Inlet, SC
| | - Carrie L Dul
- Ascension St John Hospital Great Lakes Cancer Management Specialists, Grosse Pointe Woods, MI
| | | | - Paul L Baron
- Breast and Melanoma Specialist of Charleston, Charleston, SC.,Lenox Hill Hospital, New York, NY
| | | | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA
| | - Beth B Dupree
- St Mary Medical/Alliance Cancer Specialists, Langhorne, PA.,Holy Redeemer Health System, Sedona, AZ
| | - Pond R Kelemen
- Ashikari Breast Center, Sleepy Hollow, NY.,Northwell Health Physician Partners, Mount Kisco, NY
| | - Andrew Y Ashikari
- Ashikari Breast Center, Sleepy Hollow, NY.,Northwell Health Physician Partners, Mount Kisco, NY.,Zucker School of Medicine, Hofstra University, Hempstead, NY
| | | | | | - William Dooley
- Breast Institute, University of Oklahoma Health Sciences, Oklahoma City, OK.,Stephenson Cancer Center, Oklahoma City, OK
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4
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Hershman DL, Bansal A, Sullivan SD, Lyman GH, Barlow WE, Arnold KB, Watabayashi K, Bell-Brown A, Le-Lindqwister N, Dul CL, Brown-Glaberman U, Behrens RJ, Vogel VG, Alluri N, Ramsey SD. A pragmatic cluster-randomized trial of a standing physician order entry intervention for colony stimulating factor use among patients at intermediate risk for febrile neutropenia (SWOG S1415CD). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1518] [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
1518 Background: Primary prophylactic colony stimulating factors (PP-CSF) are prescribed to patients undergoing chemotherapy to reduce the risk of febrile neutropenia (FN) but their benefit for regimens with intermediate FN risk is uncertain. Within a pragmatic, randomized trial of a standing order entry (SOE) intervention for prescribing PP-CSF, we designed a substudy to evaluate the effectiveness of PP-CSF for patients receiving therapy with intermediate FN risk. Methods: TrACER was a cluster randomized trial where NCI community Oncology Research Program practices were randomized to usual care (UC) or a guideline-based SOE intervention. In the primary study, sites were randomized 3:1 to a SOE of automated PP-CSF orders for NCCN-designated high FN risk chemotherapy regimens and alerts against PP-CSF orders for low FN risk regimens (intervention) versus usual care. A secondary randomization assigned intervention sites to a SOE intervention either to prescribe or not prescribe PP-CSF for patients receiving intermediate FN risk regimens. Clinicians were allowed to override the SOE. Patients age ≥18 with either breast, colorectal or non-small cell lung cancer were enrolled and followed for 12 mo. PP-CSF was defined as initiation within 24-72 hours after systemic chemotherapy. Sample size calculations were based on an FN risk reduction from 15% to 7.5%, and provided 80% power at a planned enrollment of 90 patients per site. Mixed effect logistic regression models were used to test differences between sites randomized to prescribe or not prescribe PP-CSF. Results: Between January 2016 and April 2020, 24 sites (2,287 patients) were randomized to the intervention. Among intervention sites, 12 were randomized to either SOE to prescribe or an alert to not prescribe PP-CSF for the 542 patients receiving intermediate FN risk regimens. Rates of PP-CSF use were higher among sites randomized to prescribe PP-CSF (37.1% vs 9.9%, OR = 5.90 (95% CI 1.72-20.20; p = 0.0048)). Overall, the rates of FN were low and identical between PP-CSF and no PP-CSF arms (3.7% vs 3.7%). Among patients who did not receive PP-CSF, rates of FN were also low and similar between arms (3.8% vs 4.1%). Conclusions: While implementation of a SOE intervention for PP-CSF significantly increased PP-CSF use among patients receiving intermediate risk regimens, FN rates did not differ between arms. Despite SOE, 63% of patients assigned to receive PP-CSF did not receive it. FN rates overall were lower than expected and did not differ between patients that did or did not receive PP-CSF. Although this guideline-informed SOE influenced prescribing, the results suggest that neither the SOE nor PP-CSF itself provide sufficient benefit to justify their use for persons receiving intermediate FN risk regimens. Clinical trial information: NCT02728596.
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Affiliation(s)
- Dawn L. Hershman
- Columbia University College of Physicians and Surgeons, New York, NY
| | | | - Sean D Sullivan
- The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA
| | | | | | | | | | | | | | - Carrie L. Dul
- Ascension Saint John Hospital (Michigan Cancer Research Consortium NCORP), Detroit, MI
| | | | - Robert J. Behrens
- Med Onc & Hem Assoc-Des Moines (Iowa-Wide Oncology Research Coalition NCORP), Des Moines, IA
| | | | - Nitya Alluri
- Saint Luke's Cancer Institute (Pacific Cancer Research Consortium NCORP), Boise, ID
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5
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Ramsey SD, Bansal A, Sullivan SD, Lyman GH, Barlow WE, Arnold KB, Watabayashi K, Bell-Brown A, Le-Lindqwister N, Dul CL, Brown-Glaberman U, Behrens RJ, Vogel VG, Alluri N, Hershman DL. A pragmatic cluster-randomized trial of a computerized clinical decision support system to improve colony stimulating factor prescribing for patients with cancer receiving myelosuppressive chemotherapy (SWOG S1415CD). J Clin Oncol 2022. [DOI: 10.1200/jco.2022.40.16_suppl.1525] [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
1525 Background: Primary prophylactic colony stimulating factors (PP-CSF) are prescribed to patients undergoing chemotherapy to reduce the risk of febrile neutropenia (FN). Prior studies have shown that 55-95% of CSF prescribing is inconsistent with practice guidelines. We conducted a cluster randomized trial to determine if guideline-informed standing orders for PP-CSF improved prescribing and reduced the incidence of FN. Methods: Patients age ≥18 with breast, colorectal or non-small cell lung cancer initiating first cancer-directed therapy with NCCN-recommended regimens were eligible. The intervention consisted of automated PP-CSF orders for high FN risk chemotherapy regimens and an alert not to use PP-CSF for low FN risk regimens. Regimen FN risk was based on NCCN guidelines. Clinicians could override the orders. Primary and secondary outcomes were PP-CSF use among patients receiving high and low risk regimens FN incidence within 6 months of initial therapy. Sample size estimates assumed an FN risk of 25% for high-risk chemotherapy. 32 NCI Community Oncology Research Program (NCORP) practices randomized 3:1 to the order entry system (intervention) versus usual care (UC) provided 90% power to detect a 50% reduction in FN at a planned enrollment of 90 patients per site. Mixed effect logistic regression models were used to test differences among randomized sites. 13 practices with pre-existing PP-CSF order sets enrolled in a parallel cohort study. Patients and other stakeholder groups informed study design, conduct and reporting. Results: Between January 2016 and April 2020, 2,946 patients were randomized (2287 intervention, 659 UC); 718 were enrolled in the cohort. Mean age across arms was 58.1. 77% of patients were female; 61% diagnosed with breast cancer. Among patients receiving high-risk regimens, PP-CSF use did not differ between arms (89.2% intervention; 95.8% UC, adjusted p = 0.21) and was similar to the cohort patients (93.0%). The FN rate for high-risk patients was 5.7% in intervention clinics and 4.2% in UC clinics (adjusted p = 0.26); FN was 14.9% among high-risk patients who did not receive PP-CSF. Among patients receiving low-risk regimens, PP-CSF use did not differ between arms (intervention 6.3%, UC 5.5%, adjusted p = 0.74) and was slightly lower than the cohort (8.3%). FN rates did not differ between low risk groups (intervention 1.5%, UC 0.8%, adjusted p = 0.51). Conclusions: Guideline-informed standing orders did not increase PP-CSF use in high-risk patients, nor did it decrease use in low-risk patients. Adherence to guidelines in both risk groups exceeded historical reports. FN rates among patients not receiving PP-CSF were substantially below those reported in CSF guidelines. Automated standing orders for PP-CSF do not appear to be helpful or necessary. Clinical trial information: NCT02728596.
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Affiliation(s)
| | | | - Sean D. Sullivan
- CHOICE Institute, School of Pharmacy, University of Washington, Seattle, WA
| | | | | | | | | | | | | | - Carrie L. Dul
- Ascension Saint John Hospital (Michigan Cancer Research Consortium NCORP), Detroit, MI
| | | | - Robert J. Behrens
- Med Onc & Hem Assoc-Des Moines (Iowa-Wide Oncology Research Coalition NCORP), Des Moines, IA
| | | | - Nitya Alluri
- Saint Luke's Cancer Institute (Pacific Cancer Research Consortium NCORP), Boise, ID
| | - Dawn L. Hershman
- Columbia University College of Physicians and Surgeons, New York, NY
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6
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Whitworth PW, Beitsch PD, Pellicane JV, Baron PL, Lee LA, Dul CL, Murray MK, Gittleman MA, Budway RJ, Rahman RL, Kelemen PR, Dooley WC, Rock DT, Cowan KH, Lesnikoski BA, Barone JL, Ashikari AY, Dupree BB, Wang S, Menicucci AR, Yoder EB, Finn C, Corcoran K, Blumencranz LE, Audeh W. Distinct Neoadjuvant Chemotherapy Response and 5-Year Outcome in Patients With Estrogen Receptor-Positive, Human Epidermal Growth Factor Receptor 2-Negative Breast Tumors That Reclassify as Basal-Type by the 80-Gene Signature. JCO Precis Oncol 2022; 6:e2100463. [PMID: 35476550 PMCID: PMC9200401 DOI: 10.1200/po.21.00463] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The 80-gene molecular subtyping signature (80-GS) reclassifies a proportion of immunohistochemistry (IHC)-defined luminal breast cancers (estrogen receptor–positive [ER+], human epidermal growth factor receptor 2–negative [HER2–]) as Basal-Type. We report the association of 80-GS reclassification with neoadjuvant treatment response and 5-year outcome in patients with breast cancer. Identity exposed: genomic assay unmasks TNBC-like breast cancer tumors disguised as HR+ #NBRST![]()
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Affiliation(s)
- Pat W Whitworth
- Nashville Breast Center, Nashville, TN.,Targeted Medical Education, Cupertino, CA
| | - Peter D Beitsch
- Targeted Medical Education, Cupertino, CA.,Dallas Surgical Group, Dallas, TX
| | | | - Paul L Baron
- Breast and Melanoma Specialist of Charleston, Charleston, SC.,Lenox Hill Hospital/Northwell Health, New York, NY
| | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA
| | - Carrie L Dul
- Ascension St John Hospital Great Lakes Cancer Management Specialists, Grosse Pointe Woods, MI
| | - Mary K Murray
- Akron General Medical Center, Akron, OH.,Cleveland Clinic Akron General, Akron, OH
| | | | | | | | - Pond R Kelemen
- Ashikari Breast Center, Sleepy Hollow, NY.,Zucker School of Medicine, Hofstra University, Hempstead, NY
| | - William C Dooley
- Breast Institute, University of Oklahoma Health Sciences, Oklahoma City, OK.,Stephenson Cancer Center, Oklahoma City, OK
| | - David T Rock
- Regional Breast Care, Fort Myers, FL.,Genesis Care, Fort Myers, FL
| | - Kenneth H Cowan
- Fred and Pamela Buffet Cancer Center and Eppley Institute for Research in Cancer at University of Nebraska Medical Center, Omaha, NE
| | - Beth-Ann Lesnikoski
- The Breast Institute at JFK Medical Center, Atlantis, FL.,Baptist MD Anderson Cancer Center, Jacksonville, FL
| | - Julie L Barone
- Exempla Saint Joseph Hospital, Denver, CO.,Vail Health, Vail, CO
| | - Andrew Y Ashikari
- Zucker School of Medicine, Hofstra University, Hempstead, NY.,Northwell Health Physician Partners, Mount Kisco, NY
| | - Beth B Dupree
- St Mary Medical Alliance Cancer Specialists, Langhorne, PA
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7
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Whitworth P, Beitsch PD, Pellicane JV, Baron PL, Lee LA, Dul CL, Nash CH, Murray MK, Richards PD, Gittleman M, Budway R, Layeequr Rahman R, Kelemen P, Dooley WC, Rock DT, Cowan KH, Lesnikoski BA, Barone JL, Ashikari AY, Dupree B, Wang S, Menicucci AR, Yoder EB, Finn C, Corcoran K, Blumencranz LE, Audeh W. ASO Visual Abstract: Age-Independent Preoperative Chemosensitivity and 5-Year Outcome Determined by Combined 70- and 80-Gene Signature in a Prospective Trial in Early-Stage Breast Cancer. Ann Surg Oncol 2022. [PMID: 35438465 DOI: 10.1245/s10434-022-11711-0] [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: 11/18/2022]
Affiliation(s)
- Pat Whitworth
- Nashville Breast Center, Nashville, TN, USA.,Targeted Medical Education, Cupertino, CA, USA
| | - Peter D Beitsch
- Targeted Medical Education, Cupertino, CA, USA.,Dallas Surgical Group, Dallas, TX, USA
| | | | - Paul L Baron
- Breast and Melanoma Specialist of Charleston, Charleston, SC, USA.,Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA, USA
| | - Carrie L Dul
- Ascension St. John Hospital Great Lakes Cancer Management Specialists, Grosse Pointe Woods, MI, USA
| | | | - Mary K Murray
- Akron General Medical Center, Akron, OH, USA.,Cleveland Clinic Akron General, Akron, OH, USA
| | | | | | | | | | - Pond Kelemen
- Ashikari Breast Center, Sleepy Hollow, NY, USA.,Zucker School of Medicine, Hofstra University, Hempstead, NY, USA
| | - William C Dooley
- BreastInstitute, University of Oklahoma Health Sciences, Oklahoma City, OK, USA.,Stephenson Cancer Center, Oklahoma City, OK, USA
| | - David T Rock
- Regional Breast Care, Fort Myers, FL, USA.,Genesis Care, Fort Myers, FL, USA
| | - Ken H Cowan
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Beth-Ann Lesnikoski
- The Breast Institute at JFK Medical Center, Atlantis, FL, USA.,Baptist MD Anderson Cancer Center, Jacksonville, FL, USA
| | - Julie L Barone
- Exempla Saint Joseph Hospital, Denver, CO, USA.,Vail Health, Vail, CO, USA
| | - Andrew Y Ashikari
- Ashikari Breast Center, Sleepy Hollow, NY, USA.,New York Medical College, Valhalla, NY, USA.,Northwell Health Physician Partners, Mount Kisco, NY, USA.,Phelps and Northern Westchester Hospitals, Westchester, NY, USA
| | - Beth Dupree
- St. Mary Medical Alliance Cancer Specialists, Langhorne, PA, USA
| | - Shiyu Wang
- Medical Affairs, Agendia Inc., Irvine, CA, 92618, USA
| | | | - Erin B Yoder
- Medical Affairs, Agendia Inc., Irvine, CA, 92618, USA
| | | | - Kate Corcoran
- Medical Affairs, Agendia Inc., Irvine, CA, 92618, USA
| | | | - William Audeh
- Medical Affairs, Agendia Inc., Irvine, CA, 92618, USA.
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8
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Whitworth P, Beitsch PD, Pellicane JV, Baron PL, Lee LA, Dul CL, Nash CH, Murray MK, Richards PD, Gittleman M, Budway R, Rahman RL, Kelemen P, Dooley WC, Rock DT, Cowan K, Lesnikoski BA, Barone JL, Ashikari AY, Dupree B, Wang S, Menicucci AR, Yoder EB, Finn C, Corcoran K, Blumencranz LE, Audeh W. Age-Independent Preoperative Chemosensitivity and 5-Year Outcome Determined by Combined 70- and 80-Gene Signature in a Prospective Trial in Early-Stage Breast Cancer. Ann Surg Oncol 2022; 29:10.1245/s10434-022-11666-2. [PMID: 35378634 PMCID: PMC9174138 DOI: 10.1245/s10434-022-11666-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 03/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND The Neoadjuvant Breast Symphony Trial (NBRST) demonstrated the 70-gene risk of distant recurrence signature, MammaPrint, and the 80-gene molecular subtyping signature, BluePrint, precisely determined preoperative pathological complete response (pCR) in breast cancer patients. We report 5-year follow-up results in addition to an exploratory analysis by age and menopausal status. METHODS The observational, prospective NBRST (NCT01479101) included 954 early-stage breast cancer patients aged 18-90 years who received neoadjuvant chemotherapy and had clinical and genomic data available. Chemosensitivity and 5-year distant metastasis-free survival (DMFS) and overall survival (OS) were assessed. In a post hoc subanalysis, results were stratified by age (≤ 50 vs. > 50 years) and menopausal status in patients with hormone receptor-positive/human epidermal growth factor receptor 2-negative (HR+/HER2-) tumors. RESULTS MammaPrint and BluePrint further classified 23% of tumors to a different subtype compared with immunohistochemistry, with more precise correspondence to pCR rates. Five-year DMFS and OS were highest in MammaPrint Low Risk, Luminal A-type and HER2-type tumors, and lowest in MammaPrint High Risk, Luminal B-type and Basal-type tumors. There was no significant difference in chemosensitivity between younger and older patients with Low-Risk (2.2% vs. 3.8%; p = 0.64) or High-Risk tumors (14.5% vs. 11.5%; p = 0.42), or within each BluePrint subtype; this was similar when stratifying by menopausal status. The 5-year outcomes were comparable by age or menopausal status for each molecular subtype. CONCLUSION Intrinsic preoperative chemosensitivity and long-term outcomes were precisely determined by BluePrint and MammaPrint regardless of patient age, supporting the utility of these assays to inform treatment and surgical decisions in early-stage breast cancer.
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Affiliation(s)
- Pat Whitworth
- Nashville Breast Center, Nashville, TN, USA
- Targeted Medical Education, Cupertino, CA, USA
| | - Peter D Beitsch
- Targeted Medical Education, Cupertino, CA, USA
- Dallas Surgical Group, Dallas, TX, USA
| | | | - Paul L Baron
- Breast and Melanoma Specialist of Charleston, Charleston, SC, USA
- Lenox Hill Hospital/Northwell Health, New York, NY, USA
| | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA, USA
| | - Carrie L Dul
- Ascension St. John Hospital Great Lakes Cancer Management Specialists, Grosse Pointe Woods, MI, USA
| | | | - Mary K Murray
- Akron General Medical Center, Akron, OH, USA
- Cleveland Clinic Akron General, Akron, OH, USA
| | | | | | | | | | - Pond Kelemen
- Ashikari Breast Center, Sleepy Hollow, NY, USA
- Zucker School of Medicine, Hofstra University, Hempstead, NY, USA
| | - William C Dooley
- Breast Institute, University of Oklahoma Health Sciences, Oklahoma City, OK, USA
- Stephenson Cancer Center, Oklahoma City, OK, USA
| | - David T Rock
- Regional Breast Care, Fort Myers, FL, USA
- Genesis Care, Fort Myers, FL, USA
| | - Ken Cowan
- University of Nebraska Medical Center, Omaha, NE, USA
| | - Beth-Ann Lesnikoski
- The Breast Institute at JFK Medical Center, Atlantis, FL, USA
- Baptist MD Anderson Cancer Center, Jacksonville, FL, USA
| | - Julie L Barone
- Exempla Saint Joseph Hospital, Denver, CO, USA
- Vail Health, Vail, CO, USA
| | - Andrew Y Ashikari
- Ashikari Breast Center, Sleepy Hollow, NY, USA
- New York Medical College, Valhalla, NY, USA
- Northwell Health Physician Partners, Mount Kisco, NY, USA
- Phelps and Northern Westchester Hospitals, Westchester, NY, USA
| | - Beth Dupree
- St. Mary Medical Alliance Cancer Specialists, Langhorne, PA, USA
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9
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Blum JL, Bardia A, Wilks S, McCune SL, Dul CL, Migas JJ, Spell DW, Zhang Z, Liu Y, Wang Y, Tripathy D. Abstract LB033: Longitudinal ctDNA changes in patients with long-term response to palbociclib combination therapy for advanced breast cancer: A preliminary analysis from the real-world POLARIS study. Cancer Res 2021. [DOI: 10.1158/1538-7445.am2021-lb033] [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
POLARIS is an ongoing, prospective, real-world (RW) study of palbociclib (PAL) in patients (pts) with hormone receptor-positive, human epidermal growth factor receptor 2-negative advanced breast cancer (HR+/HER2- ABC). A biomarker goal of this study was to evaluate serial changes in circulating tumor DNA (ctDNA) dynamics among pts with long-term clinical response to PAL plus endocrine therapy (ie, received ≥18 cycles).
Methods
The data set included pts who received PAL combination therapy, gave consent for blood collection to obtain ctDNA, and had long-term clinical response. The Guardant360 Next-Generation Sequencing platform, which analyzed approximately 73 genes, was used to sequence ctDNA for somatic single-nucleotide variants, including copy number variants. Longitudinal ctDNA changes (at baseline and various time points) and the RW clinical response to PAL are described.
Results
As of December 17, 2020, 35 pts of 1280 enrolled received ≥18 cycles of PAL combination therapy, with blood samples collected over a minimum of a 24-month period. Pts received PAL plus an aromatase inhibitor (n=16) or fulvestrant (n=19). Median age was 64 years. Thirty pts (85.7%) were white, 29 (82.9%) were postmenopausal, 31 (88.6%) had an Eastern Cooperative Oncology Group score of 0 or 1, 12 (34.3%) had visceral disease, 9 (25.7%) had de novo disease, and 24 (68.6%) had recurrent disease. Six pts (17.1%) had a RW best overall response (BOR) of complete response (CR), 9 (25.7%) had partial response (PR), and 20 (57.1%) had stable disease (SD). Two pts had disease progression resulting in change of therapy at cycles 25 and 38, respectively. Biomarker samples were collected from a median (range) total number of 9 (3-12) visits. The median (range) number of somatic variants detected was 4 (0-11) and included the most prevalent somatic mutations (eg, PIK3CA, TP53, BRCA1/2, FGFR2, GATA3). No ctDNA mutations were detected in 6 pts (17%) post baseline up to 24 months. Among 15 pts who achieved CR/PR, 12 (80%) either had no detectable or sustained very low ctDNA burden or had corresponding ctDNA decrease. Among 16 pts who remained with SD, 12 (75%) either had no detectable or sustained very low ctDNA burden or had ctDNA decrease. Among 8 pts whose disease progressed, 5 (63%) had an increasing trend in ctDNA mutation frequency.
Conclusions
This study is among the first to provide serial blood-based tumor genotyping data from routine clinical practice. Interim data indicate that even pts with ongoing detectable ctDNA have a BOR of CR, PR, or SD with PAL for HR+/HER2- ABC, suggesting certain mutations might not be drivers of PAL resistance. Dynamic changes of ctDNA mutations may be predictive for treatment response, and may have clinical utility in disease surveillance monitoring. Additional longitudinal data will be presented.
Pfizer; NCT03280303
Citation Format: Joanne L. Blum, Aditya Bardia, Sharon Wilks, Steven L. McCune, Carrie L. Dul, John J. Migas, Derrick W. Spell, Zhe Zhang, Yuan Liu, Yao Wang, Debu Tripathy. Longitudinal ctDNA changes in patients with long-term response to palbociclib combination therapy for advanced breast cancer: A preliminary analysis from the real-world POLARIS 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 LB033.
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Affiliation(s)
- Joanne L. Blum
- 1Texas Oncology, Baylor-Sammons Cancer Center, US Oncology, Dallas, TX
| | - Aditya Bardia
- 2Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | | | | | - Carrie L. Dul
- 5Great Lakes Cancer Management, Grosse Pointe Woods, MI
| | - John J. Migas
- 6Mid-Illinois Hematology & Oncology Associates, Normal, IL
| | | | | | | | | | - Debu Tripathy
- 11The University of Texas MD Anderson Cancer Center, Houston, TX
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10
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Mouabbi JA, Chand M, Asghar IA, Sakhi R, Ockner D, Dul CL, Hadid T, Aref A, Rimawi MF, Hoyos V. Lumpectomy followed by radiation improves survival in HER2 positive and triple-negative breast cancer with high tumor-infiltrating lymphocytes compared to mastectomy alone. Cancer Med 2021; 10:4790-4795. [PMID: 34080777 PMCID: PMC8290225 DOI: 10.1002/cam4.4050] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/11/2021] [Accepted: 05/14/2021] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE The goal was to compare the 5-year DFS and 5-year OS in patients with early-stage human epidermal growth factor receptor 2 breast cancer (HER2+ BC) and triple-negative breast cancer (TNBC) in relation to the amount of stromal tumor-infiltrating lymphocytes (TILs) after locoregional management by either mastectomy without radiation or lumpectomy and whole-breast radiotherapy (RT). METHODS This was a retrospective review of HER2+ BC and TNBC patients' charts and histopathology slides with clinical stage of T1-T2 N0 who presented at our facility between January 2009 and December 2019. Locoregional treatment included either mastectomy without RT (M) or lumpectomy with RT (L+R). TILs were assessed by three pathologists using the guidelines of the 2014 TILs working group. A competing risk model and Kaplan-Meier analysis were used to analyze correlations between TILs levels and clinical outcome. RESULTS We reviewed 211 patients' charts. Of them, 190 proceeded to the final analysis. Patients were split into groups of "low TILs" and "high TILs" based on a 50% TILs cut-off. Of them 26% had high TILs, 48% received RT, 97% received chemotherapy, all HER2+ BC patients received HER2-directed therapy and all HER2+ BC that were also hormone receptor positive (HR+) received endocrine therapy (ET). In patient with low TILs, L+R did not improve outcomes compared to M. Moreover, patients with high TILs had a significant improvement of their DFS and OS with L+R when compared to M. CONCLUSION The results of our study reflect that a selected group of HER2+ BC and TNBC with elevated TILs, L+R is associated with improvement of 5-year DFS and 5-year OS.
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Affiliation(s)
- Jason A. Mouabbi
- Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonTXUSA
| | | | | | | | | | | | | | - Amr Aref
- Ascension St John HospitalDetroitMIUSA
| | - Mothaffar F. Rimawi
- Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonTXUSA
| | - Valentina Hoyos
- Dan L Duncan Comprehensive Cancer CenterBaylor College of MedicineHoustonTXUSA
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11
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Mouabbi JA, Chand M, Sakhi R, Asghar IA, Ockner D, Hadid T, Dul CL, Rimawi MF, Aref A. Abstract PS15-01: Radiation therapy improves survival in early-stage HER2-positive breast cancer with high-level of tumor infiltrating lymphocytes. Cancer Res 2021. [DOI: 10.1158/1538-7445.sabcs20-ps15-01] [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: Scientific evidence strongly indicates that locoregional control in early-stage breast cancer (BC) by lumpectomy with radiation therapy or by mastectomy yields similar disease-free survival (DFS) and overall survival (OS). A recent retrospective review of a Danish prospective database demonstrated strong favorable interaction between radiotherapy (RT) and all BC subtypes that contain high amount of tumor infiltrating lymphocytes (TILs).
Objective: We aim to compare DFS and OS in patients with early-stage HER2-positive BC, whose tumors demonstrate high involvement by TILs after locoregional treatment by either mastectomy or lumpectomy and whole breast radiotherapy.
Methods: We retrospectively reviewed the charts and histopathology slides of patients with HER2-positive BC with clinical stage T1-T2 N0, who were treated in our center between January 2009 and December 2018. Locoregional management included either mastectomy (no radiation group) or lumpectomy with whole breast irradiation (radiation group). Stromal TILs were estimated using hematoxylin-eosin staining, according to the recommendations of the TILs working group 2014. This was performed by 3 independent pathologists who were blinded to the clinical course of the patients. A competing risk model, Kaplan-Meier analysis and multivariate Cox regression analysis were used to estimate correlations between TILs and clinical outcomes.
Results: A total of 110 charts were reviewed and 99 were included in the final analysis. Patients were dichotomized into groups of “low-TILs” and “high-TILs” using a 40% cut off. Approximately 25% of patients (26/99) were “high-TILs” and around 50% of the “high-TILs” and “low-TILs” patients received RT. In all groups, around 90% of patients received chemotherapy and anti-HER2 therapy. All hormone receptor-positive patients received adjuvant endocrine therapy. While RT did not result in significant DFS or OS advantage in the low-TILs group, patients with high-TILs had significant improvement of DFS and OS with the addition of RT. Table 1 depict the 5-year DFS and 5-year OS in "high-TILs" and "low-TILs" groups in relation to RT, respectively.
Conclusion: In this retrospective analysis, our findings indicate that in high-TILs early-stage HER2-positive BC, RT was associated with significant improvement of 5-year DFS and OS. The exact mechanism is not well understood. However, this observation is important and warrants confirmation in prospective clinical trials.
5-year DFS5-year OSHigh TILsLow TILsHigh TILsLow TILsRT group100%90%100%83%No RT group65%90%72%93%p-value0.0270.960.0250.184
Citation Format: Jason A Mouabbi, Momal Chand, Ramen Sakhi, Ishaq A Asghar, Daniel Ockner, Tarik Hadid, Carrie L Dul, Mothaffar F Rimawi, Amer Aref. Radiation therapy improves survival in early-stage HER2-positive breast cancer with high-level of tumor infiltrating lymphocytes [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 PS15-01.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Amer Aref
- 2Ascension St John Hospital, Detroit, MI
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12
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D'Abreo N, Crozier JA, Brufsky A, Grady I, Diab S, Mavromatis BH, Dul CL, Layeequr Rahman R, Lee LA, Gadi VK, Untch S, Yoder E, Kling HM, Truitt A, Audeh W. The FLEX real-world data platform explores new gene expression profiles and investigator-initiated protocols in early stage breast cancer. J Clin Oncol 2020. [DOI: 10.1200/jco.2020.38.15_suppl.tps7088] [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
TPS7088 Background: Genomic expression profiles have enabled the classification of breast cancers into molecular sub-types and provide prognostic information about the metastatic potential of the tumor, both of which have implications for the personalized treatment of breast cancer beyond clinical and pathological features. However, to precisely stratify tumors into actionable subgroups, full genome expression data should be combined with comprehensive clinical information. The FLEX Registry aims to aggregate a large, real-world dataset, which will enable discovery of novel genomic profiles, particularly for patient subsets that are underrepresented in traditional clinical trials and will contribute to improved precision in the management of breast cancer. Methods: The FLEX Registry (NCT03053193) is a multi-center, prospective, observational trial for patients with Stage I, II, and III breast cancer. Patients with stage I-III breast cancer who receive the 70-gene signature risk of recurrence test, with or without the 80-gene signature molecular sub-typing test, on a primary tumor are eligible for enrollment. The primary objective of FLEX is to create a large scale, population-based registry that links complete clinical data with full genome expression data to elucidate new prognostic and/or predictive gene associations in a real-world setting. The FLEX Registry employs a shared study infrastructure to develop and investigate hypotheses for targeted subset analyses and/or clinical trials based on full genome expression data. The adaptable protocol is designed to be amended with the inclusion of targeted sub-studies. Patients enrolled in the initial study are eligible for inclusion in sub-studies for which they meet all eligibility criteria and additional consent is not required. Data will be collected on patients from diagnosis through 10 years of follow-up and any necessary additional clinical data will be collected as specified in the appendix protocols. Target enrollment is a minimum of 10,000 patients; >4,000 patients have enrolled since April 2017 at more than 80 sites, including seven National Cancer Institute-designated comprehensive cancer centers. The FLEX collaborative platform enables participating investigators the opportunity to author their own sub-study protocols, as approved by the FLEX Steering Committee. Fifteen sub-studies have been approved for investigation within the FLEX Registry. Clinical trial information: NCT03053193 .
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Affiliation(s)
| | | | - Adam Brufsky
- University of Pittsburgh Medical Center, Division of Hematology Oncology, Pittsburgh, PA
| | - Ian Grady
- North Valley Breast Clinic, Redding, CA
| | - Sami Diab
- Colorado Integrative Cancer Center, Greenwood Village, CO
| | | | | | | | | | | | | | - Erin Yoder
- Medical Affairs, Agendia, Inc., Irvine, CA
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13
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Mouabbi JA, Chand M, Sakhi R, Ockner D, Szpunar S, Dul CL, Hadid T, Kafri Z, Aref A. Abstract P4-12-09: Improvement of survival with radiation therapy in early stage triple negative breast cancer patients with high level of tumor infiltrating lymphocytes. Cancer Res 2020. [DOI: 10.1158/1538-7445.sabcs19-p4-12-09] [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: There is a strong evidence indicating that locoregional control of early-stage breast cancer either by lumpectomy with radiation therapy or by mastectomy yields similar rates of disease-free survival (DFS) and overall survival (OS). Recent retrospective review of a Danish prospective database demonstrated a strong favorable interaction between radiotherapy (RT) and all breast cancer subtypes that contain high amount of tumor infiltrating lymphocytes (TILs).
Objective: We aim to compare the DFS and OS rates in patients with early-stage triple negative breast cancer (TNBC), whose tumors demonstrate high involvement by TILs after locoregional management by either mastectomy or lumpectomy and whole breast radiotherapy.
Methods: We retrospectively reviewed the charts and histopathology slides of patients with TNBC with the clinical stage of T1-T2 N0 who were treated in our center between January 2009 and December 2018. Locoregional management included either mastectomy (no radiation group) or lumpectomy with whole breast irradiation (radiation group). Stromal TILs were estimated by 3 pathologists independently using hematoxylin-eosin staining, following the recommendations of the TILs working group 2014. A competing risk model, Kaplan-Meier analysis and multivariate Cox regression analysis were used to analyze correlations between TILs and clinical outcome.
Results: A total of 101 charts were reviewed and 91 were included in the final analysis. Patients were dichotomized into groups of “low TILs” and “high TILs” using a 40% cut off. Approximately 26% of patients (24/91) were “high TILs”. About 46% of the “high TILs” group and 52% of “low TILs” group received RT. In patients with high TILs, 82% received chemotherapy in the "radiation group" and 100% in "no radiation group". In the patients with low TILs, 77% received chemotherapy in the "RT group" and 75% in "no RT group”. Table 1 and 2 depict the 5-year DFS and 5-year OS in "high TILs" and "low TILs" groups in relation to RT, respectively.
Conclusion: Our data indicate that in a selected group of high TILs TNBC, RT is associated with significant improvement of 5-year DFS and OS. This improvement is unlikely to be due to improved locoregional control as local failure was rare in all patient groups. This study is limited by its retrospective nature and the low number of subjects. Despite that, our results are important and deserve further confirmation using larger prospective clinical trials.
Table 1. 5-year DFS5-year DFSHigh TILsLow TILsRT group100%83.9%No RT group47.1%79.3%p-value0.010.96
Table 2. 5-year OS5-year OSHigh TILsLow TILsRT group100%83.7%No RT group65.6%76.7%p-value0.050.98
Citation Format: Jason Aboudi Mouabbi, Momal Chand, Ramen Sakhi, Daniel Ockner, Susan Szpunar, Carrie L Dul, Tarik Hadid, Zyad Kafri, Amr Aref. Improvement of survival with radiation therapy in early stage triple negative breast cancer patients with high level of tumor infiltrating lymphocytes [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr P4-12-09.
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Affiliation(s)
| | - Momal Chand
- 1Ascension St John Hospital, Grosse Pointe, MI
| | - Ramen Sakhi
- 1Ascension St John Hospital, Grosse Pointe, MI
| | | | | | | | - Tarik Hadid
- 2Verdi Cancer and Research Center of Michigan, Macomb, MI
| | - Zyad Kafri
- 1Ascension St John Hospital, Grosse Pointe, MI
| | - Amr Aref
- 1Ascension St John Hospital, Grosse Pointe, MI
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14
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Beitsch P, Whitworth P, Baron P, Rotkis MC, Mislowsky AM, Richards PD, Murray MK, Pellicane JV, Dul CL, Nash CH, Stork-Sloots L, de Snoo F, Untch S, Lee LA. Pertuzumab/Trastuzumab/CT Versus Trastuzumab/CT Therapy for HER2+ Breast Cancer: Results from the Prospective Neoadjuvant Breast Registry Symphony Trial (NBRST). Ann Surg Oncol 2017; 24:2539-2546. [PMID: 28447218 DOI: 10.1245/s10434-017-5863-x] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND Pertuzumab became a standard part of neoadjuvant therapy for human epidermal growth factor receptor 2-positive (HER2+) breast cancers approximately halfway through Neoadjuvant Breast Registry Symphony Trial (NBRST) enrollment, providing a unique opportunity to determine biologically which clinical HER2+ patients benefit most from dual targeting. As a neoadjuvant phase 4 study, NBRST classifies patients by both conventional and molecular subtyping. METHODS Of 308 clinical HER2+ patients enrolled in NBRST between 2011 and 2014 from 62 U.S. institutions, 297 received neoadjuvant chemotherapy (NCT) with HER2-targeted therapy and underwent surgery. This study compared the pathologic complete response (pCR) rate of BluePrint versus clinical subtypes with treatment, specifically differences between trastuzumab (T) treatment and trastuzumab and pertuzumab (T/P) treatment. RESULTS In this study, 60% of the patients received NCT-T, and 40% received NCT-T/P. The overall pCR rate (ypT0/isN0) was 47%. BluePrint classified 161 tumors (54%) as HER2 type, with a pCR rate of 65%. This was significantly higher than the pCR rate for the 91 HER2+ tumors (31%) classified as luminal (18%) (p = 0.00001) and the 45 tumors (15%) classified as basal (44%) (p = 0.0166). The patients treated with T/P had higher pCR rates than those treated with trastuzumab alone. The difference was most pronounced in the BluePrint luminal patients (8 vs. 31%). The highest pCR was reached by the BluePrint HER2-type patients treated with T/P (76%). CONCLUSIONS The addition of pertuzumab leads to increased pCR rates for all HER2+ patient groups except for the BluePrint basal-type patients. This better response was most pronounced for the BluePrint luminal-type patients.
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Affiliation(s)
- Peter Beitsch
- Targeted Medical Education, Dallas Breast Center, 8140 Walnut Hill Lane, Suite 800, Dallas, TX, 75231, USA.
| | - Pat Whitworth
- Targeted Medical Education, Nashville Breast Center, Nashville, TN, USA
| | - Paul Baron
- Targeted Medical Education, Nashville Breast Center, Nashville, TN, USA
| | - Michael C Rotkis
- Breast & Melanoma Specialists of Charleston, Charleston, SC, USA
| | | | | | | | | | - Carrie L Dul
- Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA, USA
| | | | | | - Femke de Snoo
- Northeast Georgia Medical Center, Gainesville, GA, USA
| | | | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA, USA
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15
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Whitworth P, Beitsch P, Mislowsky A, Pellicane JV, Nash C, Murray M, Lee LA, Dul CL, Rotkis M, Baron P, Stork-Sloots L, de Snoo FA, Beatty J. Chemosensitivity and Endocrine Sensitivity in Clinical Luminal Breast Cancer Patients in the Prospective Neoadjuvant Breast Registry Symphony Trial (NBRST) Predicted by Molecular Subtyping. Ann Surg Oncol 2017; 24:669-675. [PMID: 27770345 PMCID: PMC5306085 DOI: 10.1245/s10434-016-5600-x] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [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: 06/20/2016] [Indexed: 01/28/2023]
Abstract
PURPOSE Hormone receptor-positive (HR+) tumors have heterogeneous biology and present a challenge for determining optimal treatment. In the Neoadjuvant Breast Registry Symphony Trial (NBRST) patients were classified according to MammaPrint/BluePrint subtyping to provide insight into the response to neoadjuvant endocrine therapy (NET) or neoadjuvant chemotherapy (NCT). OBJECTIVE The purpose of this predefined substudy was to compare MammaPrint/BluePrint with conventional 'clinical' immunohistochemistry/fluorescence in situ hybridization (IHC/FISH) subtyping in 'clinical luminal' [HR+/human epidermal growth factor receptor 2-negative (HER2-)] breast cancer patients to predict treatment sensitivity. METHODS NBRST IHC/FISH HR+/HER2- breast cancer patients (n = 474) were classified into four molecular subgroups by MammaPrint/BluePrint subtyping: Luminal A, Luminal B, HER2, and Basal type. Pathological complete response (pCR) rates were compared with conventional IHC/FISH subtype. RESULTS The overall pCR rate for 'clinical luminal' patients to NCT was 11 %; however, 87 of these 474 patients were reclassified as Basal type by BluePrint, with a high pCR rate of 32 %. The MammaPrint index was highly associated with the likelihood of pCR (p < 0.001). Fifty-three patients with BluePrint Luminal tumors received NET with an aromatase inhibitor and 36 (68 %) had a clinical response. CONCLUSIONS With BluePrint subtyping, 18 % of clinical 'luminal' patients are classified in a different subgroup, compared with conventional assessment, and these patients have a significantly higher response rate to NCT compared with BluePrint Luminal patients. MammaPrint/BluePrint subtyping can help allocate effective treatment to appropriate patients. In addition, accurate identification of subtype biology is important in the interpretation of neoadjuvant treatment response since lack of pCR in luminal patients does not portend the worse prognosis associated with residual disease in Basal and HER2 subtypes.
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Affiliation(s)
| | | | | | - James V Pellicane
- Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA, USA
| | - Charles Nash
- Northeast Georgia Medical Center, Gainesville, GA, USA
| | | | - Laura A Lee
- Comprehensive Cancer Center, Palm Springs, CA, USA
| | | | - Michael Rotkis
- Northern Indiana Cancer Research Consortium, South Bend, IN, USA
| | - Paul Baron
- Breast and Melanoma Specialists of Charleston, Charleston, SC, USA
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16
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Wagner RM, Spzunar SM, Stefani WA, Falk JS, Williams JL, Edhayan E, Dul CL, Rodriguez D, Busuito MJ, Browne CH, Aref A, Rabbani AN, Chuba PJ. Abstract P2-13-02: Radiation and depression associated with complications of tissue expander reconstruction. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p2-13-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background: Rates of implant failure, wound healing delay, and infection are higher in patients having RT after tissue expander (TE) and permanent implant reconstruction. Some have suggested greater complications with increased body mass index (BMI) and with diabetes.
Patients and Methods: 127 patients had bilateral TE reconstruction and radiation from 2003 to 2013 at two centers. In 95% (121/127) of cases RT was performed while the TE was in place with the permanent implant inserted after RT. 3D-CRT technique included 50 Gy with daily or every other day bolus and forward planned segments. The supraclavicular and/or internal mammary lymph node bearing regions were treated in 82.7% (105/127) cases. The non-irradiated breast provided an internal control. Chi-squared testing of pretreatment factors included radiation, chemotherapy, and medical history of hypertension, diabetes, cardiovascular, and pulmonary disease. BMI, tobacco and alcohol use, use of antiestrogen, statin, antidepressant, antihypertensive, anxiolytics, and antidiabetic medications were also studied. Comparison of differences in means for continuous variables used analysis of variance, then multiple pairwise comparisons with Bonferroni correction of p-value.
Results: Mean age was 53 ± 10.1 years with just 14.6% African- American. Twelve (9.4%) were BRCA positive (9 BRCA1, 4 BRCA2, 1 Both). Nearly all complications were in the radiated breast. Complications were: Grade 0 (no complication; 43.9%), Grade 1 (tightness and/or drifting of implant or Baker grade II capsular contracture; 30.9 %), Grade 2 (infection, hypertrophic scarring, or incisional necrosis; 9.8%), Grade 3 (Baker grade III capsular contracture, wound dehiscence, or impending exposure of implant; 5.7%), Grade 4 (implant failure, exchange of implant, or Baker grade IV capsular contracture; 9.8%). 15.3 percent (19 cases) experienced grade 3 or 4 complication and 9.8% (12 cases) had grade 4 complication. Considering non-irradiated breasts, there were two (1.6%) Grade 3-4 complications. For BMI, there was no significant difference by category as defined by the CDC (p=0.91). Patients history of HRT tended to be more likely to have Grade 3 or 4 complications (31.8% vs 12.4% respectively; p=0.08). Patients with depression were more likely to experience a Grade 3 or 4 complication (29.4% vs 13.2%; p=0.01). Multiple logistic regression was used to predict the probability of a Grade 3 or 4 complication with HR use and depression as independent variables. Patients with depression were 4.2 times more likely to have a Grade 3 or 4 complication (OR=4.2, p=0.03) and patients with a history of HRT use were 3.4 times more likely to experience a Grade 3 or 4 complication (OR = 3.4, p=0.04). Only clinical diagnosis of depression was considered as 12/31 (38.7%) with antidepressants used only venlafaxine. Neither BRCA status (p=0.72) nor chemotherapy factors (p=0.42) were associated with complication rates.
Conclusions: Higher rates of TE reconstruction complications may be expected in patients receiving radiotherapy. Patients reporting medical history of depression or HRT use showed statistically significant increase in complication rates. This effect might be attributed to a drug effect or to patient factors such as body image.
Citation Format: Wagner RM, Spzunar SM, Stefani WA, Falk JS, Williams JL, Edhayan E, Dul CL, Rodriguez D, Busuito MJ, Browne CH, Aref A, Rabbani AN, Chuba PJ. Radiation and depression associated with complications of tissue expander reconstruction. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P2-13-02.
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Affiliation(s)
- RM Wagner
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - SM Spzunar
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - WA Stefani
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - JS Falk
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - JL Williams
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - E Edhayan
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - CL Dul
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - D Rodriguez
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - MJ Busuito
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - CH Browne
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - A Aref
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - AN Rabbani
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
| | - PJ Chuba
- St. John Macomb Oakland Hospital, Warren, MI; St. John Hospital & Medical Center, Grosse Pointe Woods, MI; Renaissance Plastic Surgery, Troy, MI; Plastic and Reconstructive Surgery, St Clair Shores, MI; Metro Detroit Plastic Surgery, Troy, MI
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Whitworth P, Beitsch P, Baron P, Beatty J, Pellicane JV, Murray MK, Dul CL, Mislowsky AM, Nash CH, Richards PD, Lee LA, Stork-Sloots L, de Snoo F, Untch S, Gittleman M, Akbari S, Rotkis MC. Abstract P1-14-05: Three distinct HER2 subtypes identified by BluePrint 80-gene functional subtyping predict treatment-specific response in the prospective neo-adjuvant NBRST registry. Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p1-14-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Background
Ideally classification by subtype predicts treatment response and overall outcome. BluePrint 80-gene functional molecular subtype is based on mRNA expression (as is intrinsic subtype) associated with intact translation to protein (unlike intrinsic subtype). BluePrint (BP) classifies patients into Luminal, Her2 or Basal-type. Presently subtype is approximated using conventional immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) ("conventional subtype") or assigned by gene expression profiling. The main objective of the prospective neo-adjuvant NBRST study is to compare drug sensitivity as defined by pathological Complete Response (pCR), using 80-gene functional subtype vs. conventional IHC/FISH subtyping. NBRST enrolled over 1,000 US patients between June 2011 and December 2014. In this analysis we present the results for IHC/FISH Her2-positive patients.
Methods
Here we report findings in the 260 NBRST patients who had IHC/FISH Her2+ breast cancer, according to ASCO CAP guidelines at the time of diagnosis. Treatment, including chemotherapy and HER2-targeted agents, was at the discretion of the physician adhering to NCCN approved or other peer-reviewed, established regimens over the course of the study. pCR was defined as T0/isN0. Fisher's exact test was used to compare pCR rates among IHC/FISH and functional subtypes and treatment groups.
Results
The 260 IHC/FISH Her2+ patients had median age 53 (range 23-81) and included T1-4, N0-3 tumors. Of 169 ER+/Her2+ tumors 49% were re-classified as BP Luminal, 43% as BP HER2, and 8% as BP Basal. The median ER% of ER+/Her2+/BP Luminal tumors was 93% (range 3-100), compared to 79% in ER+/Her2+/BP HER2 (range 1-91) and 8% in ER+/Her2+/BP Basal-type (range 2-99).The overall pCR rate in ER+/Her2+/BP Luminal was 17% (4% with chemo/trastuzumab; 39% chemo/trastuzumab/pertuzumab, p<0.0001) and statistically inferior (p<0.0001) to the 59% pCR rate in ER+/Her2+/BP HER2. Of 91 ER-/Her2+ tumors 74% were classified as BP HER2, 25% were re-classified BP Basal and <1% was BP Luminal. NCT pCR rates for ER-/Her2+/BP HER2 was 67% (64% with chemo/trastuzumab; 77% chemo/trastuzumab/pertuzumab, p=0.40) and significantly superior (p=0.026) to the 39% pCR rate in ER-/Her2+/BP Basal (p=0.026).
Conclusions
In the NBRST study, BP 80-gene functional subtype (based on mRNA expression and translation): 1. Re-classifies over half of all IHC/FISH ER+/Her2+ patients; 2. Predicts treatment response or resistance in Her2+ patients not segregated by conventional IHC/FISH classification and 3. Identifies ER+/Her2+ tumors that are sensitive to chemo/trastuzumab/pertuzumab but resistant to chemo/trastuzumab.
Citation Format: Whitworth P, Beitsch P, Baron P, Beatty J, Pellicane JV, Murray MK, Dul CL, Mislowsky AM, Nash CH, Richards PD, Lee LA, Stork-Sloots L, de Snoo F, Untch S, Gittleman M, Akbari S, Rotkis MC. Three distinct HER2 subtypes identified by BluePrint 80-gene functional subtyping predict treatment-specific response in the prospective neo-adjuvant NBRST registry. [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P1-14-05.
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Affiliation(s)
- P Whitworth
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - P Beitsch
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - P Baron
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - J Beatty
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - JV Pellicane
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - MK Murray
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - CL Dul
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - AM Mislowsky
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - CH Nash
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - PD Richards
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - LA Lee
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - L Stork-Sloots
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - F de Snoo
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - S Untch
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - M Gittleman
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - S Akbari
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - MC Rotkis
- Nashville Breast Center, Nashville, TN; Dallas Surgical Group, Dallas, TX; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospita, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville GA, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
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Peter B, Pat W, Paul B, Jennifer B, Pellicane JV, Murray MK, Dul CL, Mislowsky AM, Nash CH, Richards PD, Lee LL, Stork-Sloots L, de Snoo F, Untch S, Gittleman M, Akbari S, Rotkis MC. Abstract P4-14-10: Pertuzumab overcomes chemotherapy/trastuzumab resistance in ER+/Her2+ tumors classified as luminal functional subtype by the 80-gene BluePrint assay in the prospective neo-adjuvant breast registry symphony trial (NBRST). Cancer Res 2016. [DOI: 10.1158/1538-7445.sabcs15-p4-14-10] [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
The prospective Neo-adjuvant Breast Registry Symphony Trial (NBRST) enrolled over 1000 US patients between June 2011 and December 2014. The aim of NBRST study is to compare chemosensitivity as defined by pathological Complete Response (pCR) using the 80-gene BluePrint functional subtype profile vs. conventional IHC/FISH subtyping. Treatment was at the discretion of the physician utilizing standard NCCN regimens. Pertuzumab, a monoclonal antibody, inhibits the dimerization of HER2 with other HER receptors. Pertuzumab received US FDA approval for the neo-adjuvant treatment of HER2-positive breast cancer in September 2013. Essentially all patients with HER2 positive cancers were treated with chemotherapy + trastuzumab and after this date pertuzumab was added, creating 2 distinct groups of Her2 treated patients.
The aim of the current analysis is to compare the pCR rate of trastuzumab (H) vs trastuzumab and pertuzumab (H + P) by conventional and BluePrint functional subtype.
Methods
The current analysis includes women from the NBRST study, with histologically proven breast cancer, who received neo-adjuvant chemotherapy plus H or H + P and who provided written informed consent. Pathological assessment of Her2 was done according to ASCO CAP guidelines at the time of diagnosis. BluePrint (BP) classifies patients into Luminal, HER2 or Basal-type. pCR is defined as T0/isN0. All pCRs were verified with a de-identified copy of the surgical pathology report. Fisher's exact test was used to compare pCR rates within different subgroups.
Results
252 IHC/FISH Her2+ patients received H (166) or H + P (86). The median age was 53 (range 23-81). 8% was stage I, 68% stage II and 24% stage III. 65% were ER positive.
BP classified 55% of patients as HER2, 32% as Luminal, and 14% as Basal-type.
The pCR rates and p-values within different subgroups of clinical Her2+ patients are provided in the table below.
pCR rates and p-values within different subgroups of clinical Her2+ patients(n)H (pCR rate)H + P (pCR rate)p-valueTotal (n=252)40%59%0.005IHC/FISH Her2+/ER+ (163)30%57%0.001IHC/FISH Her2+/ER- (89)69%63%0.82BP HER2 (138)57%78%0.01BP Luminal (80)4%38%0.0002BP Basal (34)47%38%0.69
Conclusions
Addition of pertuzumab to trastuzumab significantly increased response rate in ER+/Her2+, BP HER2 and BP Luminal patients but not in ER-negative and BP Basal patients.
Pertuzumab overcame resistance to NCT/trastuzumab in a substantial proportion of the IHC/FISH Her2+/BP Luminal subgroup; indicated by a significantly increased pCR rate.
Citation Format: Peter B, Pat W, Paul B, Jennifer B, Pellicane JV, Murray MK, Dul CL, Mislowsky AM, Nash CH, Richards PD, Lee LL, Stork-Sloots L, de Snoo F, Untch S, Gittleman M, Akbari S, Rotkis MC. Pertuzumab overcomes chemotherapy/trastuzumab resistance in ER+/Her2+ tumors classified as luminal functional subtype by the 80-gene BluePrint assay in the prospective neo-adjuvant breast registry symphony trial (NBRST). [abstract]. In: Proceedings of the Thirty-Eighth Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2015 Dec 8-12; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2016;76(4 Suppl):Abstract nr P4-14-10.
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Affiliation(s)
- B Peter
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - W Pat
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - B Paul
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - B Jennifer
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - JV Pellicane
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - MK Murray
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - CL Dul
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - AM Mislowsky
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - CH Nash
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - PD Richards
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - LL Lee
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - L Stork-Sloots
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - F de Snoo
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - S Untch
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - M Gittleman
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - S Akbari
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
| | - MC Rotkis
- Dallas Surgical Group, Dallas, TX, Netherlands; Nashville Breast Center, Nashville, TN; Breast & Melanoma Specialists of Charleston, Charleston, SC; The Breast Place, Charleston, SC; Virginia Breast Center, Bon Secours Cancer Institute, Richmond, VA; Akron General Hospital, Akron, OH; St. John Hospital & Medical Center, Detroit, MI; Coastal Carolina Breast Center, Murrells Inlet, SC; Northeast Georgia Medical Center, Gainesville, GA; Blue Ridge Cancer Care, Roanoke, VA; Comprehensive Cancer Center, Palm Springs, CA; Agendia Inc, Irvine, CA; Breast Care Specialists, Allentown, PA; Virginia Hospital Center, Arlington, VA; Northern Indiana Cancer Research Consortium, South Bend, IN
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Whitworth PW, Beitsch PD, Rotkis MC, Pellicane JV, Murray M, Baron P, Dul CL, Mislowsky AM, Nash CH, Richards PD, Lee LA, Stork L, De Snoo F, Untch S, Gittleman M, Akbari S, Beatty J. Functional subtyping with BluePrint 80-gene profile to identify distinct triple-positive subtypes with and without trastuzumab/chemosensitivity. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.28_suppl.114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
114 Background: Classification by molecular subtype can aid in the selection of therapy for patients with breast cancer. However at present, the methodology for molecular subtyping is not standardized. The aim of the prospective NBRST study is to compare chemosensitivity as defined by pathological Complete Response (pCR) using the 80-gene BluePrint (BP) functional subtype profile vs. conventional IHC/FISH subtyping. Methods: The study includes women aged 18–90 with histologically proven breast cancer, written informed consent, no excision biopsy or axillary dissection, and no prior therapy for breast cancer. Neo-adjuvant Chemotherapy (NCT) was at the discretion of the physician adhering to NCCN approved or other peer-reviewed regimens. BP in combination with MammaPrint classifies patients into 4 molecular subgroups: Luminal A, Luminal B, HER2 and Basal. Results: 721 patients had definitive surgery. 58/335 (17%) IHC/FISH HR+/HER2- patients were re-classified by BP as Basal (57) or HER2 (1). 92/222 (41%) IHC/FISH HER2+ patients were re-classified as BP Luminal (67) or BP Basal (25). 7/164 (4%) IHC/FISH triple negative (TN) patients were re-classified as BP Luminal (5) or BP HER2 (2). NCT pCR rates were 3% in Luminal A and 9% in Luminal B patients versus 10% pCR in IHC/FISH luminal patients. The NCT pCR rate was 54% in BP HER2 patients. This is significantly superior (p = 0.02) to the pCR rate in IHC/FISH HER2+ patients (40%). BP Basal and IHC/FISH TN had a pCR rate of 35%. Functional BP subtyping divided the 137 IHC/FISH triple positive patients into two major subgroups: BP Luminal (n = 66, pCR = 11%) and BP HER2 (n = 60, pCR = 45%).11 patients were re-classified as BP Basal with pCR = 45%. Conclusions: Molecular subtyping using BP leads to a reclassification of 23% of tumors. The re-classification is most prominent in classically assessed triple positive patients where 48% of patients are re-assigned to the less responsive BP Luminal-type group vs. 44% of patients assigned to the responsive BP HER2-type group. These findings confirm the more accurate identification of molecular subgroups for treatment decision by BluePrint functional subtype classifier. Clinical trial information: NCT01479101.
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Affiliation(s)
- Pat W. Whitworth
- NRG Oncology/NSABP, ALLIANCE/ACOSOG, and Nashville Breast Center, Nashville, TN
| | | | | | | | | | - Paul Baron
- Cancer Specialists of Charleston, Charleston, SC
| | - Carrie L. Dul
- Great Lakes Management Spclsts, Grosse Pointe Park, MI
| | | | | | - Paul D. Richards
- Oncology and Hematology Association of Southwest Virginia, Salem, VA
| | | | | | | | | | | | - Stephanie Akbari
- Virginia Hospital Center Reinsch Pierce Family Center for Breast Health, Arlington, VA
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Whitworth PW, Beitsch PD, Rotkis MC, Pellicane JV, Murray M, Baron P, Dul CL, Mislowsky AM, Nash CH, Richards PD, Lee LA, Stork L, De Snoo F, Untch S, Gittleman M, Akbari S, Beatty J. Determining whether functional subtyping with BluePrint 80-gene profile could potentially identify two distinct triple positive subtypes with and without trastuzumab/chemo-sensitivity. J Clin Oncol 2015. [DOI: 10.1200/jco.2015.33.15_suppl.596] [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: 11/20/2022] Open
Affiliation(s)
- Pat W. Whitworth
- NRG Oncology/NSABP, ALLIANCE/ACOSOG, and Nashville Breast Center, Nashville, TN
| | | | | | | | | | - Paul Baron
- Cancer Specialists of Charleston, Charleston, SC
| | - Carrie L. Dul
- Great Lakes Management Spclsts, Grosse Pointe Park, MI
| | | | | | | | | | | | | | | | | | - Stephanie Akbari
- Virginia Hospital Center Reinsch Pierce Family Center for Breast Health, Arlington, VA
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Abstract
Breast cancer during pregnancy is increasingly common as women delay childbearing until later in life. Safe administration of adjuvant chemotherapy during pregnancy has been reported. Physiologic and metabolic changes during pregnancy could alter the pharmacokinetics of these agents. This is a pilot study to prospectively study the pharmacokinetics of chemotherapeutic agents during pregnancy. Herein, we report the initial results with paclitaxel in the first patient.
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Affiliation(s)
- Jennifer L Lycette
- Hematology and Medical Oncology, Oregon Health & Science University, 3181 SW Sam Jackson Park Road, Portland, OR 97239, USA.
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Abstract
Angiogenesis plays a role in breast cancer development. Preclinical and clinical evidence is reviewed. Development of targeted antiangiogenic agents provides new challenges to clinical trial design. Current antiangiogenic therapy with traditional agents and novel agents are classified and reviewed.
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Affiliation(s)
- Kathy D Miller
- Division of Hematology and Medical Oncology, Indiana University, 535 Barnhill Drive, RT-473, Indianapolis, IN 46202, USA.
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