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de Azambuja E, Agostinetto E, Procter M, Eiger D, Pondé N, Guillaume S, Parlier D, Lambertini M, Desmet A, Caballero C, Aguila C, Jerusalem G, Walshe JM, Frank E, Bines J, Loibl S, Piccart-Gebhart M, Ewer MS, Dent S, Plummer C, Suter T. Cardiac safety of dual anti-HER2 blockade with pertuzumab plus trastuzumab in early HER2-positive breast cancer in the APHINITY trial. ESMO Open 2023; 8:100772. [PMID: 36681013 PMCID: PMC10044361 DOI: 10.1016/j.esmoop.2022.100772] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 12/11/2022] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Trastuzumab increases the incidence of cardiac events (CEs) in patients with breast cancer (BC). Dual blockade with pertuzumab (P) and trastuzumab (T) improves BC outcomes and is the standard of care for high-risk human epidermal growth factor receptor 2 (HER2)-positive early BC patients. We analyzed the cardiac safety of P and T in the phase III APHINITY trial. PATIENTS AND METHODS Left ventricular ejection fraction (LVEF) ≥ 55% was required at study entry. LVEF assessment was carried out every 3 months during treatment, every 6 months up to month 36, and yearly up to 10 years. Primary CE was defined as heart failure class III/IV and a significant decrease in LVEF (defined as ≥10% from baseline and to <50%), or cardiac death. Secondary CE was defined as a confirmed significant decrease in LVEF, or CEs confirmed by the cardiac advisory board. RESULTS The safety analysis population consisted of 4769 patients. With 74 months of median follow-up, CEs were observed in 159 patients (3.3%): 83 (3.5%) in P + T and 76 (3.2%) in T arms, respectively. Most CEs occurred during anti-HER2 therapy (123; 77.4%) and were asymptomatic or mildly symptomatic decreases in LVEF (133; 83.6%). There were two cardiac deaths in each arm (0.1%). Cardiac risk factors indicated were age > 65 years, body mass index ≥ 25 kg/m2, baseline LVEF between 55% and <60%, and use of an anthracycline-containing chemotherapy regimen. Acute recovery from a CE based on subsequent LVEF values was observed in 127/155 patients (81.9%). CONCLUSIONS Dual blockade with P + T does not increase the risk of CEs compared with T alone. The use of anthracycline-based chemotherapy increases the risk of a CE; hence, non-anthracycline chemotherapy may be considered, particularly in patients with cardiovascular risk factors.
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Affiliation(s)
- E de Azambuja
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium.
| | - E Agostinetto
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M Procter
- Frontier Science, Kincraig, Kingussie, UK
| | - D Eiger
- F.Hoffmann-La Roche Ltd, Basel, Switzerland
| | - N Pondé
- Clinical Oncology Department, AC Camargo Cancer Center, São Paulo, Brazil
| | - S Guillaume
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - D Parlier
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M Lambertini
- Department of Medical Oncology, U.O. Clinica di Oncologia Medica, IRCCS Ospedale Policlinico San Martino, Genova, Italy; Department of Internal Medicine and Medical Sciences (DiMI), School of Medicine, University of Genova, Genova, Italy
| | - A Desmet
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - C Caballero
- Breast International Group, Brussels, Belgium
| | - C Aguila
- F.Hoffmann-La Roche Ltd, Basel, Switzerland
| | - G Jerusalem
- CHU Liege and Liege University, Liege, Belgium
| | - J M Walshe
- Cancer Trials Ireland, St Vincent's University Hospital, Dublin, Ireland
| | - E Frank
- Dana-Farber Cancer Institute, Boston, USA
| | - J Bines
- Instituto Nacional de Cancer, INCA, Rio de Janeiro, Brazil
| | - S Loibl
- German Breast Group, Neu-Isenburg, Germany
| | - M Piccart-Gebhart
- Institut Jules Bordet and L'Université Libre de Bruxelles (U.L.B), Brussels, Belgium
| | - M S Ewer
- University of Texas, MD Anderson Cancer Center, Houston
| | - S Dent
- Duke Cancer Institute, Duke University, Durham, USA
| | - C Plummer
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
| | - T Suter
- Department of Cardiology, Cardio-Oncology, Bern University Hospital, Bern, Switzerland
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Dang C, Ewer M, Delaloge S, Ferrero JM, Colomer R, de la Cruz Merino L, Dadswell K, Verrill M, Eiger D, Sarkar S, de Haas S, Restuccia E, Swain S. 43O Pertuzumab/trastuzumab in early stage HER2-positive breast cancer: 5-year and final analysis of the BERENICE trial. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.057] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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De Caluwe A, Buisseret L, Poortmans P, Sotiriou C, Larsimont D, Van Gestel D, Laragione A, Desmet A, Van Den Begin R, Philippson C, Eiger D, Piccart M, Romano E, Ignatiadis M. 84TiP Neo-CheckRay: Radiation therapy and adenosine pathway blockade to increase benefit of immuno-chemotherapy in early stage luminal B breast cancer: A randomized phase II trial. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.10.571] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Eiger D, Maurer C, Brandao M, Aftimos P, Punie K, Taylor D, Van den Mooter T, Poncin R, Canon JL, Duhoux F, Casert V, Clatot F, Velghe C, Craciun L, Paesmans M, de Azambuja E, Ignatiadis M, Larsimont D, Piccart M, Buisseret L. 348P First findings from SYNERGY, a phase I/II trial testing the addition of the anti-CD73 oleclumab (O) to the anti-PD-L1 durvalumab (D) and chemotherapy (ChT) as first line therapy for patients (pts) with metastatic triple-negative breast cancer (mTNBC). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.450] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Franzoi M, Conde R, Ferreira S, Eiger D, Awada A, de Azambuja E. 344P Clinical outcomes of platinum-based polichemotherapy in patients with advanced breast cancer: A 10-year single institutional experience. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Eiger D, Tsourti Z, Caparica R, Kassapian M, Napoleone S, Hultsch S, Korde L, Wang Y, Chumsri S, Pritchard K, Untch M, Bellet Ezquerra M, Rosa D, Moreno-Aspitia A, Piccart M, Dafni U, de Azambuja E. 221P Long-term outcomes of patients with node-negative, ≤3cm, HER2+ breast cancer (BC) enrolled in ALTTO. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Franzoi M, Ameye L, Eiger D, Piccart M, Brandão M, Pondé N, Desmedt C, Di Cosimo S, Paesmans M, Caparica R, Kotecki N, Lambertini M, De Angelis C, Awada A, de Azambuja E. 153P Clinical implications of body mass index (BMI) and weight in metastatic breast cancer (BC) patients treated with abemaciclib and endocrine therapy: A pooled individual patient level data analysis of MONARCH 2 and MONARCH 3 trials. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Eiger D, de Azambuja E, Moreau M, Bondele J, Sotiriou C, Franzoi M, Brandão M, Rediti M, Wang X, Awada A, Kotecki N. 159P The clinical landscape of central nervous system (CNS) involvement in metastatic triple-negative breast cancer (TNBC) patients (pts). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Brandão M, Bruzzone M, Franzoi M, de Angelis C, Eiger D, Caparica R, Dauby N, Ceppi M, Piccart M, Carrilho C, Lunet N, Buisseret L, de Azambuja E, Lambertini M. 188P Impact of HIV infection (HIV+) on baseline characteristics and survival of breast cancer (BC) patients (pts): A systematic review and meta-analysis. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.03.127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Brandão M, Caparica R, Eiger D, de Azambuja E. Biomarkers of response and resistance to PI3K inhibitors in estrogen receptor-positive breast cancer patients and combination therapies involving PI3K inhibitors. Ann Oncol 2019; 30:x27-x42. [PMID: 31859350 PMCID: PMC6923785 DOI: 10.1093/annonc/mdz280] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [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] [Indexed: 02/07/2023] Open
Abstract
In this review, we discuss biomarkers of response and resistance to PI3K inhibitors (PI3Ki) in estrogen receptor-positive breast cancer, both in the early and advanced settings. We analyse data regarding PIK3CA mutations, PI3K pathway activation, PTEN expression loss, Akt signalling, insulin levels, 18FFDG-PET/CT imaging, FGFR1/2 amplification, KRAS and TP53 mutations. Most of the discussed data comprise retrospective and exploratory studies, hence many results are not conclusive. Therefore, among all of these biomarkers, only PIK3CA mutations have proved to have a predictive value for treatment with the α-selective PI3Ki alpelisib (SOLAR-1 trial) and the β-sparing PI3Ki taselisib (SANDPIPER trial) in the advanced setting. Since the accuracy of current individual biomarkers is not optimal, a composite biomarker, including DNA, RNA and protein expression data, to more precisely assess the PI3K/AKT/mTOR pathway activation status, may arise as a promising approach. Finally, we describe the rational for new combination therapies involving PI3Ki and anti-HER2 agents, chemotherapy, CDK4/6 inhibitors, mTOR inhibitors or new endocrine treatments and discuss the ongoing trials in this field.
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Affiliation(s)
| | | | - D Eiger
- Academic Trials Promoting Team
| | - E de Azambuja
- Academic Trials Promoting Team
- Medical Oncology Department, Institut Jules Bordet
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Maurer C, Eiger D, Velghe C, Aftimos P, Maetens M, Gaye J, Paesmans M, Ignatiadis M, Piccart M, Buisseret L. SYNERGY: Phase I and randomized phase II trial to investigate the addition of the anti-CD73 antibody oleclumab to durvalumab, paclitaxel and carboplatin for previously untreated, locally recurrent inoperable or metastatic triple-negative breast cancer (TNBC). Ann Oncol 2019. [DOI: 10.1093/annonc/mdz100.046] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Eiger D, Ponde N, Agbor-Tarh D, Korde L, Moreno Aspitia A, Rodeheffer R, Ewer M, Suter T, Piccart M, de Azambuja E. Long-term cardiac outcomes of HER2+ breast cancer patients treated in the ALTTO trial. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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